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HOW MAY WE HELP YOU?

At the Advanced Recovery Rehabilitation Center we provide our clients with innovative treatment for recovering movement and speech following a stroke or head injury. Please call us to learn more or use this handy guide.

PROSPECTIVE CLIENTS

This guide can help you find treatment options suitable to your needs and answer questions you may have about our therapies.

I need more movement in my hand.

I need more movement in my arm.

I need more movement in my leg.

I need to speak more clearly.

I have trouble swallowing.

I need cognitive improvement.

What does “Constraint-Induced” mean?

How are CIMT and CIAT different from other therapies?

Who is appropriate for CIMT and CIAT?

How long after the stroke or other brain injury can CIMT/CIAT work?

Where can I read more about CIMT and CIAT?

What ages do you treat?

What kind of results do you achieve?

Will my hand/speech be completely better in two or three weeks?

How should I dress for therapy?

What do I need to bring to therapy?

Will my caregiver need to be present for therapy?

What about meals?

Do I need a prescription?

How long will it take?

Is this a residential program?

What does your clinic look like?

May I visit your facility?

Where should I park?

Is the therapy covered by insurance?

Who should I contact if I have more questions?

TOP NEXT I need more movement in my hand.

Since limited movement in the hand can be the result of many things, an evaluation by a trained therapist is always the best bet. We specialize in Constraint Induced Movement Therapy (CIMT) which is an intense treatment designed to increase movement and function in the hand and arm. We also have other therapies available that are shorter and less intense if needed. Please call us to speak with a therapist who can give you more specific information related to your specific needs.

PREV NEXT I need more movement in my arm.

Since limited movement in the arm can be the result of many things, an evaluation by a trained therapist is a good idea. We specialize in Constraint Induced Movement Therapy (CIMT) which is an intense treatment designed to increase movement and function in the hand and arm. We also have other therapies available that are shorter and less intense if needed. Give us a call to speak with a therapist who can give you more information related to your specific needs.

PREV NEXT I need more movement in my leg.

We are one of the only facilities in the country that specializes in Constraint Induced Movement Therapy for legs. Using the LiteGait® device, we are able to target treatment for those specific leg movements and patterns that are most important for walking and mobility. Give us a call and talk to one of our therapists who can give you specific information on this innovative approach designed to improvement overall function of the leg.

PREV NEXT I need to speak more clearly.

Speech problems can be the result of many different things. Things like weak or uncoordinated mouth muscles can lead to slurred speech that cannot be understood. Problems understanding what others are saying to you or thinking of the words to say yourself is a very different cause and therefore treated differently. We specialize in Constraint Induced Aphasia Therapy (CIAT) which specifically targets the ability to find the right words and say them along with understanding what other people are saying.

The same approach has also worked well for weak or uncoordinated mouth muscles and slurred speech. The CIAT program is an intense form of speech therapy that helps improve language skills even years after a stroke or other brain injury. We also provide shorter less intense treatments if needed. Give us a call to speak to a therapist that may be able to help steer you in the right direction to find an effective treatment for your specific speech problem.

PREV NEXT I have trouble swallowing.

Swallowing problems are very common after stroke or other head injury. Problems swallowing can be dangerous if not treated and lead to pneumonia. Our speech therapists have years of experience treating the various causes of swallowing problems. Give us a call and speak to one of our therapists who can provide you more information specific to your condition.

PREV NEXT I need cognitive improvement.

Cognitive-linguistic decline can often be improved by speech therapy. There are many activities that are used to stimulate the brain into more effective thinking and processing of information. Give us a call and let one of our therapists provide you with more information specific to your goals.

PREV NEXT What does “Constraint-Induced” mean?

In this context, “Constraint-Induced” means that the stronger side of the body or strongest communication skill is limited so that the weaker side or weaker communication skill is forced to work. For hand and arm therapy, a mitt is placed on the good hand to prevent you from using it while you concentrate on making the weaker hand work. To work on communication skills, there is no physical constraint used. We limit or eliminate the use of any communication method other than speech. That means little or no writing, gesturing, drawing, etc. to get the point across—only trying to use speech.

PREV NEXT How are CIMT and CIAT different from other therapies?

CIMT and CIAT use the principles of constraint, forced use, and massed practice to overcome the phenomenon of “learned non-use”. Through intense practice focused on one major goal, CIMT and CIAT can result in functional improvements even after a plateau has occurred with a shorter schedule of therapy. Most therapy centers are not set up to allow for so much time to be spent with one client. We’ve set up our practice specifically so that we can devote the number of hours needed to get you progressing again.

PREV NEXT Who is appropriate for CIMT and CIAT?

For all programs you should have no uncontrolled medical conditions such as:

• recent seizures
• problems controlling blood pressure
• problems controlling blood sugar

CIMT Qualifications

General Guidelines for Required Movement:

• At least 6 month post-onset in most cases
• 20 degrees of extension in the wrist
• 10 degrees of extension in each of the fingers

SaeboFlex Orthosis Qualifications:

General Guidelines for Required Movement:

• At least 6 month post-onset in most cases
• Ability to bend fingers when wrist is placed in extension and fingers are extended
• Any shoulder and elbow movement
• Ability to passively stretch out fingers and wrist

CIAT Qualifications

General Guidelines for Required Basic Skills

• At least 6 month post-onset in most cases
• Ability to say at least three different words spontaneously
• Ability to attend to a single task for at least two minutes with assistance
• At least moderately intact receptive language
• No more than a moderate verbal apraxia is ideal, however, clients with more severe apraxia are considered on a case-by-case basis following a full evaluation
• No more than a moderate dysarthria is ideal, however, clients with a more severe dysarthria are considered on a case-by-case basis following a full evaluation

PREV NEXT How long after the stroke or other brain injury can CIMT/CIAT work?

We’ve seen clients make progress many years after their injury. Many people believe that progress can only be made in the first year or so after a stroke or brain injury; however, recent research is showing that that is not true. Our programs are designed to stimulate the brain to reorganize by working more intensely than you probably ever have before. We’ve personally seen clients make progress more than 14 years after their stroke or brain injury.

PREV NEXT Where can I read more about CIMT and CIAT?

The Treatment Articles page has articles available on the internet written by our staff and others about CIMT and CIAT. We encourage you to do additional research to find other articles that are available.

PREV NEXT What ages to you treat?

We treat ages 3 and up. Our pediatric program includes children ages 3 to 11. Our young adult and adult program includes ages 12 and up.

PREV NEXT What kind of results do you achieve?

CIMT

Many CIMT clients are able to see a small change at the end of their first day. Subsequent days continue to build upon these early successes.

CIAT

While specific goals are established according to each client’s needs and abilities, every client who has completed at least two weeks of CIAT has achieved at least some level of improvement as measured using standardized tests. Clients who continue to use the home program we provide at the end of therapy report that their progress has continued for a year or more after completing our program.

PREV NEXT Will my hand/speech be completely better in two or three weeks?

The programs are designed to “move forward” your progress. Although we certainly expect you to see improvement in the time you are here, your progress should continue with exercises we will teach you to do at home. We believe that your progress should never be at an end. As long as you are challenging yourself and work every day, you have the potential to keep improving.

PREV NEXT How should I dress for therapy?

We suggest you wear whatever is comfortable that you can work and move in. Jeans and t-shirts with tennis shoes or sneakers are always a good choice. Be sure to bring a sweater or jacket because it does get cold in here from time to time.

