Could “learned” non-use after a stroke or spinal cord injury be unlearned?

Warning: technical jargon ahead

Edward Taub, PhD, coined the term “learned non-use” to describe an inability to use a limb affected by a stroke or spinal cord injury. He later developed methods called “constraint-induced” movement therapy (CIMT) that might help people regain use of a limb that was no longer being used.

The CIMT therapy involves hours of intense training to “unlearn” the non-use behavior. The person must actively intend to move the limb as coached by the trainer. The aim is to perform a “re-mapping” of the limb in the brain’s movement maps. Today, the CIMT therapy remains largely unused. The required time and effort limit who might have access to the therapy. Other limitations must be met before trying the therapy.

The principles of CIMT suggest that the brain and limb may be able to reconnect through highly intentional movements.

Could intention and attention be the accelerating ingredients?

Margaret is spry at 83 except for recovering from quadriplegia. She was in a horrific auto accident about 2 years before trying PhotoMed’s therapy. She didn’t expect anything to happen based upon her doctor’s prognosis. Her Medicare physical therapy had been exhausted. She was stuck with a brace on her left foot. Her right hand was mostly working except that her middle fingers always moved together. Her left hand was a clenched claw. Her left thumb painfully pressed and twisted her index finger over her middle finger.

Margaret, at her initial visit, shows her clawed hand. She isn’t too happy that her hand won’t respond to her strongest intentional thoughts. Here left thumb pressed so hard on her index finger the index finger is painfully twisted and bent.

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Margaret, 5 weeks later, her base knuckle joints are rigid. Some movement of fingers was possible by force or by bending of the wrist. Her fingers had no significant intentional movement.

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By 1 year, her left hand effectively remained a claw with her base knuckle joints being “frozen” irrespective of her wrist position. Notably, her fingers moved some with flexing her wrist, but without significant independent movement. Progress had stalled. She had learned to hold a few items by flexing her wrist.

PhotoMed’s software team added synchronized multiple cameras to the list of Instant Verification System™ capabilities. Testing in the office was rather boring. Fortunately, Margaret came to the rescue. Over the past year, she had recovered much of her right hand utility. But could her left hand make progress while testing the new camera system?

Margaret was eager to add a step of intense intention that might accelerate a return back-to-normal function, or at least utility. The following is the first field testing of the multiple camera system. This video demonstrates progress during the visit. (11:56), You can watch as she intensely resists movement and tracks movement. Margaret’s base knuckle joints began to move with a heavy pressure but not in response to her intentions. Her fingertips did move a little and with less effort when the therapy was "on".

Unfortunately, COVID 19 stopped the visits. The good news is that the resumed functioning of Margaret's hands continued.