Six hours in the laboratory: a quantification of practice time during constraint-induced therapy (CIT)

Objective: To quantify supervised in-laboratory time and practice intensity during the signature protocol specified as 6 hours/day over 10 days for the EXtremity Constraint-Induced Therapy Evaluation (EXCITE) randomized clinical trial. Design: Retrospective analysis of constraint-induced movement therapy training documentation acquired at the University of Southern California site from EXCITE (n=38). Training documentation was reviewed and analysed to determine average and between-subject variability of supervised in-laboratory time and actual task-specific practice time for concurrence with the specified constraint-induced movement therapy protocol. Setting: Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA. Subjects: Data from 38 participants (35 met inclusion criteria) who, upon enrolment in the EXCITE trial, were between 3 and 10 months post stroke and between 47 and 81 years of age. Results: The training records revealed an average of 64 hours (SD = 2.6) supervised in-laboratory time for 35 participants across 10 days of training. More importantly, the average time on task-specific practice was 3.95 hours per day (SD = 5.7) representing 62% of the in-laboratory time. Supervised in-laboratory time for 10 training days was consistent across the sample as was total practice time for days 2-10, with a substantially lower practice time on the initial training day. Conclusions: Participants tolerated an intense task-specific practice schedule that consisted of approximately two-thirds of the specified minimum 6 hour in-laboratory time and was distributed evenly between adaptive task practice (shaping) and task practice components.