PREV NEXT What do I need to bring for therapy?

We suggest bringing:

• Comfortable clothes and shoes
• A sweater or jacket
• Any medicine that may be needed during the day
• For CIMT program-lunch and snacks for the day
• For CIAT program-snacks (lunch if you like but you can eat before or after if you prefer)
• A positive attitude and lots of energy (we can share ours with you if you need)

PREV NEXT Will my caregiver need to be present for therapy?

We understand that your caregiver may be a big part of your life, but it is important that you be able to devote your full attention to the task at hand—your therapy to get moving again. While we encourage you and your caregiver to ask any questions you have (we usually devote a few minutes at the beginning and end of each session to answering questions, assigning homework, discussing progress, etc.) we ask that in most cases, your caregiver take the opportunity to spend some time on their own.

We have a page especially devoted to CAREGIVERS with ideas of interesting things to do in the area. Your caregiver will likely help you with your homework at night and will become familiar with how your therapy works. We include time for training them in the best ways to help you so that your progress can continue after you return home.

PREV NEXT What about meals?

Since the CIMT program is six hours long, you should bring a lunch. We have a refrigerator and microwave oven for your convenience. The CIAT program is three and a half hours long so feel to bring a snack or lunch if you like, but you'll have time to eat either before or after you come.

PREV NEXT Do I need a presciption?

Yes. You can get a prescription from your primary care physician or neurologist. A prescription is always required for insurance to consider coverage and it is always a good idea that your doctor knows the kind of therapy you are planning. Since the intensity of this program is very different, please request some specific wording on the prescription:

For CIMT - “Intensive physical therapy up to 6 hours daily for 2 to 3 weeks”

For CIAT - “Intensive speech therapy up to 4 hours daily for 2 to 3 weeks”

PREV NEXT How long will it take?

The CIMT program is 6 hours a day Monday through Friday. The CIAT program is 3 ½ hours a day Monday through Friday. We can vary the start and end times somewhat as needed though we do find it best be finished for the day no later than about 4:00 or 4:30.

PREV NEXT Is this a residential program?

Ours is an outpatient program so clients return home or to a hotel in the evening. You might find the Travel and Lodging page useful for nearby accommodations and other travel tips.

PREV NEXT What does your clinic look like?

We are a small clinic in a medical office building. We have 3 distinct areas. One is for CIMT and physical therapy for both upper and lower extremities. Another is for CIAT and speech therapy. The third area is used for our pediatric clients. We have a small kitchen with refrigerator and microwave oven, bottled water and all the coffee you can drink. We also have a rest area with recliners, pillows, and blankets for you to use during your rest time.

PREV NEXT May I visit your facility?

We welcome visitors to the facility. Give us a call and we can set up a time for you to view the facility and address any questions you may have. In some cases you may be able to observe a therapy session in progress.

PREV NEXT Where should I park?

There are 3 options for parking:

1. The parking lot behind the building with an entrance on Moorpark Street charges a maximum of $5.50 per day. No validation available.

2. Street parking is available at the meters for 2 hours.

3. You can park all day and without putting money in the meters if you have a handicapped placard to hang on your mirror.

PREV NEXT Is the therapy covered by insurance?

Insurance coverage is extremely variable. You should call your specific insurance carrier and ask about coverage for physical and speech therapy. Depending on network participation, etc., they sometimes cover at least a portion of the cost. Therapy is provided by appropriately certified and licensed physical and speech therapists who meet the requirements of most insurance companies and use accepted standards of practice for physical and speech therapy. We are not currently a Medicare certified facility.

We are happy to provide any information you or your insurance company needs for submitting a claim. Please visit our Payment Options page for more information.

PREV TOP Who should I contact if I have more questions?

For more information:
Please call: 1-818-386-1231
Email:
or use our handy Contact page.

CAREGIVERS

As a caregiver, you take on so many daily responsibilities. We hope this page will give you the information you need to feel right at home. If you have more questions, but sure to give us a call, but for now, sit back and relax. We know you’ve earned it!

For program information, please visit the Prospective Clients page.

What do I do while my loved one is in therapy?

What do I need to bring?

What about meals?

Where should I park?

How long will it take?

How can I help with therapy?

What does your clinic look like?

Are your facilities handicapped accessible?

Who should I contact if I have more questions?

TOP NEXT What do I do while my loved one is in therapy?

You do so much already, we suggest you take some time to do whatever you want to do while your loved one is in therapy. Not only does it allow them to better focus their concentration on the therapy, but it also allows you to get some much needed rest time for yourself!

Click here for activities and opportunities that others have found entertaining, educational, or helpful.

PREV NEXT What do I need to bring?

We suggest bringing:

• Comfortable clothes and shoes
• A sweater or jacket
• Any medicine that may be needed during the day
• For CIMT program-lunch and snacks for the day
• For CIAT program-snacks (lunch if you like but you can eat before or after if you prefer)

In addition, if you decide to stay in the clinic during the day we also suggest:

• Books, magazines, or other reading material
• Paperwork or correspondence you’ve been meaning to catch up on
• Portable radio, cassette player, or other music player (with headphones please)
• Your laptop computer—we have wireless internet access if needed

PREV NEXT What about meals?

For the CIMT program, your loved one should bring a lunch. We have a refrigerator and microwave oven if needed. There are also several nearby restaurants where you can pick up lunch if you prefer to bring something in nearer to the meal time. Meal times are an excellent opportunity to use the new skills being addressed in therapy; therefore, lunch is a time for work as a part of the daily therapy activities.

For CIAT, feel free to bring a snack or lunch if you like. While we can certainly make lunch or snack time into very productive work time, most clients prefer to eat before or after their session given the 3 ½ hour length of time.

PREV NEXT Where should I park?

There are 3 options for parking:

1. The parking lot behind the building with an entrance on Moorpark Street charges a maximum of $5.50 per day. No validation available.

2. Street parking is available at the meters for 2 hours.

3. You can park all day and without putting money in the meters if you have a handicapped placard to hang on your mirror.

PREV NEXT How long will it take?

The CIMT program is 6 hours per day Monday through Friday—usually 10am to 4pm

The CIAT program is 3 ½ hours per day Monday through Friday—usually 9:30am to 1:00pm or 12:00pm to 3:30pm

We can vary the start and end times somewhat as needed though we do find it best be finished for the day no later than about 4:00 or 4:30.

An evaluation is always completed before therapy begins — either on a day by itself or at the beginning of the first day of therapy. This evaluation usually takes no more than about 1 to 1 ½ hours.

PREV NEXT How can I help with therapy?

While we encourage you to take some time for yourself while your loved one is in the clinic during the day, we do need your help when it comes to the “homework” part of the program.

At the end of each session we assign exercises and activities based on what you’ve been working on that day. Homework activities are very important part of achieving the best results possible while you’re here and also help give you an idea of what your home program will be like.
Your role in homework assignments:

1. Help make sure activities are done correctly
2. Provide feedback.

It’s important that we know how your loved one is able to follow through with the activities—are they too easy or too difficult, is there any pain or other problems when doing the activities, are there questions about the exercises, etc.

And, of course, your encouragement, support, and positive words and attitude are always important to the success of your loved one no matter what the activity or situation.

PREV NEXT What does your clinic look like?

