Comparative effects of kinect-based versus therapist-based constraint-induced movement therapy on motor control and daily motor function in children with unilateral cerebral palsy: a randomized control trial.

BACKGROUND: Constraint-induced movement therapy (CIMT) is a prominent neurorehabilitation approach for improving affected upper extremity motor function in children with unilateral cerebral palsy (UCP). However, the restraint of the less-affected upper extremity and intensive training protocol during CIMT may decrease children's motivation and increase the therapist's workload and family's burden. A kinect-based CIMT program, aiming to mitigate the concerns of CIMT, has been developed. The preliminary results demonstrated that this program was child-friendly and feasible for improving upper extremity motor function. However, whether the kinect-based CIMT can achieve better or at least comparable effects to that of traditional CIMT (i.e., therapist-based CIMT) should be further investigated. Therefore, this study aimed to compare the effects of kinect-based CIMT with that of therapist-based CIMT on upper extremity and trunk motor control and on daily motor function in children with UCP. METHODS: Twenty-nine children with UCP were recruited and randomly allocated to kinect-based CIMT (n = 14) or therapist-based CIMT (n = 15). The intervention dosage was 2.25 h a day, 2 days a week for 8 weeks. Outcome measures, namely upper extremity and trunk motor control and daily motor function, were evaluated before and after 36-h interventions. Upper extremity and trunk motor control were assessed with unimanual reach-to-grasp kinematics, and daily motor function was evaluated with the Revised Pediatric Motor Activity Log. Between-group comparisons of effectiveness on all outcome measures were analyzed by analysis of covariance (α = 0.05). RESULTS: The two groups demonstrated similar improvements in upper extremity motor control and daily motor function. In addition, the kinect-based CIMT group demonstrated greater improvements in trunk motor control than the therapist-based CIMT group did (F(1,28) > 4.862, p < 0.036). CONCLUSION: Kinect-based CIMT has effects comparable to that of therapist-based CIMT on UE motor control and daily motor function. Moreover, kinect-based CIMT helps decrease trunk compensation during reaching in children with UCP. Therefore, kinect-based CIMT can be used as an alternative approach to therapist-based CIMT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02808195. Registered on 2016/06/21, https://clinicaltrials.gov/ct2/show/NCT02808195 .

Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy.

AIMS: Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy. METHODS: In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated. RESULTS: Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT. CONCLUSION: Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.

Younger Children with Cerebral Palsy Respond Better Than Older Ones to Therapist-Based Constraint-Induced Therapy at Home on Functional Outcomes and Motor Control.

AIMS: To examine the differences in efficacy of home-based constraint-induced therapy (CIT) on functional outcomes and motor control in two age groups of children with cerebral palsy (CP). METHODS: Twenty-three children with spastic unilateral CP receiving 4-week home-based CIT by a therapist were divided into younger (6-8 years; n = 11) and older (9-12 years; n = 12) groups. The home-based CIT involved intensive functional training of the more affected upper-limb while restraining the less affected upper-limb. The outcome measures were Peabody Developmental Motor Scale-2nd edition (PDMS-2) that was being used in a modified way, Functional Independence Measure for Children (WeeFIM), and reach-to-grasp kinematic parameters, including reaction time (RT), normalized movement time (MT), normalized movement units (MUs), peak velocity (PV), and maximum grip aperture (MGA). The outcome measures were assessed at baseline, 4-weeks (post-treatment), 3- and 6-months (follow-up). RESULTS: The younger group showed greater changes in visual motor integration skills and RT at all post-tests after intervention than the older group. Groups had comparable changes on any other measures. CONCLUSIONS: Younger children with CP responded better to home-based CIT on some areas of upper-limb functions and reach-to-grasp motor control strategies than older children.

Application of constraint-induced movement therapy in clinical practice: an online survey.

