foundations from the Foundation:
Taub, E., Miller, N. E., Novack, T. A., Fleming, W. C., Nepomuceno, C. S., Connell, J. S., & Crago, J. E. (1993). Technique to improve chronic motor deficit after stroke. Archives of physical medicine and rehabilitation, 74(4), 347-354.*
Dr. Edward Taub received his PhD in behavioral neuroscience from New York University in 1970, mentored primarily by Dr. Neal Miller. His early work was with primates, exploring the impact of somatosensory deafferentation. In a series of studies, he and his colleagues demonstrated that, following surgical abolition of sensation in the upper extremity, purposive movement of the limb nonetheless could be re-established. This was contrary to the then-dominant view in neurology and rehabilitation that spinal reflexes were the basis of voluntary movement.
Dr. Taub moved to the University of Alabama at Birmingham in 1986 to pursue what he had described a decade earlier: the application of what had been learned with primates to the problem of loss of motor function following CNS injury (1). He posited that “learned non-use” could develop for example after a stroke, when repeated efforts to move the paretic limb were met with lack of success. Patients would learn and/or be taught via rehabilitation approaches of that era, to compensate for such a loss by using the intact limb. Dr. Taub and colleagues developed a family of rehabilitation techniques termed Constraint-Induced Movement Therapy (CI Therapy) in which the patient was required by training procedures to make use of the paretic limb while the intact limb was restrained. Behavioral shaping and reinforcement techniques were built into the procedures. The paper reprinted here presented the first outcome data from an RCT of CI Therapy with stroke patients who were at least one-year post-CVA to control for spontaneous neurological recovery effects. Dr Taub and his group have also demonstrated neuroplastic changes in grey matter of the brain as a function of CI therapy, providing important information on the potential for harnessing that plasticity for functional improvement in patients with CNS injuries. CI Therapy has been widely adopted and investigated to date (2), with three Cochrane Reviews published on its outcomes.
This paper was chosen for the Foundations series despite its relative “youth” compared to other papers in the series. This is because its intellectual origins were much earlier in basic neuroscience work of the 1970’s, and because it was the initial outcome paper for the massive work on CI Therapy that has occurred in the last 30 years. Of note is that it was also the most cited paper in the three major rehabilitation journals from 1984 to 2013 (3). Finally, it is of interest because it is a rare example of a researcher successfully transitioning his research work from animals to humans, the kind of translational effort that is so sought after by funding agencies today.
(1) Taub, E. (1980). Somatosensory deafferentation research with monkeys: Implications for rehabilitation medicine. In L. P. Ince (Ed.), Behavioral Psychology in Rehabilitation Medicine: Clinical Applications (pp. 371-401). New York: Williams & Wilkins.
(2) Taub, E., Uswatte, G., & Elbert, T. (2002). New treatments in neurorehabiliation founded on basic research. Nature Reviews Neuroscience, 3(3), 228.
(3) Powell, A. J., Conlee, E. M., & Chang, D. G. (2014). Three decades of citation classics: the most cited articles in the field of physical medicine and rehabilitation. PM&R, 6(9), 828-840.
*With permission from Archives of Physical Medicine and Rehabilitation