About Forced Use Therapy according to Utley/Woll

There are numerous neurological treatment methods available to us in the world of occupational and physiotherapy. However, Forced Use Therapy according to Utley/Woll stands out from others due to its well-founded approach and impressive results. This special form of therapy is aimed at people who experience motor impairments as a result of a brain injury caused by a stroke, traumatic brain injury or other neurological disorders. The therapeutic aim is to reactivate lost functions and encourage the brain to restructure and improve functionality as quickly as possible.

Forced Use Therapy is based on the premise that a significant neuroplastic change can be induced through targeted and intensive use of the affected body segments. This method combines evidence-based treatment principles with a deep understanding of normal movement sequences as well as biomechanical and kinematic principles. This enables our therapists to perform a targeted movement analysis and thus precisely analyze movement deviations and create tailor-made treatment plans. In this way, functional and measurable motor control is regained with the client.

Zwei Frauen machen eine physiotherapeutische Übung mithilfe einer Bank und einer Holzplattform.

Among the variety of therapeutic approaches, Forced Use Therapy according to Utley/Woll stands out due to its unique combination of proven principles and innovative applications. This method has evolved from established concepts such as the Bobath concept and Edward Taub’s Constraint Induced Movement Therapy (CIMT). Other important principles such as task- and context-specific training have been integrated over time.

Forced Use Therapy shares many points of contact with the Bobath concept and at the same time differs in particular through intensive, highly repetitive, task- and context-specific training, which is based on the Forced Use principle: “the forced use of the more affected side, with simultaneous inhibition of the less affected side”. Because time is precious, especially in neurorehabilitation – Forced Use Therapy according to Utley/Woll makes effective use of this time!

The therapy and training can be carried out for 30 minutes to 6 hours. The concept is also suitable for use in a clinic as well as in the doctor’s office and for home visits.

In a 2- to 4-week intensive forced use therapy according to Utley/Woll, patients develop the next level of their skills in a short period of time. This therapy is carried out by IFUSA-certified forced use specialists.

Our history

The development of our treatment concept Forced use – Intensive therapy according to Utley/Woll ® and its philosophy began in the 1970s when Susan Woll and Jan Utley trained with Karl and Berta Bobath.

The Bobath philosophy is based on scientific findings that affected patients can regain motor control following acquired brain damage. The basis of these findings was to create conditions in the treatments that forced the patients to use their affected body parts. This forced use enabled normal strength parameters in the muscles.

At the time, Jan Utley was teaching neuroscience at Chicago Medical University in Chicago, USA. Through her studies and research, it became increasingly clear to her that the neuroplasticity of the brain made it possible to regain motor control. She realized that patients had to practice under conditions that triggered cortical reorganization in the brain.

These experiences led Jan to process and apply findings from research into neuroplasticity in her clinical practice. Important scientists such as Dr. Paul Bach y Rita, Dr. Josephine Moore, Dr. Stanley Finger and Dr. Donald Stein had a decisive influence on her at the time. In particular, the research results of Kendall, Schwartz and Jessel on neuroplasticity and the recovery of neuronal structures, published in “Principles of Neural Science”, were integrated. A close collaboration developed and Jan also trained as a Bobath instructor in 1987.

Zwei ältere Frauen mit Brille lächeln sich in einem gemütlichen, warm beleuchteten Restaurant gezwungen an.

In the 1990s, the research findings of Dr. Carolee Winstein, Dr. Steven Wolf and Dr. Eduard Taub were also incorporated into clinical applications for brain-damaged patients. From this, the first treatment strategies were developed that increasingly used forced use as a way of optimizing the recovery of motor control.

Susan Woll initially studied and worked as a physiotherapist. During this professional activity, she was dissatisfied with the low level of knowledge and the limited treatment options for neurological patients. She decided to work in Europe and went to Switzerland in the hope of finding more knowledge and experience in neurology there. However, she had the same experience as in the USA. Patients survived a stroke or traumatic brain injury, but there were no treatment strategies that allowed them to regain motor control.

In 1973, she completed a course on the treatment of adults with hemiplegia, which was led by Berta and Karl Bobath. This was a turning point for Susan. She experienced in Mrs. Bobath a therapist who not only believed in restoring motor control after acquired brain injury, but also a teacher who developed and practiced the creation of more effective treatment strategies. This course was followed by others with the aim of expanding and improving her own capabilities.

In 1981, Susan first met Jan Utley in Toronto, who, together with Isabelle Bohman, was teaching an advanced course on the treatment of stroke patients. In both she found teachers who integrated the scientific findings on restoring motor control into new treatment strategies. Susan also took a course with the Bobaths on the treatment of children with cerebral palsy. Shortly thereafter, she began her training as a Bobath Instructor and assisted on numerous courses with Jan Utley and Isabelle Bohman.

This led to the collaboration with Jan Utley, which continues to this day. They combined the findings of the Bobath concept, forced use, general brain research and manual therapy techniques. They also recognized that the treatments must be performed in functional positions such as standing and walking, in particular to use the affected leg or arm. They created activities that are used to perform activities of daily living. Their studies of motor learning principles and related research made them realize that massed practice (task-oriented) and repetition (repetition) is a prerequisite for motor control.

Susan and Jan therefore carried out a research project themselves in Los Angeles in 2002, in which forced use and frequent repetition of movements were essential components. In this project, all participants had significant motor dysfunction compared to previous CIMT (Constraint Induced Movement Therapy) studies. The patients’ progress exceeded the levels they had previously achieved with conventional treatments. The results of this study were proof that even severely affected patients can achieve motor recovery of involved body parts.

This confirmed the years of development of Forced Use Intensive Therapy according to Utley/Woll ® as an effective and promising outpatient rehabilitation therapy for the treatment of patients with acquired brain injuries. In 2006, Susan Woll and Jan Utley developed a series of courses to train specialists in Forced Use Intensive Therapy according to Utley/Woll®.

IFUSA – International Forced Use Specialist Association was founded in 2012 with the aim of further developing this treatment concept for people with acquired brain injuries.