OBJECTIVE: To investigate current knowledge and application in practice of constraint-induced movement therapy (CIMT) by therapists within the United Kingdom. DESIGN: An online 19-item survey. SETTING: Neurological rehabilitation. PARTICIPANTS: Occupational therapists and physiotherapists (N=489) currently working or within 3 months of working with the adult acquired brain injury population were recruited from 2 specialist interest groups. INTERVENTIONS: Database administrators of 2 specialist interest groups circulated an e-mail to all therapists on the database to invite them to complete the online survey. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Most therapists (62.9%, n=306) had not used CIMT. Those who had used it were only using 2 or 3 components of the core 7-component CIMT protocol. Therapists identified 2 main barriers to the implementation of CIMT: lack of resources (staffing; 20.7%, n=63) and lack of training (20%, n=61). CONCLUSIONS: Adoption into practice remains limited. Despite a significant evidence base in support of CIMT, most therapists are not using CIMT in practice. This article indicates how concerns and barriers related to CIMT may be minimized to translate this robust intervention from research into clinical practice.

Adult experiences of constraint-induced movement therapy programmes: a qualitative study using the Theoretical Domains Framework and Capability, Opportunity, Motivation - Behaviour system.

AIM: To explore the experiences of adults who completed a constraint-induced movement therapy (CIMT) programme, and the barriers and enablers to their participation. METHODS: Qualitative design using semi-structured interviews. Stroke and brain injury survivors (n = 45) who had completed CIMT as part of their usual rehabilitation were interviewed 1 month post-CIMT. Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Inductive coding was used to identify initial themes. Themes were then deductively mapped to the Capability, Opportunity, Motivation - Behaviour system, a behaviour change model, to identify barriers and enablers to CIMT programme adherence and engagement. RESULTS: Enablers influencing participation included being provided with education about the programme (Capability - psychological), seeing improvements in arm function (Motivation - reflective), being committed to the programme (Motivation - reflective) and having strong social support from staff, family and allied health students (Opportunity - social). The structured programme was a motivator and offered a way to fill the time, particularly during inpatient rehabilitation (Opportunity - physical). Barriers to participation included experiencing physical and mental fatigue (Capability - physical) and frustration early in the CIMT programme (Motivation - automatic), and finding exercises boring and repetitive (Motivation - automatic). CONCLUSION: Therapist provision of educational supports for CIMT participants and their families is important to maximise CIMT programme uptake. During CIMT delivery, we recommend the provision of positive feedback and coaching in alignment with CIMT principles, and the inclusion of social supports such as group-based programmes to enhance participant adherence.

Perspectives From Persons With Multiple Sclerosis for a Comprehensive Real-World Change Therapy for Mobility.

Objective: To assess the personal perspectives of persons with multiple sclerosis (MS) on the acceptability of a novel physical therapy program that is designed to transfer gains from the clinic to their real-world lower extremity (LE) use, termed LE constraint-induced therapy (CIT). The program includes several behavior change techniques (prescribed home exercises, daily structured therapist interviews and problem solving for LE activities, keeping an activity diary) and a concentrated physical treatment schedule. Design: Anonymous internet survey. Setting: Participants accessed the survey from computers in the community. Participants: Five hundred adults (N=500) were recruited from an MS support organization's registry for having indicated from mild to total limb spasticity because they were anticipated to have markedly impaired LE use in the community. Interventions: Not applicable. Main Outcome Measures: Participants were offered the options on a nonnumerical Likert scale of "Very likely," "Likely," "Neutral," "Unlikely," or "Very unlikely" to indicate their personal acceptability for each of 5 different key treatment procedures after these were explained. Totals for each option within each key procedure were analyzed for their acceptability. Results: Of the 281 persons who responded, 90% expressed interest in participating in LE CIT. A large majority of persons who completed the survey selected either "Very likely" or "Likely" for each key procedure (median=88%, range=65%-90%, P<.01). This indicated strong acceptance for the procedures of LE CIT. In addition, more respondents who already had had previous physical therapy accepted LE CIT than did respondents who had not had physical therapy (P<.01). Conclusions: The results suggest there is strong acceptance of CIT for mobility with preliminary evidence of benefiting community LE use for persons with MS. The results support further clinical trials of LE CIT for persons with MS.

Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy.

