David Morris

• PT, PhD
• Professor (Full) at University of Alabama at Birmingham

Background Integrating behavioral intervention into motor rehabilitation is essential for improving paretic arm use in daily life. Demands on therapist time limit adoption of behavioral programs like Constraint-Induced Movement (CI) therapy, however. Self-managed motor practice could free therapist time for behavioral intervention, but there remain...

Diet and nutrition are critical components of health, recovery from disease and illness, performance, and normal growth across the lifespan. Thus, it is important for physical therapists to be knowledgeable about nutrition and to have competency in providing information and guidance to patients/clients. Yet, there is an overwhelming amount of diet...

It has been established that physical therapist practice includes screening for and providing information on diet and nutrition to patients, clients, and the community. Yet, an overwhelming amount of often contradictory diet and nutrition information poses a challenge for physical therapists to identify and maintain knowledge that they can rely on...

Constraint-Induced Movement Therapy (CIMT) is comprised of a set of techniques shown to produce significant changes in upper extremity (UE) function following stroke and other disorders. The significant positive results obtained with the UE protocol has led to the development of LE-CIMT, an intervention to improve lower extremity (LE) function. How...

Constraint-induced movement therapy (CI therapy) has been shown to reduce disability for individuals with upper extremity (UE) hemiparesis following different neurologic injuries. This article describes the study design and methodological considerations of the Bringing Rehabilitation to American Veterans Everywhere (BRAVE) Project, a randomized con...

Research Objectives To determine the efficacy of CI Therapy compared to LEFT, a holistic fitness program (meditative and physical excercises) for improving upper extremity (UE) motor deficit and PTSD symptomatology in veterans and civilians with TBI. Design Single-blinded RCT with 1-year follow-up Setting Academic medical center Participan...

Purpose: To evaluate the efficacy of an expanded form of Constraint-Induced Movement Therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper-extremity hemiparesis, suitable for treating severe hemiparesis. Methods: Twenty-one adults ≥1 year after stroke with severe upper-extremity hemiparesis (with little or no...

Experts around the world support the integration of health promotion and wellness (HPW) services into traditional health care services. If successfully executed, the addition of HPW services would reduce rates of death and disability and significantly reduce health care costs. While all health care providers should be engaged in providing HPW servi...

Purpose: To evaluate the efficacy of an expanded form of Constraint-Induced Movement Therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper-extremity hemiparesis, suitable for treating severe hemiparesis. Methods: Twenty-one adults ≥1 year after stroke with severe upper-extremity hemiparesis (with little or no c...

Cerebral palsy (CP) is a group of non-progressive neuro-developmental conditions occurring in early childhood that causes movement disorders and physical disability. Measuring activity levels and gait patterns is an important aspect of CP rehabilitation programs. Traditionally, such programs utilize commercially available laboratory systems, which...

Background Globally, physical therapy professional organizations have called for physical therapists to perform lifestyle behavior management during customary care, or health-focused care, due to increasing morbidity and mortality related to noncommunicable diseases. Given the potential for health-focused care to improve health outcomes, physical t...

Background Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it...

Screening for medical referral is essential to physical therapist practice; however, no studies have examined medical screening across physical therapy practice settings. The purpose of this study was to determine if physical therapists in a variety of practice settings, given brief clinical vignettes, would screen for medical referral in a similar...

Background: Interprofessional education is not a new concept but is one that has become critical as the healthcare industry is held more accountable for costs, quality and outcomes. Healthcare is being transformed by a focus on patient-centered care and the increasing complexity of care. The need for collaborative and interdependent professional te...

Now available in paperback, this updated new edition summarizes the latest developments in cognitive neuroscience related to rehabilitation, reviews the principles of successful interventions and synthesizes new findings about the rehabilitation of cognitive changes in a variety of populations. With greatly expanded sections on treatment and the ro...

Acommon challenge in stroke rehabilitation research is the translation of research findings into the clinical setting. Multiple factors present obstacles to dissemination and adoption, including the complexity of the physical rehabilitation protocols and the shift in practice required by treatment philosophies that require innovative approaches.

Bipedal locomotor control requirements may be useful as classifications for walking dysfunction because they go beyond gait analysis to address all issues contributing to walking dysfunction. The objective of this study is to determine if locomotor experts could achieve consensus about requirements for bipedal locomotion. Locomotor experts from phy...

Background and purpose: Constraint-induced movement therapy is a set of treatments for rehabilitating motor function after central nervous system damage. We assessed the roles of its 2 main components. Methods: A 2 × 2 factorial components analysis with random assignment was conducted. The 2 factors were type of training and presence/absence of...