We are a small clinic in a medical office building. We have 2 distinct treatment areas—one for CIMT and physical therapy for both upper and lower extremities and the other for CIAT and speech therapy. We have a small kitchen with refrigerator and microwave oven, bottled water and all the coffee you can drink. We also have a rest area with recliners, pillows, and blankets for use during rest time.

PREV NEXT Are your facilities handicapped accessible?

Our facilities are handicapped accessible. We have an elevator and appropriately wide doorways to allow for walkers and wheelchairs.

PREV TOP Who should I contact if I have more questions?

For more information:
Please call: 1-818-386-1231
Email:
or use our handy Contact page.

HEALTHCARE PROVIDERS

Please call us or use this handy guide to answers qustions you or your clients may have about our therapies.

How do I refer a client to you?

What kind of therapies do you offer?

What is Constraint Induced Movement Therapy (CIMT) (also known as Constraint Induced Therapy (CIT))?

What is the SaeboFlex™ Orthosis?

How does the SaeboFlex™ Orthosis relate to CIMT?

What is Constraint Induced Aphasia Therapy (CIAT)?

How are CIMT and CIAT different from other therapy?

What kind of results do you achieve?

What does the research say about CIMT and CIAT?

Who is appropriate for CIMT and CIAT?

What ages to you treat?

Is yours a residential program?

Can I do CIMT or CIAT with my clients?

What are your therapists' qualifications and training?

May I visit your facility?

Who should I contact if I have more questions?

TOP NEXT Referral Information

For consultation or referral:
Please call: 1-818-386-1231,
Email: ,
Or simply print and fill out this referral form (PDF).

PREV NEXT What kind of therapies do you offer?

Advanced Recovery Rehabilitation Center is an outpatient clinic offering physical therapy and speech therapy. We use Constraint Induced Movement Therapy (CIMT) and Constraint Induced Aphasia Therapy (CIAT) to provide our clients with the most up-to-date and effective rehabilitative therapies available. Our current CIMT programs address both upper extremities and lower extremities.

The CIAT program addresses both expressive and receptive aphasia. We also provide shorter, non-CIMT/CIAT treatments including Speech and Language Therapy for apraxia, dysarthria, dysphagia, and cognitive-linguistic decline as well as adult and pediatric Physical Therapy.

Visit our List of Services page for more information.

PREV NEXT What is Constraint Induced Movement Therapy (CIMT) (also known as Constraint Induced Therapy (CIT))?

Constraint Induced Movement Therapy (CIMT) was first developed by Dr. Edward Taub at the University of Alabama, Birmingham over 30 years ago. Since then, over 70 articles have been published in scientific journals on the topic. The articles have shown that CIMT is an effective technique for the recovery of movement in affected upper and lower extremities and speech. CIMT has been shown to be effective in treating the effects of stroke and other brain injuries. MRI and TMS imaging studies have shown that brain recovery (and therefore motor recovery) occurs both in the area previously damaged as well as other areas suggesting that the brain may be able to recruit other parts of the brain to function in place of the damaged area. There are minimal degrees of movement required for best results.

To counteract the phenomenon of learned non-use, CIMT uses three principles:

• Constraint of the unaffected extremity
• Forced use on the part of the affected extremity
• Massed practice

CIMT clients work six hours a day, five days a week for two to three weeks ideally with the unaffected extremity constrained using a soft mitt for up to 90% of waking hours. This intensity of practice results in cortical reorganization which in turn promotes increased movement on the affected side.

PREV NEXT What is the SaeboFlex™ Orthosis?

The SaeboFlex™ is a dynamic splint that allows retraining of the arm, wrist and hand affected by stroke or brain-related injury. The device attaches to the forearm, hand and fingers and allows the opportunity to perform grasp and release exercises. The device has no motor or electrical parts but works by a system of springs. These springs provide resistance to the muscles that grip and aid the muscles that help open the hand and fingers. The SaeobFlex Orthosis is used in conjunction with a CIMT treatment model if minimal movement requirements for traditional CIMT are not yet met.

PREV NEXT How does the SaeboFlex™ Orthosis relate to CIT?

Using the SaeboFlex™ Orthosis to achieve adequate grasp and release, clients participate in the standard six hours per day of treatment with activities modified to meet their individual needs and functional level.

PREV NEXT What is Constraint Induced Aphasia Therapy (CIAT)?

CIAT, based on CIMT principles, is modified to treat aphasia by limiting the client’s use of compensatory strategies such as writing, gesturing, drawing, etc. Therefore, CIAT forces the brain to adapt and find an alternate way to express the idea—the goal being verbalization and spoken words. There is no physical restraint used. CIAT focuses primarily on expressive aphasia although those with moderate receptive aphasia can still benefit.

Clients in the program receive treatment three and a half hours a day, five days a week for two to three weeks. Homework assignments each night and on weekends continue the language stimulation. Constraint of compensatory strategies combined with extensive and frequent treatments has the greatest effect on how much progress a client achieves. These same principles can also be used in treating clients with apraxia and dysarthria with good results.

PREV NEXT How are CIMT and CIAT different from other therapy?

CIMT and CIAT employ the principles of constraint, forced use, and massed practice to overcome the phenomenon of learned non-use. Through intense practice focused on one major goal, CIMT and CIAT can result in functional improvements even after a plateau has occurred with a shorter schedule of therapy.

PREV NEXT What kind of results do you achieve?

CIMT

Many CIMT clients are able to see a small change at the end of their first day. Subsequent days continue to build upon these early successes.

CIAT

While specific goals are established according to each client’s needs and abilities, every client who has completed at least two weeks of CIAT has achieved at least some level of improvement as measured using standardized testing (usually the Boston Naming Test and/or portions of the Boston Diagnostic Aphasia Examination). Overall communicative effectiveness is subjectively rated and includes all parts of functional verbal communication including intelligibility, word finding, the need for increased time, etc. On average, the percentage rating of overall communicative effectiveness has doubled in two to three weeks.

PREV NEXT What does the research say about CIMT and CIAT?

There are numerous research studies published regarding CIMT and CIAT. Here are a few. We encourage you to use your favorite search engine to find others.

Constraint-Induced Therapy in Stroke: Magnetic-Stimulation Motor Maps and Cerebral Activation

Motor cortex plasticity during constraint-induced movement therapy in stroke patients.

Stroke rehabilitation - a new approach?

Constraint-Induced Therapy of Chronic Aphasia after Stroke

Long-Term Stability of Improved Language Functions in Chronic Aphasia After Constraint-Induced Aphasia Therapy

Efficacy of Constraint-Induced Movement Therapy for Children With Cerebral Palsy With Asymmetric Motor Impairment

PREV NEXT Who is appropriate for CIMT and CIAT?

CIMT Qualifications

General Guidelines for Required Movement:

• At least 6 month post-onset in most cases
• 20 degrees of extension in the wrist
• 10 degrees of extension in each of the fingers

SaeboFlex™ Orthosis Qualifications:

General Guidelines for Required Movement:

• At least 6 month post-onset in most cases
• Ability to bend fingers when wrist is placed in extension and fingers are extended
• Any shoulder and elbow movement
• Ability to passively stretch out fingers and wrist

CIAT Qualifications

General Guidelines for Required Basic Skills

• At least 6 month post-onset in most cases
• Ability to say at least three different words spontaneously
• Ability to attend to a single task for at least two minutes with assistance
• At least moderately intact receptive language
• No more than a moderate verbal apraxia is ideal, however, clients with more severe apraxia are considered on a case-by-case basis following a full evaluation
• No more than a moderate dysarthria is ideal, however, clients with a more severe dysarthria are considered on a case-by-case basis following a full evaluation

PREV NEXT What ages to you treat?