Introduction: Cerebral palsy (CP) is the leading cause of childhood-onset physical disability. Children with CP often have impaired upper limb (UL) function. Constraint-induced therapy (CIT) is one of the most effective UL interventions for children with unilateral CP. However, concerns about CIT for children have been repeatedly raised due to frustration caused by restraint of the child's less-affected UL and lack of motivation for the intensive protocol. Virtual reality (VR), which can mitigate the disadvantages of CIT, potentially can be used as an alternative mediator for implementing CIT. Therefore, we developed a VR-based CIT program for children with CP using the Kinect system. Aims: The feasibility of the Kinect-based CIT program was evaluated for children with unilateral CP using a two-phase study design. Materials and Methods: In phase 1, ten children with unilateral CP were recruited. To confirm the achievement of the motor training goals, maximal UL joint angles were evaluated during gameplay. To evaluate children's perceptions of the game, a questionnaire was used. In phase 2, eight children with unilateral CP were recruited and received an 8 weeks Kinect-based CIT intervention. Performance scores of the game and outcomes of the box and block test (BBT) were recorded weekly. Results: In phase 1, results supported that the design of the program was CIT-specific and was motivational for children with unilateral CP. In phase 2, game performance and the BBT scores began showing stable improvements in the fifth week of intervention. Conclusion: It suggested the Kinect-based CIT program was beneficial to the motor function of the affected UL for children with unilateral CP. According to the results of this feasibility study, larger and controlled effectiveness studies of the Kinect-based CIT program can be conducted to further improve its clinical utility. Clinical Trial Registration: ClinicalTrials.gov, NCT02808195; Comparative effectiveness of a Kinect-based unilateral arm training system vs. CIT for children with CP.

Constrained-Induced Dysarthria Therapy: Case Report.

We describe a 33-year-old woman with chronic bulbar dysarthria after ischemic brainstem stroke who underwent a new form of constraint-induced therapy, namely constraint-induced dysarthria therapy, based on three principles: avoidance of supportive devices, intensive therapy, and gradually augmenting difficulty. After a 2-month intervention, improvement was noted for speech intelligibility, fluency, and intensity. This led to increased communicative participation, including during conversation situations, which has been maintained over a 12-month follow-up.

Content validity and satisfaction with a caregiver-integrated web-based rehabilitation intervention for persons with stroke.

Background Family members provide valuable contributions during rehabilitation after stroke, but frequently report higher incidences of burden, depression, and social isolation during caregiving. Thus, effective interventions to reduce stroke impact on the family are needed. Objectives To evaluate the content validity and satisfaction of a caregiver-focused web-based intervention designed to improve stroke survivor physical function while reducing caregiver negative outcomes. Methods Caregivers of individuals with stroke (N = 6) and expert rehabilitation researchers (N = 4) were presented with a novel, web-based intervention (CARE-CITE) designed to foster problem-solving and skill-building while facilitating caregiver involvement during constraint-induced movement therapy. Caregivers rated CARE-CITE for usefulness, ease of use, acceptability, and time to complete. Rehabilitation experts evaluated content for accuracy, feasibility, acceptability, problem relevance and ease of use. Ratings were assessed using a five-point Likert-type response scales (1 = strongly disagree to 5 = strongly agree). Results On average, all caregivers agreed or strongly agreed that the modules were useful (4.42), easy to use (4.60), and acceptable (4.41). Mean total satisfaction score was 4.45, and average review time was 15 min per module. Expert reviewers agreed or strongly agreed that each module was accurate (4.95), feasible (4.8), easy to use (4.86), acceptable (4.96), and had appropriate problem relevance (4.65). Conclusions The CARE-CITE intervention may be a viable program for caregivers of patients with stroke. Currently a pilot study is underway to evaluate the impact of the intervention on caregiver mental health, family conflict around stroke recovery and stroke survivor upper extremity function.

A follow-up study on the relationship among participation, activity and motor function in survivors of stroke following constraint-induced therapy.

PURPOSE: The aim of this follow-up study was to examine the relationships among motor function, activity and participation following constraint-induced therapy (CIT). METHODS: In this correlational study, 12 individuals who had previously participated in CIT completed the Fugl Meyer Assessment for the Upper Extremity and Wolf Motor Function Test (motor assessments), the Motor Activity Log (activity measure) and the Daily Experiences of Pleasure, Productivity and Restoration Profile (participation measure). Motor and activity changes over time were assessed using repeated measures ANOVA and Friedman's tests. Spearman's correlations were used to examine the associations between the participation measure and motor and activity measures were analyzed using Spearman's correlations. RESULTS: No statistically significant correlations were found among motor and activity scores and the amount of time spent in activity categories (e.g. self-care, leisure). Yet, moderate to strong correlations were found between motor assessments and time spent with others versus alone. CONCLUSION: The lack of significant correlations between motor, activity and participation measures challenges assumptions that improved motor abilities will translate to greater participation. Correlations found between motor and activity measures and the context of participation suggests participation post-stroke is complex, and survivors of stroke may benefit from rehabilitation practices that encompass more than motor therapy.

