Successful outcomes in stroke following forced use: what are the contributing factors?

Forced use is an experimental treatment designed to overcome nonuse of a hemiparetic upper extremity. It has demonstrated significant and long-lasting effects in regaining functional use of the affected arm with select chronic hemiparetic subjects. Occupational therapists, who frequently treat post-acute hemiparetic patients, may benefit from knowing this technique. Since a search of the OT literature uncovered no information on forced use, studies outside the standard OT resources were used. In particular, this review analyzes forced use in an attempt to determine the factors that contribute to its success. Although many factors such as subject criteria, psychological and motor learning factors, time, and use appeared likely to affect the success of forced use, they could not be confirmed through the existing experiments. Future controlled research on the clinical relevance of forced use is suggested.