Neurobehavioral aspects of recovery: Assessment of the learned nonuse phenomenon in hemiparetic adolescents

Objective: To test the learned nonuse assumption of constraint-induced movement therapy (CIMT), through behavioral assessment, that residual movement abilities are not used to their fullest extent in persons with chronic hemiparesis. Design: Repeated-measures cohort design. Setting: Rehabilitation clinic in southwest Germany. Participants: Twenty-one persons with upper-limb hemiparesis after brain injury and 21 age-matched healthy controls. Participants were hospitalized when tested. Interventions: Not applicable. Main Outcome Measures: Spontaneous affected hand use for the items of the Motor Activity Log and the Actual Amount of Use Test were compared with the subjects' actual ability to perform these items with the affected hand. Results: A significant difference between the residual movement capability and the spontaneous use was found in both tests Most movements could be performed with mode-rate to good movement quality with the affected hand, but were still performed with the unaffected "good" hand in the spontaneous-use condition. This effect was equally strong in right- and left-side affected persons. Conclusion: Hemiparetic persons do not use their residual movement capabilities to the fullest extent. According to the learned nonuse model, this behavior reflects a learned suppression of affected arm movements, which may be overcome by CIMT. (C) 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.