Similar Effects of Two Modified Constraint-Induced Therapy Protocols on Motor Impairment, Motor Function and Quality of Life in Patients with Chronic Stroke.

Modified constraint-induced movement therapy (CIMT) protocols show motor function and real-world arm use improvement. Meanwhile it usually requires constant supervision by physiotherapists and is therefore more expensive than customary care. This study compared the preliminary efficacy of two modified CIMT protocols. A two-group randomized controlled trial with pre and post treatment measures and six months follow-up was conducted. Nineteen patients with chronic stroke received 10 treatment sessions distributed three to four times a week over 22 days. CIMT3h_direct group received 3 hours of CIMT supervised by a therapist (n=10) while CIMT1.5h_direct group had 1.5 hours of supervised CIMT+1.5 hours home exercises supervised by a caregiver (n=9). Outcome measures were the Fugl-Meyer Assessment, the Motor Activity Log, and the Stroke Specific Quality of Life Scale. The modified CIMT protocols were feasible and well tolerated. Improvements in motor function, real-world arm use and quality of life did not differ significantly between treated groups receiving either 3 or 1.5 hours mCIMT supervised by a therapist.

Effect of trunk-restraint training on function and compensatory trunk, shoulder and elbow patterns during post-stroke reach: a systematic review.

PURPOSE: The purpose of this systematic review was to determine the effect of trunk restraint (TR) training on post-stroke compensatory trunk movements during functional reach, and to identify functional gains of TR within the context of the International Classification of Functioning, Disability and Health (ICF). METHODS: Six databases were searched prior to 20 February 2013. Randomized control trials (RCTs) comparing the effects of a post-stroke reaching intervention with and without TR in the adult post-stroke population were included in this review. Data related to study inclusion/exclusion criteria, methodology, study participants and between-group outcomes (p < 0.05) were extracted. All outcomes were categorized according to functional domains defined within the ICF. RESULTS: Five RCTs met the inclusion criteria. TR groups demonstrated significant between-group differences (p < 0.05) for decreased compensatory trunk displacement (4/5 RCTs), increased elbow extension (3/5 RCTs) and increased shoulder flexion (2/5 RCTs). All significant between-group differences fell within the Body Structure/Function domain of the ICF. CONCLUSIONS: Trunk restraint is a simple, cost-effective technique that may help to reduce compensatory trunk/shoulder/elbow movements in the post-stroke adult population. Synthesis of study outcomes also highlights applications of TR to clinical practice and areas for further research. Implications for Rehabilitation The ability to use the shoulder and elbow to perform functional reach is a primary goal in post-stroke recovery; however, compensatory trunk movements are often used to achieve the reaching goal. Long-term use of compensatory strategies may contribute to secondary impairments, such as learned non-use, joint contractures and pain. Trunk restraint enables functional reach practice, while limiting compensatory strategies in the moderately to severely impaired stroke population.

Constrained-Induced Dysarthria Therapy: Case Report

We describe a 33-year-old woman with chronic bulbar dysarthria after ischemic brainstem stroke who underwent a new form of constraint-induced therapy, namely constraint-induced dysarthria therapy, based on three principles: avoidance of supportive devices, intensive therapy, and gradually augmenting difficulty. After a 2-month intervention, improvement was noted for speech intelligibility, fluency, and intensity. This led to increased communicative participation, including during conversation situations, which has been maintained over a 12-month follow-up.

Impacto de la rehabilitación neurológica a través de la terapia de restricción inducida modificada en la mejora del apoyo social en usuarios con ataque cerebro vascular / Impact of neurological rehabilitation through modified constraint induced therapy in improving social support patients with stroke

Introduction: Access to rehabilitation in stroke patients is critical, considering the physical and psychological disabilities and generates social impact involved. Purpose: Evaluate the effectiveness of neurorehabilitation in collective mode, compared to the individual mode, in improving social support among patients with stroke, after application of the constraint induced of movement therapy. Methods: A randomized controlled trial of 36 patients who had a stroke were divided into two intervention groups. The independent variable was the implementation of collective or individual therapy for 3 hours for 10 consecutive days and the dependent variable was social perception evaluated by the Medical Outcomes Study-Social Support Survey (MOS-SSS) at baseline (pre-test) and end (post-test). Results: After controlling the pre-test scores, analysis of covariance revealed significant differences in favor of the collective mode in all post-test social support dimensions. Conclusions: Compared with the individual mode, the collective mode significantly improves several aspects of the patient’s perceived social support, thus providing evidence of its clinical and practical effectiveness.

