Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study

Objective: To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. Design: Two-group randomized controlled trial with pretreatment and posttreatment measures. Setting: Rehabilitation clinics. Subjects: Thirty-two chronic stroke patients (21 men, 11 women; mean age=57.9 years, range=43—81 years) 13—26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. Intervention: Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. Main measures: Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. Results: There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (P=0.018) more efficiently and depended more on the feedforward control of reaching (P=0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (P<0.0001) and the Functional Independence Measure (P=0.016). Conclusions: In addition to improving functional use of the affected arm and daily functioning, modified constraint-induced movement therapy improved motor control strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.

[1]  S. Moore,et al.  A modified constraint-induced therapy (mCIT) program for the upper extremity of a person with chronic stroke , 2005, Physiotherapy theory and practice.

[2]  L. Tickle-Degnen,et al.  A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability. , 2000, Archives of physical medicine and rehabilitation.

[3]  C. Granger,et al.  Interrater reliability of the 7-level functional independence measure (FIM) , 1994, Scandinavian journal of rehabilitation medicine.

[4]  S. Wolf,et al.  The Effects of Constraint-Induced Therapy on Precision Grip: A Preliminary Study , 2004, Neurorehabilitation and neural repair.

[5]  Elisabeth Svensson,et al.  Parallel reliability of the Functional Independence Measure and the Barthel ADL index , 2000, Disability and rehabilitation.

[6]  J. Stevens.  Applied Multivariate Statistics for the Social Sciences , 1986 .

[7]  Scott T. Grafton,et al.  Forward modeling allows feedback control for fast reaching movements , 2000, Trends in Cognitive Sciences.

[8]  M. Levin,et al.  Compensation for distal impairments of grasping in adults with hemiparesis , 2004, Experimental Brain Research.

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

[10]  T. Platz,et al.  Reduced skilfulness of arm motor behaviour among motor stroke patients with good clinical recovery: does it indicate reduced automaticity? Can it be improved by unilateral or bilateral training? A kinematic motion analysis study , 2001, Neuropsychologia.

[11]  J. Carr,et al.  Neurological Rehabilitation: Optimizing Motor Performance , 2003 .

[12]  Peter Levine,et al.  Modified Constraint-Induced Therapy after Subacute Stroke: A Preliminary Study , 2002, Neurorehabilitation and neural repair.

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

[14]  S. Jackson,et al.  Is Grasping Impaired in Hemispatial Neglect? , 2002, Behavioural neurology.

[15]  M. Levin.  Interjoint coordination during pointing movements is disrupted in spastic hemiparesis. , 1996, Brain : a journal of neurology.

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

[17]  H. Nagasaki.  Asymmetric velocity and acceleration profiles of human arm movements , 2004, Experimental Brain Research.

[18]  Christina Brogårdh,et al.  Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use , 2006, Clinical rehabilitation.

[19]  Philip N. Sabes,et al.  The planning and control of reaching movements , 2000, Current Opinion in Neurobiology.

[20]  V B Brooks,et al.  Adaptive programming of arm movements. , 1988, Journal of motor behavior.

[21]  A. Gentile,et al.  Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. , 2004, Archives of physical medicine and rehabilitation.

[22]  J. Kuhtz-Buschbeck,et al.  Grasping with the left and right hand: a kinematic study , 2005, Experimental Brain Research.

[23]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[24]  Peter Levine,et al.  Modified Constraint-Induced Therapy in Acute Stroke: A Randomized Controlled Pilot Study , 2005, Neurorehabilitation and neural repair.

[25]  Gitendra Uswatte,et al.  Constraint-induced movement therapy: New approaches to outcome measurement in rehabilitation. , 1999 .

[26]  C. Granger,et al.  The functional independence measure: a new tool for rehabilitation. , 1987, Advances in clinical rehabilitation.

[27]  C. Trombly.  Deficits of reaching in subjects with left hemiparesis: a pilot study. , 1992, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[28]  E. Taub,et al.  Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. , 1999, Stroke.

[29]  G. Müller,et al.  [Movement therapy in hemiplegia]. , 1977, Beitrage zur Orthopadie und Traumatologie.

[30]  J. André,et al.  Inter-rater agreement of two functional independence scales: the Functional Independence Measure (FIM) and a subjective uniform continuous scale. , 1994, Disability and rehabilitation.

[31]  B. Hamilton.  A uniform national data system for medical rehabilitation. , 1987 .

[32]  P A Thompson,et al.  The Motor Activity Log-28 , 2006, Neurology.

[33]  R. Gonzalez.  Applied Multivariate Statistics for the Social Sciences , 2003 .

[34]  Sharon Wood-Dauphinee,et al.  The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial , 2006, Clinical rehabilitation.

[35]  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.

[36]  R. D Seidler,et al.  Feedforward and feedback processes in motor control , 2004, NeuroImage.

[37]  S. Perry,et al.  Stroke Rehabilitation: Guidelines for Exercise and Training to Optimize Motor Skill , 2004 .

[38]  Jürgen Schulte Mönting,et al.  Is the movement-evoked potential mandatory for movement execution? A high-resolution EEG study in a deafferented patient , 2006, NeuroImage.

[39]  J. H. van der Lee,et al.  Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. , 1999, Stroke.

[40]  H. Chui,et al.  The Modified Mini-Mental State (3MS) examination. , 1987, The Journal of clinical psychiatry.

[41]  Timothy D. Lee,et al.  Motor Control and Learning: A Behavioral Emphasis , 1982 .

[42]  A. Dromerick,et al.  Does the Application of Constraint-Induced Movement Therapy During Acute Rehabilitation Reduce Arm Impairment After Ischemic Stroke? , 2000, Stroke.

[43]  J. Grotta,et al.  Constraint-Induced Movement Therapy , 2004, Stroke.

[44]  A. Vermeer,et al.  Effect of task context on reaching performance in children with spastic hemiparesis , 2002, Clinical rehabilitation.

[45]  Diane P. Martin,et al.  A validation of the functional independence measurement and its performance among rehabilitation inpatients. , 1993, Archives of physical medicine and rehabilitation.