The Brave

Edward Taub, PhD (right) looks on while a patient performs a task with his weakened hand, the other hand in a mitt.

 UAB, Lakeshore Foundation and DOD Join Forces to Aid Veterans

One of the great ironies of war is that from the suffering of armed conflicts have come some of the greatest advances in medical history.

Antibiotics in World War II, new trauma surgery techniques and air ambulances in Korea, and the modern paramedic and emergency medical procedures that grew out of Vietnam and more recent conflicts are all saving civilian lives today. Wars in the Persian Gulf are writing new chapters in treatment of injuries to the point that a higher percentage of soldiers are surviving serious wounds than ever before.

Helping more survivors also brings the challenge of finding better ways to overcome the after-effects of traumatic brain injuries which have become more prevalent due to an increase in blast injuries.

In The Brave Initiative, funded by a $2.7 million grant from the Department of Defense, UAB and The Lakeshore Foundation are working in parallel to study and compare the effectiveness of UAB’s Constraint-induced Movement Therapy (CI therapy) and Lakeshore’s Enriched Fitness Training (LEFT) in improving function along with physical and psychological conditions in veterans with motor impairment from traumatic brain injuries.

“We hope to gather data on what each type of therapy does best so we can merge and refine what we learn to create a new, more effective standard of care,” principal investigator and UAB psychology professor Edward Taub, PhD, said. “80 patients will be randomly assigned to either CI therapy or LEFT. Judging from past experience, we anticipate that CI therapy will be strong in improving function, while LEFT should be very effective in improving physical and psychological condition.

Developed by Taub at UAB over the past 30 years, CI therapy has proven exceptionally effective in helping patients overcome motor impairment from stroke, brain injuries and deficits from neurological conditions such as MS. It has been shown to increase white matter in the brains of children with cerebral palsy and has been used in an adapted form to help patients overcome aphasia.

Co-investigator UAB psychology professor Gitendra Uswatte, PhD, pointed out another key finding that came to light through CT therapy.

“Contrary to the long-held belief that therapy must begin within a limited time frame after the injury to be effective, with CI therapy we have seen improvement in motor deficits years after strokes and brain injuries,” Uswatte said. “The concept grew out of Dr. Taub’s early work with primates. Neuroplasticity allows the motor training techniques used in CI therapy to teach the brain to rewire itself.”

“When people have motor impairment from a stroke or brain injury, they may find one arm and hand to be more difficult to use,” Taud said. “It can be frustrating. To avoid the frustration, they begin to teach themselves to rely more on the other hand, using the impaired hand less.

“To improve motor function in the more seriously affected hand and arm, we use a mitt to constrain the use of the hand patients normally depend on. We benchmark their best time doing tasks with the affected hand, and then we help them use a set of training techniques so they see their speed and agility improve as their brains begin to rewire the control of movement to other areas that haven’t been damaged.”

CI therapy is used extensively in other countries, and the paper Taub and his associates wrote introducing the concept, “Technique To Improve Motor Deficit After Stroke,” is the most cited paper in rehabilitation journals over the past 30 years. During the Dalai Lama’s visit to Birmingham, using CI therapy to harness the neuroplasticity of the brain was a topic of conversation between Taub, his associates and the leader of Tibetan Buddhism, who has an interest in the brain’s ability to heal itself.

Another irony is that although the effectiveness of CI therapy in clinical use internationally has been confirmed in what could well be the most papers in this area of rehabilitation, CI therapy is not accessible to most residents in the state where it was developed except through self funding because it is not covered by the predominant insurer in Alabama.

However, it will be provided at no charge to study participants in the CI therapy group. This study is a rigorous randomized clinical trial (RCT), and will begin and end with an MRI to assess progress in both groups. Participants will receive treatment for three and a half hours daily for ten days, which will be preceded and followed by two days of testing for a total of 14 weekdays. There will be follow-up by phone and at the end of a year to see how the intensive course of therapy translates into improving arm function in everyday tasks and in quality of life.

For non-local participants, the grant will cover transportation and housing for the participant and a companion. To qualify, potential participants should be active-duty or veteran military personnel at least 19 years of age and be at least three months post TBI with movement problems or weakness in one or both hands.

To learn more about how to participate, call (205) 934-9768 or visit


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CI therapy, Constraint=induced Movement Therapy, Department of Defense, Edward Taub, Gitendra Uswatte, impaired arm movement, Lakeshore Foundation, Lakeshore’s Enriched Fitness Training (LEFT), neural deficit, neuroplasticity, PHD, The Brave Initiative, Traumatic Brain Injury, UAB


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