Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients—A Systematic Review and Meta-Analysis

Reddy, Ravi Shankar; Gular, Kumar; Dixit, Snehil; Kandakurti, Praveen Kumar; Tedla, Jaya Shanker; Gautam, Ajay Prashad; Sangadala, Devika Rani

doi:10.3390/ijerph191912809

Cited by 10 publications

(7 citation statements)

References 75 publications

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“…The limitations in the usage of the hand may further affect trunk stability [ 54 , 55 ]. The positive associations between the trunk and upper limb impairment observed in the present study suggested evaluating and minimizing the upper limb impairments and encouraging the utilization of the upper limb, which in turn can reduce the upper limb impairments and improve the trunk control, functional balance, and gait functions in late subacute stage [ 56 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

Gular

Sivasubramanian

Reddy

et al. 2022

IJERPH

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Background: The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. Methods: This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk’s stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). Results: The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. Conclusions: The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence.

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Section: Discussionmentioning

confidence: 99%

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

Gular

Sivasubramanian

Reddy

et al. 2022

IJERPH

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“…It is also possible that some of the trends observed reflect a type II statistical error due to the small number of experiments for some of the assays. While our study only focused on forelimb immobilization, lower-limb immobilization has also been studied at the clinical level in stroke and related conditions [ 26 ]. Clinical studies of lower-limb immobilization have claimed to improve leg function, although whether this necessarily improves balance and gait speed has been debated.…”

Section: Discussionmentioning

confidence: 99%

Use of Botulinum Toxin for Limb Immobilization for Rehabilitation in Rats with Experimental Stroke

et al. 2023

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Motor rehabilitation strategies after unilateral stroke suggest that the immobilization of the healthy, unimpaired limb can promote the functional recovery of a paretic limb. In rodents, this has been modeled using casts, harnesses, and other means of restricting the use of the non-paretic forelimb in models of experimental stroke. Here, we evaluated an alternative approach, using botulinum toxin injections to limit the function of the non-paretic forelimb. Adult male rats were subjected to permanent ligation of the left distal middle cerebral artery, resulting in right forelimb paresis. The rats were then subjected to: (1) no treatment; (2) botulinum toxin injections 1 day post stroke; or (3) cast placement 5 days post stroke. Casts were removed after 5 weeks, while the botulinum toxin injection effectively immobilized subjects for approximately the same duration. Rats with bilateral forelimb impairment due to the stroke plus casting or botulinum injections were still able to feed and groom normally. Both immobilization groups showed modest recovery following the stroke compared to those that did not receive immobilization, but the casting approach led to unacceptable levels of animal stress. The botulinum toxin approach to limb immobilization had both advantages and disadvantages over traditional physical limb immobilization. The major advantage was that it was far less stress-inducing to the subject animals and appeared to be well tolerated. A disadvantage was that the paresis took roughly 10 weeks to fully resolve, and any degree of residual paresis could confound the interpretation of the behavioral assessments.

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“…Constraint-induced movement therapy (CIMT) is a rehabilitation therapy designed to improve upper limb motor function after stroke . In animal and clinical studies, CIMT is widely used to improve the affected limb function after stroke by forcing the use of the affected limb and restricting the use of the healthy side. , However, the mechanisms of CIMT are still unclear. It is necessary to explore the pathophysiological mechanism of rehabilitation therapy for a cerebral stroke.…”

Section: Introductionmentioning

confidence: 99%

Constraint-Induced Movement Therapy Modulates Neuron Recruitment and Neurotransmission Homeostasis of the Contralesional Cortex to Enhance Function Recovery after Ischemic Stroke

Zhang,

Xing,

Zheng

et al. 2024

ACS Omega

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Stroke often results in long-term and severe limb dysfunction for a majority of patients, significantly limiting their activities and social participation. Constraint-induced movement therapy (CIMT) is a rehabilitation approach aimed explicitly at enhancing upper limb motor function following a stroke. However, the precise mechanism remains unknown. This study explores how CIMT may alleviate forelimb paralysis in ischemic mice, potentially through structural and functional remodeling of brain regions beyond the infarct area, especially the contralateral cortex. We demonstrated that CIMT recruits neurons from the contralesional cortex into the network that innervates the affected forelimb, as evidenced by PRV retrograde nerve tracing. Additionally, we investigated how CIMT influences synaptic plasticity in the contralateral cortex by evaluating synaptic growth marker levels and neurotransmission's homeostatic regulation. Our findings uncover a rehabilitative mechanism by which CIMT treats ischemic stroke, characterized by increased recruitment of neurons from the contralateral cortex into the network that innervates the affected forelimb, facilitated by homeostatic regulation of neurotransmission.

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Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients—A Systematic Review and Meta-Analysis

Cited by 10 publications

References 75 publications

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

Use of Botulinum Toxin for Limb Immobilization for Rehabilitation in Rats with Experimental Stroke

Constraint-Induced Movement Therapy Modulates Neuron Recruitment and Neurotransmission Homeostasis of the Contralesional Cortex to Enhance Function Recovery after Ischemic Stroke

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