Dr. Edward Taub is a University Professor in the Department of Psychology at the University of Alabama at Birmingham. Drs. Neal E. Miller, Fred Keller and Joseph V. Brady were his main mentors. He received his masters degree from Columbia University where he was introduced to the behavior analysis methods he later incorporated into CI Therapy, the family of rehabilitation treatments he developed. He received his doctoral degree from New York University in psychology under the supervision of Dr. Edgar E. Coons. His research has been primarily in the fields of motor control, behavioral neuroscience, behavioral medicine, and neurorehabilitation. Among his major accomplishments is the development of the aforementioned family of techniques — Constraint-Induced Movement Therapy (or CIMT) — that have been shown to be effective in improving the rehabilitation of movement in stroke, traumatic brain injury, cerebral palsy in young children, multiple sclerosis, and other neurological injuries. In recent years the application of the basic methodology has been extended to the cognitive domain: CI Aphasia Therapy (CIAT) and CI Cognitive Therapy (CICT). His body of CI therapy research was named by the Society of Neuroscience as one of the top 10 Translational Neuroscience Accomplishments of the 20th century and one of the 10 “most exciting lines of neuroscience”. Dr. Taub has been President of Section J (Psychology) of the American Association for the Advancement of Science (AAAS), President of the Biofeedback Society of America, a Guggenheim Fellow, a Humboldt Foundation Fellow, and Co-President of the Claude Bernard Club, a research honorary society in the field of applied psychophysiology. He has been on the Board of Directors of four national scientific societies and is a Fellow of four societies. He has received the top awards for his research from three national professional organizations and from the University of Alabama at Birmingham. In 2003, the research from his laboratory was named by the Society for Neuroscience as being one of the 10 leading examples of translational research in the field of neuroscience in the twentieth century.

B.F. Skinner famously proposed that the laws of behavior could be developed without any reference to the nervous system.  That this is possible is amply demonstrated by the now- long and successful history of operant conditioning/behavior analysis research and practice over the past 90 years.  However, there is nothing in Skinner’s original formulation that implies that behavior and the nervous system do not interact in important ways.  It is evident that the nervous system is the final common pathway, integrating input from the environment and various internal systems to activate the peripheral nervous system, muscles and skeleton to produce movements that operate on the external environment – in short, producing behavior.  What wasn’t known clearly until the pathbreaking work from the Mezenich laboratory in the 1990’s was that behavior in turn can have an equally profound effect on the nervous system.   This process is now termed, among other things, use-dependent cortical reorganization or brain plasticity.

A clear case in point is the development of Constraint-Induced Therapy, a family of rehabilitation treatments developed here.  Members of this family of treatments were used initially for the rehabilitation of the impaired movements of the upper and lower extremities (CI Movement Therapy) after stroke, traumatic brain injury, multiple sclerosis, spinal cord injury and cerebral palsy (Pediatric CI Movement Therapy), and subsequently for impaired speech after stroke (CI Aphasia Therapy) and impaired executive function after stroke and COVID-19 (CI Cognitive Therapy).  The foundation of this therapy is based entirely on behavior analysis principles and practice that I learned from my revered first mentor at Columbia University, Fred Keller, and later from my equally valued later mentor, Joseph V. Brady at the Institute of Behavioral Research (IBR) and Walter Reed Army Institute of Research with further impact from Neal Miller. The process by which this came about will be described in my talk.

Numerous experiments have shown that different members of the CI Therapy family of treatments have a profound effect on the structure and function of the brain, and this in turn can have a marked effect on improving impaired movement, speech, and executive function after central nervous system injury.  This is an example of the more general continual strong interaction of behavior and the nervous system serving to modify and shape both throughout the life span in a great feedback loop fundamental to the generation of behavior and the way in which the control of behavior can be used for the rehabilitation of movement impaired by CNS injury.  It is important to take into consideration this “great feedback loop” in evaluating the potential of behavior analysis for improving the human condition. 

Constraint-Induced Movement Therapy or CI Therapy is a family of neurorehabilitation treatments based almost entirely on behavior analysis methodology.  It is derived from basic research experiments with monkeys given a surgical abolition of sensation from a single forelimb in which a useless deafferented limb was converted to a useful (though not normal) limb by shaping and other behavioral methods.  Subsequently, the primate results provided the basis for the development of the CI Therapy family of interventions for humans for the rehabilitation of impaired function after stroke, traumatic brain injury, cerebral palsy, multiple sclerosis and other types of central nervous system damage.  The impaired functions improved by this behavior analysis-based treatment include upper and lower extremity movement, focal hand dystonia in musicians, post-amputation phantom limb pain, aphasia and executive cognitive function.

The same behavior analytic techniques are employed in all variants of CI Therapy. They target the behaviors associated with the impaired function; e.g., movements, expressive speech, activities of daily living (ADL) generally considered to importantly involve executive cognitive function.  The techniques include shaping of relevant ADL in the treatment setting and a Transfer Package (TP) of techniques to facilitate transfer of the behavior improved by shaping in the laboratory to everyday situations outside the treatment setting and the long-term retention of this real-world improvement. The TP techniques include a behavior contract in which a patient-caregiver dyad agree to keep trying to carry out difficult-to-perform impaired behaviors, daily assignment of homework that is monitored, daily discussion of the amount and quality of performance of lists of impaired behaviors in a structured interview, daily sessions of problem solving to overcome perceived (or real), barriers to carrying our specific impaired behaviors at home, and then post-treatment, assignment of daily homework and periodic, scheduled phone interviews. The result is usually very large improvements in impaired function. When long-term homework performance is carried out and follow-up contact is maintained, improvement sometimes improves into the normal range.  The extent to which this is possible with different severities of initial deficit is yet to be determined.