Introducción: El acceso a rehabilitación en usuarios con ataque cerebro vascular es fundamental, considerando las discapacidades físicas y psicológicas que genera y el impacto social que conlleva. Objetivo: Evaluar la efectividad de la neurorehabilitación en modalidad colectiva, comparada con la modalidad individual, en la mejora del apoyo social en usuarios con ACV, después de la aplicación de la terapia de restricción inducida de movimiento. Método: Se realizó un ensayo clínico aleatorizado con 36 usuarios con ACV divididos en dos grupos de intervención. La variable independiente fue la implementación de la terapia en modalidad colectiva o individual por 3 horas diarias durante 10 días consecutivos y la variable dependiente fue el apoyo social percibido evaluado mediante la Medical Outcomes Study-Social Support Survey (MOS-SSS) antes (pretest) y después (post-test) de la intervención. Resultados: Controlando los puntajes pre-test, análisis de covarianza revelaron diferencias significativas a favor de la modalidad colectiva en todas las dimensiones post-test del apoyo social. Conclusiones: La rehabilitación en modalidad colectiva, en comparación con la modalidad individual, mejora significativamente diversos aspectos del apoyo social percibido del usuario, apoyando así su efectividad clínica y práctica.

Terapia de restricción inducida en afasia: diseño de sujeto único en afasia de conducción / Induced Aphasia Therapy Restriction: Design Single Subject in Conduction Aphasia / Terapia de restrição induzida em afasia: desenho de sujeito único em afasia de condução

Introducción: la terapia de restricción inducida en afasia (TRIA) es un método terapéutico para la recuperación funcional del lenguaje expresivo en pacientes con afasia, cuyo efecto ha sido comprobado a partir de estudios de corte experimental desde hace más de una década en países como Estados Unidos y Alemania y, más recientemente, se ha instaurado en la práctica profesional del fonoaudiólogo en Colombia. Objetivo: el presente artículo muestra un diseño de sujeto único en afasia de conducción, en el cual se estima el efecto de un protocolo de terapia de restricción inducida del lenguaje. Materiales y métodos: se trata de una paciente de género femenino de 49 años de edad, con nivel de educación superior y con afasia de conducción, resultado de un accidente cerebro vascular de 2 años de evolución, quien recibió TRIA, con una intensidad de 2 horas diarias, cinco días a la semana, durante 4 semanas. Como parte del protocolo de TRIA, fueron presentados 40 estímulos verbales diferentes cada cinco sesiones (grupo de estímulos 1 y 2: verbos y sustantivos, grupo 3: expresiones frecuentes y grupo 4: antónimos) para un total de 160 estímulos, con estrategias de estimulación y facilitación del lenguaje oral, pero con restricción de las formas no verbales de la comunicación. Se tomaron mediciones antes y después de la TRIA, mediante el uso de pruebas estandarizadas. Resultados: el rendimiento comparativo pre- y pos- de las pruebas indican una mejoría en varios dominios del lenguaje expresivo, tales como la fluidez verbal, la longitud de frase, la línea melódica, la forma gramatical, la producción de estructuras sintácticas de mayor complejidad, el incremento en el uso de conectores, sustantivos, adjetivos y verbos y la disminución de neologismos, parafasias, dubitaciones y muletillas. La hipótesis inicial plantea que la TRIA induce cambios en el desempeño verbal de los pacientes; sin embargo, se requiere de una exposición sostenida en el tiempo para inducir generalización de los aprendizajes.

