| Summary: | Recovery of movement and function of the upper limb post acquired brain injury (ABI) is problematic. Constraint induced movement therapy (CIMT) involves constraint of the less affected limb for 90% of waking hours for two or more consecutive weeks while intensively training the hemiplegic upper extremity using both physical and behavioural methods. Despite the robust evidence base for CIMT large gaps remain including two key issues which have emerged from two systematic reviews conducted within this thesis. Firstly the majority of research has not used the full multi component core CIMT protocol, and secondly the current level of CIMT implementation within the United Kingdom (UK) is unknown. A subsequent UK wide online survey was conducted to investigate therapist knowledge and application of CIMT in practice. Two main points were made; firstly the majority of therapists did not use CIMT (62.9% n==306) due 10 resource barriers and lack of training, and secondly those who did use CIMT, did not implement the whole package. A clinical feasibility randomised controlled trial (RCT), incorporating standardisation methods to ensure treatment fidelity, was therefore conducted and confirmed that CIMT could be applied using a multi disciplinary approach in a UK clinical setting to the stroke and traumatic brain injury population (TBI). Success was highlighted by the high adherence rates and overall improved outcomes in terms of upper limb function and quality of life compared to those receiving conventional Bobath based upper limb therapy. This feasibility was further highlighted during a focus group study which described a therapist journey from an initial challenge stage to modelling in which therapists discussed the use of CIMT in their future practice. Overall this doctoral work has determined use, and barriers and subsequent enablers to CIMT implementation in the UK in addition to providing a feasible framework for delivering CIMT in the NHS setting.
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