Modified constraint-induced therapy after subacute stroke: a preliminary study.

OBJECTIVE: To determine the efficacy of a modified constraint-induced therapy (mCIT) administered to patients with subacute stroke. DESIGN: Prospective, multiple-baseline, before-after, randomized clinical trial. SETTING: Subacute outpatient clinic. SUBJECTS: Fourteen patients with subacute stroke who exhibited learned nonuse and stable motor deficits in their affected upper limbs. INTERVENTION: Four patients participated in half-hour, structured physical and occupational therapy sessions that emphasized affected arm use in valued functional activities, 3 times per week for 10 weeks. Their less affected upper limbs were restrained 5 days per week during 5 hours identified as times of frequent use (mCIT). Five patients received regular therapy (TR) with similar therapeutic contact time to mCIT and 5 patients received no therapy (CON). MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (Fugl), Action Research Arm (ARA) test, and Motor Activity Log (MAL). RESULTS: After intervention, Fugl, ARA, and MAL scores remained virtually the same for TR and CON groups; scores improved by 11.4 and 11.5points, respectively, on the Fugl and ARA for the mCIT group. Amount and quality of arm use, as measured by the MAL, also improvedfor mCIT patients (2.49 and 0.47, respectively). CONCLUSIONS: mCIT may be an efficacious method of improving affected arm function and use in stroke patients exhibiting learned nonuse.

Modified constraint-induced therapy in subacute stroke: a case report.

OBJECTIVE: To determine the efficacy of a modified constraint-induced therapy (CIT) protocol administered to a patient with subacute stroke. DESIGN: Multiple-baseline, before-after trial. SETTING: Subacute outpatient clinic. PATIENT: A 68-year-old woman who had a left anterior cerebral artery infarct 5 months before study entry and who exhibited learned nonuse of the affected upper limb. INTERVENTION: Thirty minutes of structured physical therapy and 30 minutes of occupational therapy 3 times a week for 10 weeks, each session emphasizing affected arm use. During the same period, her unaffected arm and hand were restrained 5d/wk during 5 hours initially identified as a time of frequent use. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (FMA), Action Research Arm Test (ARA), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL). RESULTS: The patient exhibited substantial improvements on the FMA and ARA. She also improved on the WMFT in her ability to perform tasks and in the time taken to complete the tasks. Amount and quality of arm use also improved, as measured by the MAL. CONCLUSIONS: Modified CIT may be an efficacious method of improving function and use of the affected arms of patients with learned nonuse.

Stroke patients' and therapists' opinions of constraint-induced movement therapy.

OBJECTIVE: To determine the opinions of patients with stroke and therapists about constraint-induced movement therapy (CIT). SUBJECTS AND INTERVENTION: Two hundred and eight patients with stroke in the northeastern USA responded to a self-report questionnaire administered through the mail and via telephone interviews. A similar questionnaire was administered to 85 physical and occupational therapists in the northeastern USA during their clinical staff meetings. The questionnaire described CIT to participants using excerpts from a recently published CIT study. Subjects then responded to various statements concerning their opinions of the protocol and supplied rationale for their opinions. RESULTS: Sixty-eight per cent of patients said they were not interested in participating in CIT, citing concerns with the practice schedule and the restrictive device schedule. Therapists cited concerns about patient adherence and safety, and speculated that facilities may not have the clinical resources to provide CIT. CONCLUSIONS: Patients with stroke and therapists in some environments may hold sceptical views about the utility of CIT. Although it has been shown to be effective in laboratory research, CIT may have low clinical practicality in some environments.

Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial.

OBJECTIVE: To determine efficacy of a modified constraint-induced movement therapy (mCIMT) protocol for patients with chronic stroke. DESIGN: Multiple-baseline, pre-post, single-blinded randomized controlled trial. SETTING: Outpatient clinic. PARTICIPANTS: Seventeen patients who experienced stroke more than 1 year before study entry and who had upper-limb hemiparesis and learned nonuse. INTERVENTION: Seven patients participated in structured therapy sessions emphasizing more affected arm use in valued activities, 3 times a week for 10 weeks. Their less affected arms were also restrained 5d/wk for 5 hours (mCIMT). Four patients received regular therapy with similar contact time to mCIMT. Six patients received no therapy (control). MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (FMA), Action Research Arm (ARA) Test, and Motor Activity Log (MAL). RESULTS: The mCIMT patients exhibited greater motor changes on the FMA and ARA (18.4, 11.4) than regular therapy (6.0, 7.1) or control (-2.9, -4.5). Statistical analyses showed significant differences in motor improvement on the FMA (F(2,12)=11.2, P=.002) and the ARA (F(2,12)=14.0, P=.001). Post hoc analyses showed that, when pretreatment motor differences are controlled, mCIMT resulted in substantially higher posttreatment FMA and ARA scores. Amount and quality of arm use, measured by the MAL, improved only in mCIMT patients. CONCLUSIONS: mCIMT may be an efficacious method of improving function and use of the more affected arms of chronic stroke patients. Findings further affirm that repeated, task-specific practice is critical to reacquisition of function, whereas practice schedule intensity is less critical.