Introduction: Constraint-induced therapy in aphasia (CITA) is a therapeutic method for functional recovery of expressive language in aphasia patients, whose effect has been found from experimental studies in countries as Germany and United States of America for more than one decade and it has been established in the practice of the speech- language therapist in Colombia. Objective: This research consists on a case study of conduction aphasia which estimates the effect of a protocol constraint-induced therapy on language performance. Materials and methods: The patient is a female 49 years with superior education level that has conduction aphasia results of stroke with two years of evolution; she received CITA with an intensity of two hours per day, five days week, for four weeks. As part of the protocol of CITA, 40 different verbal stimuli were presented in five sessions (Set 1 and Set 2: verbs and nouns, Set 3: expressions and Set 4: antonyms) conforming 160 stimuli to strategies of stimulation and facilitation of oral language but using restriction of nonverbal forms of communication. Measurements were taken before and after the CITA using standardized tests. Results: The pre and pos comparative performance tests indicate an improvement in multiple domains of expressive language such as: verbal fluency related to sentence length, grammatical melodic line and form, production of more complex syntactic structures, better employment of connectors, nouns, adjectives and verbs into the oral productions; and decreased neologisms, anomies, hesitations and interjections. The hypothesis is CITA induces positive changes in the verbal performance of aphasia patients; however, it requires a sustained exposure over time to induce generalization of learning.

Introdução: a terapia de restrição induzida em afasia (TRIA) é um método terapêutico para a recuperação funcional da linguagem expressiva em pacientes com afasia, cujo efeito tem sido comprovado a partir de estudos de corte experimental desde há mais de uma década em países como os Estados Unidos e a Alemanha e, mais recentemente, se tem instaurado na prática profissional do fonoaudiólogo na Colômbia. O presente artigo mostra um desenho de sujeito único em afasia de condução, no qual se estima o efeito de um protocolo de terapia de restrição induzida da linguagem. Materiais e métodos: trata-se de uma paciente de gênero feminino de 49 anos, com nível de educação superior e com afasia de condução resultado de um acidente cerebrovascular de dois anos de evolução, quem recebeu TRIA com uma intensidade de duas horas diárias, cinco dias à semana, durante quatro semanas. Como parte do protocolo de TRIA foram apresentados 40 estímulos verbais diferentes cada cinco sessões (grupo de estímulos 1 e 2: verbos e substantivos, grupo 3: expressões frequentes e grupo 4: antónimos) para um total de 160 estímulos, com estratégias de estimulação e facilitação da linguagem oral, mas com restrição das formas não verbais da comunicação. Tomaram-se medições antes e depois da TRIA, mediante o uso de provas estandardizadas. Resultados: o rendimento comparativo pré- e pós- das provas indicam uma melhoria em vários domínios da linguagem expressivo, tais como: a fluidez verbal, a longitude de frase, a linha melódica, a forma gramatical, a produção de estruturas sintáticas de maior complexidade, o incremento no uso de conetores, substantivos, adjetivos e verbos, e a diminuição de neologismos, parafasias, dubitações e batologias. A hipótese inicial apresenta que a TRIA induz mudanças no desempenho verbal dos pacientes; no entanto, requer-se de uma exposição sustentada no tempo para induzir generalização das aprendizagens.

Effect of Constraint-induced Aphasia Therapy on Chronic Aphasia after Stroke / 中国康复理论与实践

Objective To investigate the effect of short-term constraint-induced aphasia therapy on chronic aphasia after stroke. Meth-ods 30 stroke patients with chronic aphasia accepted speech therapy for a total of 30 hours. The control group (n=15) accepted routine speech training and the treatment group (n=15) accepted constraint-induced aphasia therapy 3 hours a day. They were assessed with the Western Aphasia Battery (WAB) and the Communicative Activity Log (CAL) before and after treatment. Results The treatment group im-proved significantly in oral expression, naming and repetition function of WAB after treatment (P<0.001), but not significantly in listening understanding (P=0.066);while the control group improved significantly in oral expression (P<0.001). The treatment group also significant-ly improved in CAL (P<0.001). Conclusion Constraint-induced aphasia therapy can significantly improve the speech for stroke patients with chronic aphasia in the short term.