We treat clients ages two and up.

Ages 3 through 11 are included in our Pediatric Program.

Ages 12 and older are included in our Adult Program.

PREV NEXT Is yours a residential program?

Ours is an outpatient program so clients return home in the evening. Many of our clients travel from outside of the area and we can provide you with information regarding lodging if needed.

PREV NEXT Can I do CIMT or CIAT with my clients?

Since one of the key elements in CIMT and CIAT is massed practice, treatment sessions must be extended (six hours daily for CIMT and three and a half hours daily for CIAT). Given the requirement for such extended periods of time, schedules in most facilities are not structured for such an extensive time to be spent with one client.

PREV NEXT May I visit your facility?

We welcome visitors to the facility. Give us a call and we can set up a time for you to view the facility and address any questions you may have.

PREV TOP Who should I contact if I have more questions?

For more information:
Please call: 1-818-386-1231,
Email: info@advancedrecovery.org,
Or simply print and fill out this referral form (PDF).

PHYSICIANS

This page is intended to give physicians a snapshot of the principles of Constraint Induced Movement and Aphasia therapies. Information is provided to help you determine the appropriateness of this therapy for your patients and the qualifying requirements. Please call if you have more questions or would like to refer a client.

Referral Information

For consultation or referral:
Please call: 1-818-386-1231,
Email: ,
Or simply print and fill out this referral form (PDF).

What We Do

At the Advanced Recovery Rehabilitation Center we provide our adult and pediatric clients with the latest in rehabilitative therapies for recovery of speech and movement following stroke and brain-related injuries. We feature state licensed and nationally certified therapists. Our facilities comply with the ADA and all staff are CPR certified.

We Offer:

Constraint Induced Movement Therapy (CIMT)

Based on research by Edward Taub, Ph.D., CIMT compels patients to use the weaker extremity by constraining the dominant one resulting in increased movement and functionality. This innovative approach teaches the brain to “rewire” itself following a stroke or brain-related injury and overcome the phenomenon of learned non-use. Clients in the program receive treatment six hours a day, five days a week for two to three weeks. It is the only rehabilitation technique shown to produce a marked change in brain organization and function and scientific literature indicates that most people recover approximately fifty-percent of their previous function when initial qualifications below are met.

CIMT Qualifications

General Guidelines for Required Movement:

• At least 6 month post-onset in most cases
• 20 degrees of extension in the wrist
• 10 degrees of extension in each of the fingers

SaeboFlex™ Orthosis

The SaeboFlex is a dynamic splint that stroke survivors use to retrain the arm, wrist and hand affected by the stroke. The device attaches to the stroke survivors forearm, hand and fingers and allows them the opportunity to perform grasp and release exercises. The device has no motor or electrical parts but works by a system of springs. These springs provide resistance to the muscles that grip and aid the muscles that help open the hand and fingers. The SaeobFlex Orthosis is used in conjunction with a CIMT treatment model if requirements for traditional CIMT are not yet met.

SaeboFlex™ Orthosis Qualifications:

General Guidelines for Required Movement:

• At least 6 month post-onset in most cases
• Ability to bend fingers when wrist is placed
  in extension and fingers are extended
• Any shoulder and elbow movement
• Ability to passively stretch out fingers and wrist

Constraint Induced Aphasia Therapy (CIAT)

CIAT, based on CIMT principles, is modified to treat aphasia by limiting the patient's use of compensatory strategies such as writing, gesturing, drawing, etc. during the therapy session. Therefore, CIAT forces the brain to adapt and find an alternate way to express the idea-verbalization and spoken words. CIAT focuses primarily on expressive aphasia although those with moderate receptive aphasia can still benefit.

Clients in the program receive treatment three and a half hours a day, five days a week for two to three weeks. Homework assignments each night and on weekends continue the language stimulation. There is no physical restraint used in CIAT. Constraint of compensatory strategies combined with extensive and frequent treatments has the greatest effect on how much progress a patient achieves. These same principles have also been applied to treat clients with apraxia and dysarthria with good results.

CIAT Qualifications

General Guidelines for Required Basic Skills;

• At least 6 month post-onset in most cases
• Ability to say at least three different words spontaneously
• Ability to attend to a single task for at least two minutes with assistance
• At least moderately intact receptive language
• No more than a moderate verbal apraxia is ideal, however, clients with more severe apraxia are considered on a case-by-case basis following a full evaluation
• No more than a moderate dysarthria is ideal, however, clients with a more severe dysarthria are considered on a case-by-case basis following a full evaluation

Other Services

Shorter, non-CIMT/CIAT treatments are also available including Speech and Language Therapy for apraxia, dysarthria, dysphagia, and cognitive-linguistic decline as well as adult and pediatric Physical Therapy.

Our History

Out of the need for a more effective stroke rehabilitation, Linda Ogren and Jennifer Nolan-Sariego, Ph.D. researched constraint induced therapy. Impressed with the evidence, we endeavored to provide this innovative approach to clients who had reached a plateau in their previous therapy programs. In 2002 we established the Advanced Recovery Rehabilitation Center and began by offering CIMT and SaeboFlex™ Orthosis for upper extremities. In 2004 we expanded to include the first CIAT program in the United States. In 2006 we expanded again to offer CIMT for lower extremities and pediatric CIMT for both upper and lower extremities.

LIST OF SERVICES

We offer many advanced programs for the recovery of movement and speech following a stroke or brain injury.

Constraint Induced Movement Therapy (CIMT) was first developed by Dr. Edward Taub at the University of Alabama, Birmingham over 30 years ago. Since then, over 70 articles have been published in scientific journals on the approach. The articles have shown that CIMT is effective for the recovery of movement in affected upper and lower extremities and speech after a stroke or other brain injury. Studies have shown that brain recovery (and therefore recovery of movement) occurs both in the damaged area as well as other areas leading us to believe that the brain may be able to recruit other parts of the brain to help the damaged area. There are minimal degrees of movement required for best results.

Using Dr. Taub's Adult CI Therapy program as a model, the Pediatric CI Therapy program was started years later. Dr. Stephanie DeLuca a developmental psychologist and Dr. Karen Echols a physical therapist and development psychologist have been involved in administering the Pediatric CI Therapy at the University of Alabama. Advanced Recovery's Pediatric CI Therapy program follows the University of Alabama program of 6 hours a day for 21 consecutive days with play-based and functional activities designed for the child's stage of development. The child's non-affected arm is casted from the upper arm to the tips of the fingers. The fiberglass cast is designed to be removable for weekly skin checks.

Physical Therapy Services for Adults and Children

CIMT for Upper Extremity

CIMT clients work six hours a day, five days a week for two to three weeks ideally with the unaffected extremity constrained using a soft mitt for adult clients and cast for pediatric clients for up to 90% of the day. This intensity of practice results in cortical reorganization promoting increased movement on the affected side.

CIMT for Lower Extremity

Clients work 4 hours a day, 5 days a week for 2 to 3 weeks including use of the LiteGait® device, a partial weight bearing gait and balance training device. The goal of the program is to improve balance, correct posture, and strengthen weakened muscles to regain the ability to walk. The intensity triggers cortical reorganization to promote restoration of your walking pattern.

