Application of Constraint-induced Movement Therapy for People with Severe Chronic Plegic Hand

Objective: To determine the efficacy of intense constraint-induced movement therapy (CIMT) for patients who cannot achieve finger extension due to a severe plegic hand after stroke. Design: Pre-post, pre-1 month follow-up, singleblinded, multi-baseline case. Participants: Fifteen participants who were all >12 months post-stroke. Interventions: Two weeks of CIMT including restraint of the nonparetic upper extremity and 6 hours of training each day. Outcome: There was a statistically significant effect of CIMT on upper extremity motor impairment assessed by the Fugl-Meyer Motor Assessment (FMA), the Motor Activity Log for low functioning patients (Grade 5 MAL) and Active Range of Motion (AROM). Post hoc analysis showed significant differences between preand post-treatment motor impairment scores, and the improvements in these scores were maintained at 1 month after completion of treatment. Improvements were mostly in the use of the involved upper extremity for bimanual activities. Conclusions: Intense CIMT conferred significant changes in objective measures in subjects with chronic severe plegic hand after stroke. Additional studies of the long-term benefits of this treatment on post-stroke motor impairments and related functional disabilities are warranted.

[1]  J. P. Miller,et al.  Methods for a Multisite Randomized Trial to Investigate the Effect of Constraint-Induced Movement Therapy in Improving Upper Extremity Function among Adults Recovering from a Cerebrovascular Stroke , 2003, Neurorehabilitation and neural repair.

[2]  Lin Fumei,et al.  Correlation of Spasticity With Hyperactive Stretch Reflexes and Motor Dysfunction in Hemiplegia , 1999 .

[3]  E. Taub,et al.  Constraint Induced Movement Techniques To Facilitate Upper Extremity Use in Stroke Patients. , 1997, Topics in stroke rehabilitation.

[4]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[5]  E. Taub,et al.  A treatment for a chronic stroke patient with a plegic hand combining CI therapy with conventional rehabilitation procedures: case report. , 2006, NeuroRehabilitation.

[6]  S. G. Nelson,et al.  Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. , 1983, Physical therapy.

[7]  M. Leathley,et al.  Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. , 1999, Archives of physical medicine and rehabilitation.

[8]  E. Taub,et al.  Constraint-Induced Therapy Approach to Restoring Function After Neurological Injury , 2001, Topics in stroke rehabilitation.

[9]  H. Flor,et al.  Plasticity in the motor system related to therapy-induced improvement of movement after stroke. , 1999, Neuroreport.

[10]  J. Szaflarski,et al.  Modified Constraint-Induced Therapy in Chronic Stroke: Results of a Single-Blinded Randomized Controlled Trial , 2008, Physical Therapy.

[11]  D. Arciniegas,et al.  Constraint-induced movement therapy after stroke: efficacy for patients with minimal upper-extremity motor ability. , 2005, Archives of physical medicine and rehabilitation.

[12]  S. Black,et al.  The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties , 2002, Neurorehabilitation and neural repair.

[13]  H. Vet,et al.  Clinimetric Properties of the Motor Activity Log for the Assessment of Arm Use in Hemiparetic Patients , 2004, Stroke.

[14]  T. Elbert,et al.  New treatments in neurorehabiliation founded on basic research , 2002, Nature Reviews Neuroscience.

[15]  E. Taub,et al.  Constraint-induced movement therapy: characterizing the intervention protocol. , 2006, Europa medicophysica.

[16]  Peter Levine,et al.  Modified Constraint-Induced Therapy in Patients With Chronic Stroke Exhibiting Minimal Movement Ability in the Affected Arm , 2007, Physical Therapy.

[17]  Staci McKay,et al.  Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury. , 2005, Journal of rehabilitation research and development.

[18]  才藤 栄一,et al.  5. 早期脳卒中例に対するConstraint-Induced Movement Therapy (第8回日本リハビリテーション医学会中部・東海地方会) , 2001 .

[19]  D. J. White,et al.  Measurement Of Joint Motion A Guide To Goniometry , 2016 .

[20]  M. Hallett,et al.  Motor cortex plasticity. , 1997, Electroencephalography and clinical neurophysiology. Supplement.

[21]  Mental practice as a gateway to modified constraint-induced movement therapy: a promising combination to improve function. , 2007, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[22]  E. Taub,et al.  A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke , 2006, Stroke.

[23]  Sue Ann Sisto,et al.  Modified Constraint-Induced Therapy in Chronic Stroke , 2002, American journal of physical medicine & rehabilitation.

[24]  J. Liepert,et al.  Treatment-induced cortical reorganization after stroke in humans. , 2000, Stroke.

[25]  D. Joyce White Cynthia C. Norkin,et al.  Measurement of Joint Motion , 1985 .

[26]  E. Taub,et al.  Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. , 1999, Journal of rehabilitation research and development.

[27]  E. Taub,et al.  Reliability and Validity of the Upper-Extremity Motor Activity Log-14 for Measuring Real-World Arm Use , 2005, Stroke.

[28]  J. Liepert,et al.  Motor cortex plasticity during constraint-induced movement therapy in stroke patients , 1998, Neuroscience Letters.

[29]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[30]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[31]  N. Miller,et al.  Technique to improve chronic motor deficit after stroke. , 1993, Archives of physical medicine and rehabilitation.

[32]  D. Arciniegas,et al.  Constraint-induced therapy for moderate chronic upper extremity impairment after stroke , 2005, Brain injury.