Effect of mCIMT with and without interval on hand in patient suffering from stroke

Abstract

Introduction. Paresis of hand has severe impact on the life of the stroke patients. Modified constrained induced movement therapy (mCIMT) can be used to treat the involved limb of the patient. It involves constraining of functional hand and increasing the activity of paretic hand which overcomes the “learned disuse” that develops following stroke but the constraining also creates difficulties for the patient and reduces his/her compliance to the treatment. Hence this trial aims to study the effect of mCIMT with and without interval to see if providing relaxation in between the treatment would be able to produce similar effect as mCIMT without interval protocol. Matgerial and methods. 44 patients were recruited in the study and were divided in to three groups: mCIMT without interval (n = 18), mCIMT with interval (n = 16) and control group (n = 10). Participants in three groups were examined for pain and functionality of hand through Patient rated wrist hand evaluation score and Box and Block test at pre and post intervention. The intervention was given for 6 days/week for two weeks. Therapy time was 2 hours and constrain was for 6 hours a day. Clinical trial registration number -CTRI/2019/12/022547. Results. No baseline differences were found in between the three groups. There was significant increase in box and block test score and significant decrease in PRWHE score in pre and post treatment readings for with and without interval mCIMT but non-significant changes in PRWHE score and box and block test were seen in control group. Conclusion. Both interval and without interval mCIMT was effective. Interval mCIMT was seen to be more comfortable than without interval mCIMT for the patient.

An Exploration of the Effectiveness of Different Intensity Protocols of Modified Constraint-Induced Therapy in Stroke: A Systematic Review

“…Five studies [ 32 , 36 , 42 , 43 , 49 ] used high-intensity protocols (total treatment time), 15 studies [ 23 , 24 , 54 – 58 , 28 – 30 , 33 , 38 , 39 , 51 , 53 ] used moderate intensity, and 16 studies [ 25 , 26 , 45 – 48 , 50 , 52 , 27 , 31 , 34 , 35 , 37 , 40 , 41 , 44 ] used low-intensity protocols. With regards to splint wearing time, 12 studies [ 23 , 24 , 51 , 58 , 25 – 27 , 29 , 36 , 37 , 41 , 49 ] followed high-intensity restriction, 18 studies [ 30 , 31 , 44 , 45 , 47 , 50 , 54 – 56 , 32 – 35 , 38 – 40 , 42 ] used moderate, and 6 studies [ 28 , 43 , 46 , 48 , 52 , 53 ] used low-intensity restriction ( Table 3 ).…”

“…Out of the 36 studies, 29 were classified as “high” risk, according to RoB2 [ 24 , 25 , 36 – 41 , 43 , 44 , 46 , 47 , 26 , 48 , 51 – 58 , 27 – 30 , 33 – 35 ], 3 as “some concerns” [ 31 , 42 , 50 ], and 4 as “low” [ 23 , 32 , 45 , 49 ]. Table 4 shows the quality assessment of the studies, according to RoB2.…”

“…Characteristics. The 36 studies included in this review were published between April 2010 and December 2021, in 21 countries: United States [23,24], Australia [25][26][27], Brazil [28], Chile [29], China [30], Egypt [31], Germany [32], India [33][34][35][36][37][38], Iran [39], Israel [40], Italy [41], Japan [42], Jordan [43], Korea [44,45], Netherlands [46,47], Nigeria [48,49], Norway [50,51], Spain [52], Switzerland [53], Taiwan [54][55][56][57], and Turkey [58], with a total of 721 participants. Participants ranged from 5 to 85 among the studies, while their mean age was between 46.2 and 65.3 years.…”

“…Figure 3 presents a graphical display of MAL-QOM data in relation to the various intensities of mCIMT protocols used in each study. Baldwin, et al, [26] Bang, [45] Bang, et al, [46] Barzel, et al, [33] Bhardwaj, et al, [34] Bhattacharjee, et al, [35] Brunner, Skouen & Strand, [51] De Diego, Puig & Navarro, [53] Doussoulin, et al, [30] El-Helow, et al, [32] Gauthier, et al, [24] Huseyinsinoglu, Ozdincler & Krespi, [59] Kaviraja, et al, [36] Khan, et al, [54] Kwakkel, et al, [47] Lin, et al, [55] McNulty, et al, [27] Otadi, et al, [41] Rocha, et al, [29] Shah, Kumar & Muragod, [37] Singh & Pradhan, [38] Smania, et al, [42] Takebayashi, et al, [43] Tariah, et al, [44] Trane, et al, [52] Treger, et al, [41] Trinh, et al, [28] Uswatte, et al, [25] Van Delden, et al, [48] C. Y. Wu, et al, [56] C. Y. Wu, et al, [57] C.-Y. C. Y. Wu, et al, [58] Yadav, et al, [39] Yu, et al, [31] ⁎ Green = low risk; yellow = some concerns; red = high risk.…”