The pediatric LiteGait® is called the WalkAble™. The WalkAble™ safely supports children to crawl, stand and play, throw, catch and kick and learn to walk.

SaeboFlex™ for Functional Tone Management

The SaeboFlex™ is a dynamic splint that allows retraining of the arm, wrist and hand affected by stroke or brain-related injury. The device attaches to the forearm, hand and fingers to let you perform grasp and release exercises. The device has no motor or electrical parts but works by a system of springs. These springs work on the muscles that grip and helps open the hand and fingers. The SaeboFlex™ Orthosis is used in conjunction with CIMT principles if minimal movement requirements for CIMT are not yet met.

The SaeboFlex™ can be custom fitted for a young child. There are a few size limitations. Please call us for more details.

Treatment of Orthopedic Conditions

Orthopedic conditions such as joint replacements, fractures, sprains/strains, and surgeries are debilitating. Muscle weakness, pain, swelling, and stiffness are a few of the effects of orthopedic conditions. Our physical therapist evaluates and provides skilled treatments that strengthen muscles, decrease pain, and restore motion.

Treatment of Neurological Conditions

Injury, disease, and aging to the brain, spinal cord, and nerve roots disrupt communication between the brain and the muscles. This results in a localized or general loss of controlled movement and sensation. Physical therapy treatments focus on restoring function by facilitating pathways between the brain and the muscles.

Speech-Language Therapy Services

Constraint-Induced Aphasia Therapy (CIAT) utilizing Advanced Recovery’s exculsive treatment protocol:

Aphasia Rehabilitation with Re-learning Using Constraint Principles - (ARRC-P)

Advanced Recovery Rehabilitation Center was the first in the nation to offer Constraint-Induced Aphasia Therapy.

Based on CIMT principles, this new protocol (ARRC-P) is modified to treat aphasia by limiting the use of compensatory strategies such as writing, gesturing, drawing, etc. ARRC-P forces the brain to adapt and find an alternate way to express the idea—the goal being spoken words. ARRC-P does not use any type of physical constraint. It focuses mainly on expressive aphasia (problems getting words out) although those with moderate receptive aphasia (problems understanding) can still benefit.

Clients in the program receive treatment three and a half hours a day, five days a week for two to three weeks. Homework assignments each night and on weekends help you continue to practice. Constraining compensatory strategies combined with extensive and frequent treatments has the greatest effect on how much progress you can achieve. These same principles can also be used to treat apraxia and dysarthria.

Dysphagia Treatment - VitalStim®

Dysphagia (or swallowing problems) can be very dangerous and often lead to aspiration pneumonia. Swallowing happens in 3 stages and requires about 50 pairs of muscles. A disruption anywhere along the way can cause major or minor problems. We are proud to include VitalStim® therapy in our treatment program. Our speech therapists are trained to help you exercise and coordinate the muscles that need to be addressed and modify your diet in any way.

Treatment for Expressive and Receptive Aphasia

Shorter non-CIAT treatments are available for the treatment of expressive and receptive aphasia. We use functional every-day activities that you can also do at home to maximize your progress.

Cognitive-Linguistic Training

Cognitive-linguistic problems can often be helped by Speech Therapy. Skills like concentration, memory, problem solving, and multi-tasking are all parts of high level language and we can design a program of exercises and activities that can help bring your thinking back into focus.

Treatment for Apraxia of Speech

Apraxia is the name for uncoordinated mouth muscles. When these muscles are not coordinated, the sounds needed to make understandable speech can be very limited. Improving coordination takes intense practice and many repetitions. We design a program that helps you work at home between therapy sessions to get the most progress possible.

Dysarthria Treatment

Dysarthria is the name for weak mouth muscles and often results in speech that sounds mumbled or slurred. Exercises for the specific muscles that are weak such as the front, middle, or back of the tongue, lips, or cheeks can improve strength and speech clarity. Our therapists are trained in identifying which specific muscles are weak and can design a program to target those muscles so that you get the maximum effect possible.

MEET THE CLIENTS

We are very proud of the progress our clients make.

“When I first talked to Linda, I said, ‘I want to use my wheelchair to come in, but I want to walk out.’

Tami Toms was my therapist and she tailored my therapy with my goals in mind. On the first day she had me walk…more than I’d walked in 3 years…By the end of my scheduled therapy, I was walking consistently with a walker and occasionally without a device and with only minimal assistance from Tami.

I look forward to going home…but I look at my therapy in a whole new way. Thank you Tami.”

Lee Piper

“Frustrated and searching for help, I found AR... My experience has re-instilled my faith in the therapy process. My leg and arm are notably stronger and I feel I am on the path to recovery. Unlike other programs, I received personal attention and straight-forward answers... For the first time since my stroke I feel there is hope that I will again lead a normal life. This is the single most important thing I have gained through my experience.”

Jed Schneckloth

“Both therapists who worked with Jed worked extremely hard. I think the price of the therapy when compared to conventional therapy is not at all out of line. Jed made definite gains...”

Janice Schneckloth

Mother of Jed Schneckloth

“This is the second time for speech therapy and it was as excellent as the first time. The positive, encouraging attitude of the therapist has helped in the retrieval and improvement of Wolf’s speech. The intensity and duration of each session were excellent. Games and other planned activities were interesting and stimulating to the client.”

Rena Rotenberg

Wife of Wolf Rotenberg

“Jump started Ed’s recovery. I never knew for sure ‘if’ he could get better. Advanced Recovery gave us that hope and made things happen at a faster pace which really encouraged Ed.

He went from talking in sentences to paragraphs in four weeks. He went from never moving his arm to using his arm for a few tasks.”

Meg McNally

Wife of Ed McNally

Pictured - Ed McNally back at work overseeing preparations for the 2006 Grammys.

“Excellent programme--intense but made it through. Expensive but worth every penny. Staff are friendly and very professional...My daughter has definitely benefitted from the programme.”

Theresa Lo

Mother of Athena Mai

“I realized that without CIT my left hand would continue to ‘go down hill.’ CIT has brought life and action into my left hand.

Previously I had no direction; now I know what to do and where to go. I now have a better understanding of my disability. This helps me in my daily activities. Before arriving I was unable to use my left hand on a computer keyboard. Now I can.

It’s my new religion.”

Kirstin Strand

“We were grateful for the patience and energy of the therapists who worked with Ryan over these three weeks. They had a plan and stuck to it and fit so much into a single day it wore me out to watch them. They are incredibly knowledgeable and innovative and clearly passionate about what they do.”

Lindy Michaels

Mother of Ryan Corbin

“This is both exhausting and rewarding--it is rewarding in that I am able to do what I thought I could not do. My wrong habits are being corrected and through this exercise I am learning to do what is naturally right. The LiteGait is helping me to correct my gait without increased risk on my part and with amazing ease rebuilding my brain.”

Ernesto Medina, MD

“The duration of my treatment is short but sweet and unforgettable. Everybody worked as one to make sure that I am getting what I need for recovery. Laughter takes away the trouble and stresses of life. I thank you all for being so nice and patient with me. Tami, you are exceptional in every aspect of the word. You are witty, pretty and accomodating.”

