The Effects of Modified Constraint-Induced Movement Therapy in Acute Subcortical Cerebral Infarction

Abstract

Background: Constraint-induced movement therapy (CIMT) promotes upper extremity recovery post stroke, however, it is difficult to implement clinically due to its high resource demand and safety of the restraint. Therefore, we propose that modified CIMT (mCIMT) be used to treat individuals with acute subcortical infarction.Objective: To evaluate the therapeutic effects of mCIMT in patients with acute subcortical infarction, and investigate the possible mechanisms underlying the effect.Methods: The role of mCIMT was investigated in 26 individuals experiencing subcortical infarction in the preceding 14 days. Patients were randomly assigned to either mCIMT or standard therapy. mCIMT group was treated daily for 3 h over 10 consecutive working days, using a mitt on the unaffected arm for up to 30% of waking hours. The control group was treated with an equal dose of occupational therapy and physical therapy. During the 3-month follow-up, the motor functions of the affected limb were assessed by the Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL). Altered cortical excitability was assessed via transcranial magnetic stimulation (TMS).Results: Treatment significantly improved the movement in the mCIMT group compared with the control group. The mean WMF score was significantly higher in the mCIMT group compared with the control group. Further, the appearance of motor-evoked potentials (MEPs) were significantly higher in the mCIMT group compared with the baseline data. A significant change in ipsilesional silent period (SP) occurred in the mCIMT group compared with the control group. However, we found no difference between two groups in motor function or electrophysiological parameters after 3 months of follow-up.Conclusions: mCIMT resulted in significant functional changes in timed movement immediately following treatment in patients with acute subcortical infarction. Further, early mCIMT improved ipsilesional cortical excitability. However, no long-term effects were seen.

Early Rehabilitation After Stroke: a Narrative Review

“…A smaller trial ( n = 29) by Yu et al also compared mCIMT beginning within 2 weeks of stroke to standard care [56]. The primary outcome measures were Wolf Motor Function Test score and Motor Activity Log interviews.…”

Effects of modified constraint-induced movement therapy on upper extremity function and occupational performance of stroke patients

“…It is known that the CIMT and mCIMT are the most effective medical intervention in the recovery of upper extremity function of stroke patients 8 , 9 ) . Previous studies demonstrated that the mCIMT is effective in improving functional outcomes of the upper limb and activity levels of patients with hemiplegia 5 , 6 , 7 , 8 , 9 ) .…”

“…Numerous studies on mCIMT state that it promotes the recovery of the upper extremities during motor recovery 5 ) . However, there are no studies providing objective evidence based on standard clinical tests to assess overall changes in the occupational performance 6 ) . That is, changes in overall the occupational performance of an individual, as indicatives of the recovery in to ADLs and upper extremity function before and after medical intervention, need to be considered as well as single measurement of motor function only 7 ) .…”

Constraint-induced movement therapy in stroke patients

“…Yu et al (18) evaluated the therapeutic effects of mCIMT in patients with acute subcortical infarction. The role of mCIMT was investigated in patients experiencing subcortical infarction in the preceding 14 days.…”