HEALTHCARE PROVIDERS

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 What are your therapists’ qualifications and training?

Physical Therapy

Tami Toms, MPT

Masters of Science Degree in Physical Therapy

Licensed by the State of California

Trained in use of CIMT techniques and SaeboFlex™

Tracy Norton, MPT

Masters of Arts Degree in Occupational Therapy

Board Certified in Physical Agent Modalities

Licensed by the State of California

Trained in use of CIMT techniques and SaeboFlex™

SpeechTherapy

Jennifer Brown, MS, CCC-SLP

Masters of Science Degree in Communication Disorders

Licensed by the State of California

Certificate of Clinical Competence from the
American Speech-Language and Hearing Association

Muriel Goldojarb, MA, CCC-SLP

Masters of Arts Degree

Licensed by the State of California

Certificate of Clinical Competence from the
American Speech-Language and Hearing Association

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).