Oseas Mendoza

“The program is awesome. Not only did my husband’s speech and language improve but his confidence in using his language skills has increased. The professional atmosphere is conducive to learning and Jennifer’s encouraging manner is motivating and rewarding. I highly recommend this program for anyone with aphasia or related speech challenges.”

Darlene Carson

Wife of Paul Carson

“I have been amazed at Sarah’s improvement using the SaeboFlex. We had been discouraged by therapists who didn’t give us any hope... Now we have seen progress and Sarah has motivation...

The aphasia therapy has really helped my daughter with her language fluency and comprehension. It is intensive, but the staff are so supportive. I wish we had made use of the program earlier and I wish we lived in the Los Angeles area so we could make more use of the program. But we are very pleased with the progress Sarah has made during the time she has had at Advanced Recovery. Mahalo!”

Meg McGowan

Mother of Sarah White

“Overall I was more than pleased with ARRC. On the professional level, having therapy for the 4-6 hours a day everyday is much more productive than traditional therapy. The CIAT is extremely intense but the therapist watches carefully and continually adapts to the patient’s level of anxiety. Saebo and CIMT are fantastic. It works, it works, it works!!! On a personal level, it is hard work for both the patient and caregiver. Jennifer, Tami, and the whole team went out of their way to make my mother and I feel at home... What they accomplished with my mother seemed so natural to them that any client there will feel they are in the right spot for the right help at the right time. We can’t wait to return!”

Denise Faulkner

Daughter of Norma Jean DuBay

“I am impressed with the expertise of these therapists. I have been to the other clinics and did not experience the same level of describing and pinpointing my problem areas.

The therapy is intense and taxed me mentally and physically. The experience was a bit of emotional roller coaster, and I learned that I needed a lot of rest outside therapy.

I do believe that the potential of this program is well-designed and implemented in an effective manner.”

Mike Minahan

“The entire staff at Advanced Recovery is wonderful. They are very supportive and taught what to do...to promote my husband’s recovery from stroke...He came in using a walker and is leaving using a cane most of the time but sometimes without any aide at all.”

Joann Bosarge

Wife of Bud Bosarge

My 3 weeks at Advanced Recovery were very beneficial. I gained a lot of confidence and strength especially on my weak side. Tami was very positive, encouraging and knowledgeable. It was difficult but there were fun times.

Bud Bosarge

“Tremendous. I’ve made incredible progress in the last two weeks. I wish I could just continue indefinitely. It makes a difference having this much one-on-one attention from a knowledgeable and talented therapist. ”

Doug Rudrow

“We had a great positive experience at Advanced Recovery. I was very worried about the frustration level of my 6-year-old daughter. The staff was top-notch and extremely patient. They made every task fun. They encouraged her every step of the way. She obtained more movement in her right hand and has gained confidence to use it in her everyday life. We are so grateful!”

Angela Manno

Mother of Caitlin Manno

MEET THE STAFF

Out of the need for a more effective stroke rehabilitation, Linda Ogren researched constraint induced therapy. Impressed with the evidence, we endeavored to provide this innovative approach to clients who had reached a plateau in their previous therapy programs. In 2002 we established the Advanced Recovery Rehabilitation Center and began by offering CIMT and SaeboFlex Orthosis for upper extremities. In 2004 we expanded to include the first CIAT program in the United States. We now offer CIMT for lower extremities and pediatric CIMT for both upper and lower extremities.

All therapy is performed by licensed and/or certified therapists, including Physical Therapists, Occupational Therapists, and Speech and Language Pathologists.

We welcome you to learn more about the team who can help you recover more speech and movement today!

“My grandmother, father, and husband have all had strokes. The experience of watching my family members battle with the recovery process fueled my drive to help all stroke survivors. My grandmother couldn't even talk for the last two years of her life.

I have a BA Degree in Psychology from Loyola Marymount Universary, an AA Degree in Economics from El Camino College, am a Registered Hypnotherapist with the American Board of Hypnotherapy, had Neuro-Linguistic Programming training, and have had years of business experience in the corporate world.”

Linda L. Ogren
President

“My grandmother had a stroke while I was attending college. She lived with us until she was able to return home. The progress she made with her speech therapist impressed me so much that I decided to follow in his footsteps.

I earned a Master's Degree in Speech Pathology from Texas Tech University Health Sciences Center in Lubbock, Texas in 1998. Since then I have managed rehabilitation departments for large nursing facilities.

I met Linda at the Race to Strike Out Stroke - 5K/10K Run/Walk and Health Fair. I joined the team shortly thereafter to start the first constraint-induced therapy program for aphasia in the United States. This team and our patients make this a special place for me.”

Jennifer Brown, M.S., CCC-SLP
Speech Therapist

“In 1992, I completed my studies in the physical therapy masters program at Childrens Hospital/Chapman College. I’ve worked with patients in hospitals, skilled nursing facilities, and home health. In these settings, I’ve provided skilled therapy techniques to patients with spinal cord injury, total joint replacement, stroke, limb amputation, fractures, laminectomy, bunionectomy, craniotomy, and many other diagnoses.

As the physical therapist for Advanced Recovery, I apply the Constraint Induced Movement Therapy (CIMT) model to progress patients beyond traditional, non-CIMT therapy goals. Using specialized equipment with task directed movements, I have seen patients reach higher levels of function than previously thought possible.

My interest in CIMT is strengthened by the first hand experience I had with my grandmother after her stroke. Had CIMT been available to her, she would have struggled less with routine daily tasks. Caring for a family member taught me valuable lessons and gave me insight that can’t be taught or read in a book. It is with heartfelt passion that I help patients who come through our door to achieve their personal goals and to become less dependent on others.

It takes determination and focus from both the therapist and patient during treatment sessions, but the rewards are priceless. I’m ready for the challenge, are you?”

Tami Toms, MPT
Physical Therapist

“In 1994 I completed my M.A. Degree in Occupational Therapy from the University of Southern California. Prior to that, I earned my B.S. Degree in Biology from the University of California at Riverside.”

“In addition to my training with Saebo, I am also board certified by the State of California for Physical Agent Modalities (PAM). I have a Certification for Neurodevelopmental Therapy (NDT) and many years of experience treating neurologically imparied patients. I have worked with patients in many settings and have been a manager for large rehab companies in long term care for many years.”

“I am so thrilled to be a member of the Advanced Recovery team. The opportunity to provide treatment that goes above and beyond what most settings can provide to their clients is so exciting. Before joining the team, I did a lot of research into the techniques at Advanced Recovery and was so excited by thte outcomes that I wanted to be a part of this too.”

Tracy Norton, OTR/L, PAM
Occupational Therapist

“I received my Master’s Degree in Speech-Language Pathology in 1994 at Hunter College in NYC. I am NY state licensed and ASHA certified.

Since receiving my degree I have had the opportunity to work in a variety of settings such as Mount Sinai Hospital, Weiler Hospital at the Albert Einstein College of Medicine and Burke Rehabilitation Hospital. I’ve also worked in nursing homes, adult day care centers and with children as well.

My primary interest is in adults with neurological disorders, especially stroke and brain injury. It is this interest that started me on the path to working with Advanced Recovery. I had been researching intensive language therapy and Constraint Induced Aphasia Therapy and could not find anywhere to learn the techniques. It seemed to be very effective from what I'd read and I wanted clients to be able to benefit from it.