Physical therapists (PTs) have a unique opportunity to intervene in the area of health promotion. However, no instrument has been validated to measure PTs' views on health promotion in physical therapy practice. The purpose of this study was to evaluate the content validity and test-retest reliability of a health promotion survey designed for PTs....

Over the past decade, HIV has been transformed from a terminal to chronic disease. Physical and occupational therapists are seeing increasing numbers of patients/clients who are aging with HIV. Nearly half of the adults with HIV experience mild to severe cognitive deficits, which can interfere with everyday functioning such as driving and medicatio...

Objective: To determine whether the combination of Constraint-Induced Movement Therapy (CIMT) and conventional rehabilitation techniques can produce meaningful motor improvement in chronic stroke patients with initially fisted hands. Design: Case series. Setting: University hospital outpatient laboratory. Participants: Consecutive sample (N=...

Tools chosen to measure poststroke upper-extremity rehabilitation outcomes must match contemporary theoretical expectations of motor deficit and recovery because an assessment's theoretical underpinning forms the conceptual basis for interpreting its score. The purpose of this study was to investigate the theoretical framework of the Wolf Motor Fun...

Although constraint-induced movement therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages after stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to...

Balance dysfunction and falls-related injuries represent serious public health issues, resulting in great expense and human suffering. The physical problems leading to balance dysfunction include musculoskeletal-related structural limitations, diminished sensory capabilities, motor coordination deficits, and loss of anticipatory control mechanisms....

Poor nutrition and obesity can directly lead to pathological conditions managed by physical therapists or negatively influence recovery from movement dysfunction. The physical therapist/client relationship provides an opportunity for screening for poor nutrition as well as recommending and supporting better nutrition practices by the clients under...

An enduring problem in the field of rehabilitation has been the lack of standardization in the protocols of treatments and tests. To develop a process evaluation method to standardize the administration of rehabilitation procedures used in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial, a randomized controlled trial of upper-ext...

To assess upper extremity (UE) capabilities following stroke, the Wolf Motor Function Test (WMFT) measures time to complete 15 UE tasks and 2 strength tasks, but takes 30 to 45 minutes for the clinician to complete. In an effort to streamline the WMFT, this study evaluated the association between the magnitude of improvement on any timed task of th...

E5 was pressed. Neurophysiologic measures included lesioned hemisphere corticospinal excitability and intracortical inhibition, and inter-hemispheric inhibition from the non1esioned to the lesioned hemisphere , as measured by motor-evoked potential (MEP) amplitudes, cortical silent periods, and ipsilateral silent periods, respectively. All measurem...

The aim of constraint-induced movement therapy (CIMT) is to promote use of a limb that is functionally impaired after a stroke. In one form of CIMT to treat upper limb impairment, use of the less severely affected arm is restricted for many hours each weekday over 2 consecutive weeks. The EXCITE trial has previously shown the efficacy of this inter...

Purpose:: To develop a measure of 3 social cognitive theory constructs (self‐efficacy expectations, outcome expectations, and outcome expectancies) for predicting home exercise program (HEP) adherence in older adults after discharge from home health physical therapy. Methods:: A questionnaire was developed, pilot‐tested, and administered to 50 part...

To examine the relationship between change scores on the log mean Wolf Motor Function Test (lmWMFT) and the intensity of supervised Constraint Induced Movement Therapy (CIMT) in participants with subacute and chronic stroke. A retrospective analysis of data from 169 EXCITE participants who received CIMT either immediately after randomization or one...

To develop a measure of 3 social cognitive theory constructs (self-efficacy expectations, outcome expectations, and outcome expectancies) for predicting home exercise program (HEP) adherence in older adults after discharge from home health physical therapy. A questionnaire was developed, pilot-tested, and administered to 50 participants (mean age 7...

Participant recruitment is considered the most difficult aspect of the research process. Despite the integral role of recruitment in randomized clinical trials, publication of data defining the recruitment effort is not routine in rehabilitation initiatives. The recruitment process for the Extremity Constraint-Induced Therapy Evaluation (EXCITE) tr...

Single-site studies suggest that a 2-week program of constraint-induced movement therapy (CIMT) for patients more than 1 year after stroke who maintain some hand and wrist movement can improve upper extremity function that persists for at least 1 year. To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on impro...

Data from monkeys with deafferented forelimbs and humans after stroke indicate that tests of the motor capacity of impaired extremities can overestimate their spontaneous use. Before the Motor Activity Log (MAL) was developed, no instruments assessed spontaneous use of a hemiparetic arm outside the treatment setting. To study the MAL's reliability...

Research on monkeys with a single forelimb from which sensation is surgically abolished demonstrates that such animals do not use their deafferented limb even though they possess sufficient motor innervation to do so, a phenomenon labeled learned nonuse. This dissociation also occurs after neurological injury in humans. Instruments that measure the...

Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment approach that improves more-affected extremity use following a stroke, especially in the life situation. The originators of the approach describe CI therapy as consisting of a family of therapies including a number of treatment components and subcomponents. When thinking...

Recent years have seen a proliferation of animal and human studies that have associated significant changes in regional brain physiology with sustained altered environmental or somatic stimuli. The behavioral consequences in such instances can be adaptive or maladaptive. As would be expected, constraint-induced movement therapy (CI therapy), which...

Two important components of Constraint-Induced Movement therapy are thought to be intense training of the more-impaired arm and physical restraint of the less-impaired arm. This preliminary study examined the effects of type of training (task-practice, shaping) and restraint (sling, half-glove, no restraint) on treatment outcomes. Seventeen individ...

Purpose: This paper describes the development, implementation, and outcomes of two courses for entry-level, master's degree earning physical therapist students. The courses were designed to address perceived barriers to early clinical education experiences, and to proactively provide appropriate structure for the imminent transition to a clinical d...

Constraint-Induced Movement therapy (CI therapy) is a neurorehabilitation technique developed to improve use of the more affected upper extremity after stroke. A number of studies have reported positive effects for this intervention, but an experiment with a credible placebo control group has not yet been published. We conducted a placebo-controlle...

The great prevalence of traumatic brain injury (TBI) and its high economic costs make reducing TBI-related disability a national health care priority. In our research laboratory, CI therapy has been found to significantly improve upper extremity function for persons with chronic TBI. The results have suggested that persons with TBI are less likely...

Constraint-Induced Movement therapy (CI therapy) is a recognized rehabilitation approach for persons having stroke with mild to moderately severe motor upper extremity deficits. To date, no rehabilitation treatment protocol has been proven effective that addresses both motor performance and spontaneous upper extremity use in the life situation for...

In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity...

A volunteer sample of 22 participants with chronic traumatic brain injury (TBI) (onset >1 year) and relative hemiplegia that revealed moderate disability in the more-affected upper limb (UL) participated. Constraint-induced (CI) movement therapy (CI therapy) was employed for a 2-week period; treatments included massed practice, shaping of the more-...

The Wolf Motor Function Test (WMFT) has been used in rehabilitation studies of chronic stroke patients, but until now its psychometric properties have not been evaluated in patients with subacute stroke. Two hundred twenty-nine participants with subacute stroke (3-9 months postinjury) at 7 research sites met inclusion criteria for the EXCITE Trial...

This article describes the study design, methodological considerations, and demographic characteristics of a phase III RCT to determine if 1) constraint-induced therapy (CI therapy) can be applied with therapeutic success 3 to 9 months after stroke across different sites, 2) gains that might occur persist over 2 years, 3) initial level of motor abi...

Constraint-Induced Movement therapy (CI therapy) has been demonstrated to improve motor function and upper extremity (UE) use of persons with hemiparesis resulting from chronic stroke through two separate but linked mechanisms, overcoming learned nonuse, and facilitating use-dependent cortical reorganization. The principles of CI therapy and adapta...

A therapeutic approach to rehabilitation of movement after stroke, termed constraint-induced (CI) movement therapy, has been derived from basic research with monkeys given somatosensory deafferentation. CI therapy consists of a family of therapies; their common element is that they induce persons with stroke to greatly increase the use of a more-af...

To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity motor function in adults with hemiplegia. Interrater and test-retest reliability. A clinical research laboratory at a university medical center. A sample of convenience of 24 subjects with chronic hemiplegia (onset >1yr), showing moderate motor impairmen...

Traditional rehabilitation programs for persons with neurologic dysfunction emphasize a compensation, true recovery, or substitution approach to improve functional abilities. Constraint-induced (CI) movement therapy substantially increases more-affected extremity use in the life situation due to the influence of two different underlying mechanisms:...

A new therapeutic approach to rehabilitation of movement after stroke, termed Constraint-Induced (CI) Movement Therapy, has been derived from basic research with monkeys given somatosensory deafferentation. CI consists of a family of therapies; their common element is that they induce stroke patients to greatly increase the use of a more affected u...

Patients with neurological disorders present therapists with complex challenges for treatment, including weakness, hypertonicity, voluntary movement deficit, limited range of motion, sensory loss, incoordination, and postural instability. The presence of one or more of these impairments negatively influences these patients by contributing to proble...

Constraint-Induced Movement therapy (CI therapy) is a rehabilitation approach designed to promote neural plasticity, improve movement control and increase functional independence in patients following neurological injuries. Mounting evidence suggests that this approach is effective for producing improvements in motor function and actual amount of u...