Compulsory use therapy is a form of treatment in which the movements of the healthy side are prevented and the use of the weak side is encouraged in the stroke In the first scientific studies investigating this method, 90% of the daylight hours were restricted to the healthy side with a sling or glove, and the paralyzed arm and hand were tried to be used for 6 hours a day for 2 weeks. When applied at this intensity, the results were found to be positive. Later, in some centers, the density was slightly reduced and compulsory use was reduced to 3 hours a day. Thus, the continuation of the application for more than 2 weeks can be more easily tolerated by the patient. One of the advantages of compulsive use therapy is that it can be done at home. However, this method may not be suitable for everyone. For this reason, stroke patients and their relatives should first discuss the issue with their doctors and physiotherapists and try this method if they approve.

Before trying compulsive-use therapy at home, it should be ensured that patients are able to sit, stand, reach, and walk safely when their intact arm is restrained. Gloves may be less restrictive than a sling that immobilizes the arm as a whole. If the use of the healthy hand is restricted with a fingerless glove, if the person loses balance, the healthy side can get support by using the arm. On the other hand, if restraint is made only with gloves, the person may unconsciously get used to receiving constant support from the healthy side. If there is a risk of experiencing balance problems, the patient should be kept under observation during the treatment. The paralyzed side should be operated for 3 to 6 hours a day for at least 2 weeks. In a modified method, 3 hours of work per day continues for 1-6 months.

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Example Activities for Compulsive Use Therapy

  • dusting the table
  • moving, pushing or sliding things
  • turn book page
  • Turning the faucet on and off
  • Turning the lamp switch on and off
  • Turning the doorknob
  • opening the door
  • washing the face
  • Transferring uncooked rice or bean grains from one container to another using the hand or a spoon
  • combing the hair
  • Taking things off the table
  • Pouring water into glasses or containers
  • Writing, drawing or finger painting
  • flushing the toilet
  • Opening the clothespin
  • Don’t pet or caress a cat or dog
  • Don’t hit the balloon
  • ball rolling
  • Kneading exercise dough
  • ball spin
  • Putting items such as small pillows from one place to another
  • Transition from lying to sitting position using the weaker arm
  • Flipping cards from one face to another for playing cards or any other game
  • Practice pressing piano or keyboard keys
  • Playing a game on a mobile phone or tablet
  • Carrying a light bag or bag
  • Practice with edible foods using fingers such as fruit
  • Playing desktop games that require hand and arm use

Compulsory use therapy is demanding and may not be suitable for everyone. This treatment concept emphasizes that the weak side should be used to see recovery after stroke. Many stroke and brain injury patients make no effort to use their paralyzed side except for physical therapy sessions that do not last even 1 hour a day. However, such a short period of time is not enough to activate brain plasticity and to see significant improvement. Even patients who cannot apply compulsory use treatment according to their defined definitions can benefit if they make an effort to perform the above-mentioned activities with their paralyzed side.

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