I was so excited when Jennifer Brown offered to train me in her protocol. Now that I’ve completed my training and seen how it works, I’m even more impressed. I’m very proud to be the NY representative for Advanced Recovery and to be a part of this ground-breaking team.”

Carolyn Falconer, M.S., CCC-SLP
Speech Therapist

“Like many others, I am an almost native of California. I grew up in Hollywood, just off famous Melrose Ave. I attended UCLA and CSULA graduating in 1951 with a BA degree and General Elementary Teaching credential. I taught 2nd and 3rd grades on and off over the next 8 years, then retired after my 3rd son was born.

In 1964 I decided to change careers and enrolled in the Communications Disorders department at CSUN. On receiving my MA degree I was offered a position as Speech Pathologist at Sepulveda VA Medical Center, where I continued to work for 32 years. For the last 20 of those years I served as Chief of the Speech Pathology Section.

I participated and was primary investigator in 3 federally funded research projects. I have been co-author of several articles published in professional journals, and have written and had marketed 3 therapy computer programs. I have made numerous presentations at state, national, dental, and geriatric conferences of topics dealing with aphasia, dysarthria, laryngectomy, and the use of alternative communication devices. As you can see, I’m still at it and love my work.”

Muriel Goldojarb, M.A., CCC-SLP
Speech Therapist

“I have a degree in Sociology and Social Welfare from Shikoku Christian College in Zentsuji, Japan. I love to work here because the people make it feel like a home. I enjoy meeting new people and it’s a big compliment when clients say they consider me a member of their family.”

TRAVEL & LODGING

(Information is subject to change without notice.)

ASSISTED LIVING

Some of our clients can qualify for a respite care stay at an Assisted Living facility. Currently, there are two facilities nearby that offer this service, although there are medical tests and physician assessments required in order to qualify for any assisted living stay in California. Both are excellent facilities, and include meals.

Senior Transitions may be able to assist you in finding a facility that fits your needs. You can find them online or call 1-866-35-ELDER (353-5337)

MOTELS AND HOTELS NEAR US

RONALD MCDONALD HOUSE CHARITIES®

RV PARKS

GROUND TRANSPORTATION

The following are some possible ground transportation services:

AIR TRAVEL

National Patient Travel HELPLINE at 1-800-296-1217

www.PatientTravel.org

(The information listed below is taken directly from this website)

This web site is a service of the National Patient Travel Center - the facility housing all the programs of Mercy Medical Airlift - a national charity. The Center is in Virginia Beach, Virginia and provides a variety of services to those seeking a way to travel long-distances for specialized medical evaluation, diagnosis and treatment. The National Patient Travel HELPLINE can be reached on 1-800-296-1217. It is available 24 hours a day, seven days a week.

PAYMENT OPTIONS

We offer a wide range of payment options to suit your needs. Openings available now.

Credit Cards

We gladly accept
MasterCard and Visa.

Insurance

Advanced Recovery is an in-network provider for Blue Shield of California and HealthNet (upper extremeity and walking programs only).

Some plans also pay out-of-network benefits. Check with your insurance provider.

We can assist you in filing a claim if you have insurance coverage, although we
cannot guarantee that your particular policy will cover your therapy expenses.

It is advised that you check with your specific insurance carrier to verify
whether or not physical and/or speech therapy is included as part of your
coverage.

In order to submit insurance claims, you must have a prescription from your physician ordering the therapy.

Some insurance companies have covered CIMT and CIAT. A few of the companies that have provided coverage for physical and speech therapy are:

MediCredit

Would you like to receive our services for yourself or for a loved one*, yet are unable to pay for therapy upfront? We now offer patient financing and have teamed up with MediCredit to make our services more affordable to you.

Here are some of the exceptional benefits you can receive when working with MediCredit:

• 12 Month Interest-Free patient financing
• A through C credit rating approvals
• 10 to 15 minute average approval time
• Loan amounts up to $25,000 available for those who qualify
• 100% financing available
• Absolutely no prepayment penalties
• Excellent customer service
• We (MediCredit) are our own bank; this keeps your costs to a minimum

*In order to apply for services for a loved one, that person (the patient receiving services) must be the primary applicant, while you apply as a co-applicant. After the first billing, the subsequent bills would then come to you, if desired. Please contact MediCredit directly for more information, and to indicate your preference for this billing method.

ARTICLES

Interesting articles from our staff and others about our innovative therapies.

ADVANCEWEB.COM

Constraint Induced Therapy for Aphasia

by Jennifer Brown, M.S., CCC-SLP

RNWEB.COM

New hope for stroke patients

By Ellen Barker, RN, MSN, CNRN, APN

A new therapy offers hope that movement will be restored to weakened limbs following a stroke.

STROKESOCAL.ORG

Constraint Therapy for Aphasia

A new therapy approach.

STROKEASSOCIATION.ORG

Constraint Induced Language Therapy for Aphasia

By Emily Springer

An excerpt from the article "Constraint-Induced Language Therapy for Aphasia," Stroke Connection Magazine, March/April 2006.

SAGEPUB.COM

Constraint-Induced Therapy in Stroke: Magnetic-Stimulation Motor Maps and Cerebral Activation

by George F. Wittenberg, Robert Chen, Kenji Ishii, Khalafalla O. Bushara, Edward Taub, Lynn H. Gerber, Mark Hallett, and Leonardo G. Cohen

NIH.GOV

Motor Cortex Plasticity During Constraint-Induced Movement Therapy in Stroke Patients

by Liepert J, Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E, Weiller C.

HEALTHANDAGE.COM

Stroke rehabilitation - a new approach?

Summarized by Robert W. Griffith, MD

AHAJOURNALS.ORG

Constraint Induced Therapy of Chronic Aphasia after Stroke

by Friedemann Pulvermüller, PhD, Bettina Neininger, MA, Thomas Elbert, PhD, Bettina Mohr, PhD, Brigitte Rockstroh, PhD, Peter Koebbel, MA, Edward Taub, PhD

Long-Term Stability of Improved Language Functions in Chronic Aphasia After Constraint Induced Aphasia Therapy

by Marcus Meinzer, PhD, Daniela Djundja, MSc, Gabriela Barthel, MSc, Thomas Elbert, PhD, Brigitte Rockstroh, PhD

AAPUBLICATIONS.ORG

Efficacy of Constraint Induced Movement Therapy for Children With Cerebral Palsy With Asymmetric Motor Impairment

by Edward Taub, PhD, Sharon Landesman Ramey, PhD, Stephanie DeLuca, PhD, and Karen Echols, PhD

STAFF ARTICLE

This article was first published in 2004 in Advance for Speech Language Pathologists and Audiologists Vol. 14, Issue 40, Page 14.

CONSTRAINT INDUCED THERAPY FOR APHASIA

by Jennifer Brown, M.S., CCC-SLP

For many people living with aphasia today, the results of traditional rehabilitation are disappointing. Many are able to make at least modest progress in their communication skills during the first few weeks following onset, but when they fail to progress rapidly enough within a traditional schedule of therapy (30-60 minutes per treatment 3-5 times per week); they may no longer satisfy the requirements of their insurance companies for continued therapy to be covered. In the environment of increasingly limited reimbursement and increasing caseloads, treatment often turns to teaching patients to compensate rather than attempting to restore lost function. In addition, doctors (and sometimes speech-language pathologists) tell many patients that progress can only be made within the first year resulting in traditional therapy that often yields little functional result and leaving many people frustrated, dependent, and never reaching their full potential.

