Effects of Constraint-Induced Movement Therapy on Patients With Chronic Motor Deficits After Stroke

Abstract

Background and Purpose-Constraint-induced movement therapy (CI therapy) has previously been shown to produce large improvements in actual amount of use of a more affected upper extremity in the "real-world" environment in patients with chronic stroke (ie, Ͼ1 year after the event). This work was carried out in an American laboratory. Our aim was to determine whether these results could be replicated in another laboratory located in Germany, operating within the context of a healthcare system in which administration of conventional types of physical therapy is generally more extensive than in the United States. Methods-Fifteen chronic stroke patients were given CI therapy, involving restriction of movement of the intact upper extremity by placing it in a sling for 90% of waking hours for 12 days and training (by shaping) of the more affected extremity for 7 hours on the 8 weekdays during that period. Results-Patients showed a significant and very large degree of improvement from before to after treatment on a laboratory motor test and on a test assessing amount of use of the affected extremity in activities of daily living in the life setting (effect sizes, 0.9 and 2.2, respectively), with no decrement in performance at 6-month follow-up. During a pretreatment control test-retest interval, there were no significant changes on these tests. Conclusions-Results replicate in Germany the findings with CI therapy in an American laboratory, suggesting that the intervention has general applicability. (Stroke. 1999;30:586-592.)

Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke

“…16 Nevertheless, this result should be viewed with caution, especially because the robot group did not show improvements in the proximal Fugl-Meyer test over this same 6-month period, and the FIM instrument does not penalize subjects who perform activities using compensation with the less affected limb. Future studies should consider the Motor Activity Log, [5][6][7][8][9] which assesses the actual amount of use of the more affected limb in ADLs and the quality of movement. It would also have been useful to determine if the group differences at the 6-month point were retained 1 year after the treatment.…”

“…4 In chronic stroke subjects, constraint-induced therapy (CIT) can lead to substantial increases in use of the more affected limb in activities of daily living (ADLs). [5][6][7] This therapy involves intensive repetitive exercise of the more affected limb coupled with constraint of the opposite limb and results in positive cortical reorganization in the motor cortex. 8 In less severely impaired stroke subjects, simple repetitive exercise may be superior to other types of therapy.…”

Motions or muscles? Some behavioral factors underlying robotic assistance of motor recovery

“…Gowland stated that only 5 percent of persons who receive intensive therapy for severe upper-limb weakness poststroke regain functional use of their paretic upper limb during rehabilitation [4]. Several approaches to provide upperlimb exercise after stroke have been studied, including constraint-induced movement therapy (CIMT) [6][7][8][9][10]. While CIMT appears to be a promising therapy, it requires a significant level of residual motor function and is not feasible for individuals with more severe weakness after stroke.…”

Increased Perfusion in Motor Areas after Constraint-Induced Movement Therapy in Chronic Stroke: A Single-Photon Emission Computerized Tomography Study

“…The affected arm and hand therapy followed closely the practice established by Taub et al (1999) and further refined by Miltner et al (1999). Therapy included 10 weekdays of continuously supervised exercises provided within two weeks.…”