Efeitos de um protocolo modificado da terapia por contensão induzida em criança com paralisia cerebral hemiparética / Effects of a modified protocol of induced restraint therapy in children with hemiparetic brain paralysis

Avaliar os efeitos de um protocolo de intervenção modificado da Terapia por Contensão Induzida na qualidade do movimento e na frequência do uso da extremidade superior acometida em criança com paralisia cerebral hemiparética. Estudo longitudinal, de caso único, realizado com uma criançade quatro anos de idade submetida à intervenção por três horas diárias, durante dez dias, restrição da extremidade superior não acometida por oito horas diárias. Os dados foram coletados pela Pediatric Upper Extremity Motor Activity Log e analisados por meio de média aritmética. Observou-se melhora na qualidade do movimento e aumento da frequência do uso do membro superiorparético do período de pré para a pós-intervenção, mantendo-se o resultado consistente nas coletas de dados posteriores, além de aquisição de habilidades motoras funcionais. O protocolo de intervenção utilizado neste estudo foi eficaz no tratamento da criança com hemiparesia, os resultados podem ser úteis aos profissionais que trabalham com essa clientela, auxiliando-os no processo de intervenção.

Evaluate the effects of a modified ConstraintInduced Therapy intervention protocol regarding movement quality and frequency of use of the affected upper extremity on children with hemiplegic cerebral palsy. Longitudinal study of a single case, performed with a four year old submitted to intervention during three hours daily, for ten days, restricting thenon-affected upper extremity for eight hours daily. Data were collected using the Pediatric Upper Extremity Motor Activity Log and analyzed using the arithmetic mean. Significant improvement in quality of movement and frequency of use of the upper limbfrom pre to post-intervention were noted, maintaining the result in later data collection, besides the acquisition of functional motor skills. The modifi ed constraint-induced movement therapy protocol of this study was effective in treating the child with hemiplegiccerebral palsy, the results may be useful for professionals working with this clientele, assisting them in the intervention process.

Terapia de Contenção e Uso Induzido (CIT) em crianças com paralisia cerebral do tipo hemiplegia / Constraint-Induced Therapy (CIT) in children with hemiplegic cerebral palsy

Esta revisão foi realizada a partir da seleção e análise crítica de 12 artigos científicos, publicados nas línguas inglesa e portuguesa, entre 1997 e 2006, que investigaram os efeitos da Terapia de Contenção e Uso Induzido (CIT) em crianças com paralisia cerebral do tipo hemiplegia. Os efeitos da intervenção foram analisados a partir da significância estatística dos resultados (p < 0,05) e da estimativa do tamanho dos efeitos (effect size: ES) com a aplicação do coeficiente d de Cohen (sem efeito quando d ≤ 0,2; efeito pequeno quando 0,2 < d ≤ 0,5; efeito regular quando 0,5 < d ≤ 0,8; e efeito grande quando d > 0,8). Seis estudos reportaram significância estatística dos resultados documentados e, desses, quatro disponibilizaram informações que permitiram a estimativa do tamanho dos efeitos da intervenção. A CIT parece contribuir significativamente para a melhora da função manual (0,53 ≤ d < 0,8; d > 2,82), do desempenho motor (d = 0,4) e do autocuidado (d = 2,25) de crianças com paralisia cerebral do tipo hemiplegia, assim como estimular a emergência de novos comportamentos motores (d = 3,04) e da função bimanual (d = 1,16). A análise crítica dos artigos incluídos nesta revisão revela o caráter promissor da CIT e reforça a necessidade de que estudos futuros possam replicar os resultados dessa intervenção e testar, com maior rigor metodológico, a eficácia da Terapia de Contenção e Uso Induzido.

Selection and critical analysis of 12 scientific articles published in English and Portuguese, from 1997 to 2006, investigating the effects of the Constraint Induced Therapy (CIT) in children with hemiplegic cerebral palsy guided this review. The effects from the intervention were analyzed by means of statistical significance of the results (p < 0,05) and effect size (ES) estimates, using Cohen’s d coefficient (no effect when d ≤ 0,2; small effect when 0,2 < d ≤ 0,5; regular effect when 0,5 < d ≤ 0,8 and large effect when d > 0,8). Six studies reported statistical significance of the results and, among those, four provided information that allowed the estimation of their intervention’s effect size. CIT seems to contribute significantly for the improvement of the manual function (0,53 ≤ d < 0,8; d > 2,82), motor performance (d = 0,4) and self-care (d = 2,25) of children with hemiplegic cerebral palsy, as well as to stimulate the emergence of new motor behavior (d = 3,04) and of bimanual function (d = 1,16). The critical analysis of the articles included in this review revealed the promising status of the CIT and reinforces the need for future studies to replicate the observed effects and to test, using more rigorous methodological designs, the effectiveness of the constrained-induced therapy.