Even those who may have potential for continued meaningful improvement often are not able to receive the additional treatment they require after reaching a “plateau” following a few weeks or months of traditional treatment. A recent study showed that treatment is more effective when provided more frequently and for longer periods at a time rather than shorter treatments spread out over a longer time such as in traditional therapy schedules.[i]

Constraint Induced (CI) therapy has been used by physical and occupational therapists to help patients regain the ability to use an arm or leg that has been affected by stroke. Developed by Edward Taub, Ph.D., from the University of Alabama, these principles aim to overcome the “learned non-use” that results from stroke survivors’ experience of failure during initial attempts to use the affected extremity. Eventually, the new pattern of using only the unaffected (or less affected) side becomes so strong that there are no longer even any attempts to use the affected side.[ii] To overcome this learned non-use, therapists constrain the use of the “good” side and tasks must be completed using the affected extremity. Treatments are intense and frequent lasting 6 hours a day 5 days a week in most cases.

Just as a person would naturally use his or her stronger hand to complete daily tasks, many people with aphasia find easier ways to communicate when speech is too difficult or time consuming. Patients experience failure during early attempts to communicate and eventually the learned non-use results in fewer verbal attempts and greater instances of compensation. Increased understanding on the part of their conversation partner rewards these compensations and, therefore, patients increasingly forgo verbal communication in favor of more successful communication methods. By doing so, they not only begin removing themselves from the people and activities they once enjoyed, they also allow the damaged part(s) of the brain to remain unused. Constraint Induced Aphasia Therapy (CIAT) aims to reorganize those parts of the brain that control language but have been damaged by stroke.[iii],[iv],[v] In a way, it’s speech treatment with “half your brain tied behind your back”—the good half.

A German study[vi] concluded that CI therapy for aphasia was effective; however, few, if any, programs have used these principles to treat expressive aphasia. In an attempt to study the effects of CIAT in an English speaking population, we adapted CI principles for use in speech-language treatment sessions with two volunteer participants. When modified to treat aphasia, CIAT limits the patient’s use of writing, gesturing, drawing, or even giving up on the message altogether during the therapy session and, therefore, forces the brain to adapt and find an alternate way to express the idea—verbalization and spoken words. Patients in the program receive treatment 3 ½ hours a day 5 days a week for at least 2 weeks. Homework assignments each night and on weekends continue the language stimulation. It is thought that the constraining of compensatory strategies combined with extensive and frequent treatments has the greatest effect on how much progress a patient achieves.

Without the typical 30 to 60 minute time limit, treatment can focus on restoring functions of the brain rather than using a more compensatory approach that is often necessary with the limited frequency and duration of treatment with traditional schedules. Treatment so far has been effective both one-on-one and in groups. We have provided CIAT in groups of up to three participants to one therapist with most reporting a preference for the group treatments. They cite the increased feedback, examples of how others are progressing with their language, and a feeling of support in the group setting.

Participants made significant progress during their courses of treatment. Participant 1 was 1-year post onset with treatment mainly addressing word finding. After 4 weeks of treatment, his progress (figure 1) in areas related to word finding skills allowed him to return to operating his business, record a radio commercial, and participate in a television news interview.

Figure 1

Participant 2 was 5 years post-onset with treatment focused on increasing fluency, prosody, and grammatical completeness. Her progress (figure 2) occurred over the course of 2 weeks of treatment.

Figure 2

Even after treatment ended in the clinic, these patients were able to continue their progress by continuing with practice activities at home and with family and friends. The learned non-use gives way to increased communicative confidence and willingness to communicate in increasingly demanding contexts.

Unfortunately, CIAT is not currently covered by insurance. In terms of the total number of treatment hours, two weeks of CIAT is equal to roughly 3 months of more traditional treatment (1 hour 3 times a week). By demonstrating that patients can make more progress given the same number of treatment hours it is hoped that third party payers will find that this approach to aphasia treatment not only produces better results in many cases, but is cost effective as well with regard to issues such as total cost of treatment, need to return for additional treatment at a later time, and patients’ ability to communicate with caregivers for timely management of other medical conditions.

Current treatment options for expressive aphasia are too few and the goals we set for many of our patients are far too low. Given the results of CIAT with these first two participants, research into this therapeutic approach to expressive aphasia would be worthwhile.

Additional Reading

Musso, M., Weiller, C., Kiebel, S., Muller, S., Lulau, P., and Rijntjes, M.. (1999). Training-induced plasticity in aphasia. Brain. 122, 1781-1790.

Small, S.L. (2000). The future of aphasia treatment. Brain and Language. 71, 227-232.

[i] Bhogal, S.K., Teasell, R., and Speechley, M. (2003). Intensity of aphasia therapy, impact on recovery. Stroke. 34, 987.

[ii] Taub, E., Uswatte, G., and Pidikiti, R. (1999). Constraint-induced movement therapy: A new family of techniques with broad application to physical rehabilitation: A clinical review. Journal of Rehabilitation Research and Development. 36, 237-251.

[iii] Leipert, J., Bauder, H., Miltner, W.H.R., Taub, E., and Weiller, C. (2000). Treatment-induced cortical reorganization after stroke in humans. Stroke. 31, 1210-1216.

[iv] Liepert, J., Miltner, W.H.R., Bauder, H., Sommer, M., Dettmers, C., Taub, E., and Weiller, C. (1998). Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neuroscience Letters. 250, 5-8.

[v] Levy, C.E., Nichols, D.S., Schmalbrock, P.M., Keller, P., and Charkeres, D.W. (2001). Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy. American Journal of Physical Medicine and Rehabilitation. 80, 4-12.

[vi] Pulvermuller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbel, P., and Taub, E. (2001). Constraint-induced therapy of chronic aphasia after stroke. Stroke. 32, 1621.

Current Ads

These are advertisements we have currently placed in various magazines.

Upper Extremity

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CONTACT PAGE

We're eager to hear from you! You can call, mail, e-mail or use our short contact form below. If you include a phone number, please let us know what hours are appropriate and we will contact you as soon as possible. Thank you!

Advanced Recovery Rehabilitation Center
4419 Van Nuys Boulevard, Suite 412
Sherman Oaks, CA 91403

Phone: (818) 386-1231

Fax: (818) 386-0483

Email:

Activities

Activities and opportunities that others have found entertaining, educational, or helpful.

Within walking distance

Shopping Along Ventura Blvd
Sherman Oaks Library
Pacific Sherman Oaks 5 Movie Theater
Black Dog Yoga Studio

Food

El Torito Mexican Restaurant
Oliva Trattoria Italian Ristorante
Gyu-Kaku Sushi
Lannathai Thai Food
Hamburger Hamlet
Marie Callender
Solley’s Deli
New York Bagel Café
India’s Tandori 
McDonald’s
Taco Bell
Quiznos
In-n-Out Burger
Dominos Pizza
Panda Express

Banking

CitiBank
Wells Fargo
CalNational

Within driving distance

Westfield Shopping Mall
Northridge Mall
Lake Balboa
Rocky Peak Park
Santa Monica Mountains
Griffith Park
LA Zoo
Autry Museum
Universal CityWalk
Hollywood Boulevard
Ronald Reagan Presidential Library
Getty Museum
Santa Monica Pier
Nethercutt Museum
Rodeo Drive in Beverly Hills