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First published online May 1, 2008

Short- and long-term outcome of constraint-induced movement therapy after stroke: a randomized controlled feasibility trial

AE Dahl, T. Askim, R. Stock, E. Langørgen, S. Lydersen, and B. IndredavikView all authors and affiliations
Volume 22, Issue 5
https://doi.org/10.1177/0269215507084581

Abstract

Objective: Constraint-induced movement therapy (CIMT) is a method to improve motor function in the upper extremity following stroke. The aim of this trial was to determine the effect and feasibility of CIMT compared with traditional rehabilitation in short and long term.
Design: A randomized controlled trial.
Setting: An inpatient rehabilitation clinic.
Subjects: Thirty patients with unilateral hand impairment after stroke.
Intervention: Six hours arm therapy for 10 consecutive weekdays, while
using a restraining mitten on the unaffected hand.
Main measures: The patients were assessed at baseline, post-treatment and at six-month follow-up using the Wolf Motor Function Test as primary outcome measure and the Motor Activity Log, Functional Independence Measure and Stroke Impact Scale as secondary measurements.
Results: The CIMT group (n=18) showed a statistically significant shorter performance time (4.76 seconds versus 7.61 seconds, P= 0.030) and greater functional ability (3.85 versus 3.47, P= 0.037) than the control group (n=12) on the Wolf Motor Function Test at post-treatment assessment. There was a non-significant trend toward greater amount of use (2.47 versus 1.97, P= 0.097) and better quality of movement (2.45 versus 2.12, P=0.105) in the CIMT group according to the Motor Activity Log. No such differences were seen on Functional Independence Measure at the same time. At six-month follow-up the CIMT group maintained their improvement, but as the control group improved even more, there were no significant differences between the groups on any measurements.
Conclusions: CIMT seems to be an effective and feasible method to improve motor function in the short term, but no long-term effect was found.

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References

Taub E., Uswatte G., Elbert T. New treatments in neurorehabilitation founded on basic research. Nat Rev Neurosci 2002; 3: 228-36.
Google Scholar
Taub E., Uswatte G., Pidikiti R. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation - a clinical review. J Rehabil Res Dev 1999; 36: 237-51.
Google Scholar
Taub E., Miller NE, Novack TA, Cook EW III, Fleming WC, Nepomuceno CS, Connell JS, Crago JE Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 1993; 74: 347-54.
Google Scholar
Taub E., Uswatte G., King DK, Morris D., Crago JE, Chatterjee A. A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke 2006 ; 37: 1045-49.
Google Scholar
Hakkennes S., Keating JL Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials. Aust J Physiother 2005; 51: 221-31.
Google Scholar
van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Devillé WL, Bouter LM Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke 1999; 30: 2369-75.
Google Scholar
Wolf SL, Winstein CJ, Miller JP et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial . JAMA 2006; 296: 2095-104.
Google Scholar
Dromerick AW, Edwards DF, Hahn M. Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke? Stroke 2000; 31: 2984-88.
Google Scholar
Grotta JC, Noser EA, Ro T. et al. Constraint-induced movement therapy. Stroke 2004; 35: 2699-701.
Google Scholar
Page SJ, Levine P., Leonard AC Modified constraint-induced movement therapy in acute stoke: a randomized controlled pilot study. Neurorehabil Neural Repair 2005; 19: 27-32.
Google Scholar
Boake C., Noser EA, Ro T. et al. Constraint-induced movement therapy during early stroke rehabilitation . Neurorehabil Neural Repair 2007; 21: 14-24.
Google Scholar
Page SJ, Sisto SA, Levine P., Johnston MV, Hughes M. Modified constraint induced therapy: a randomized feasibility and efficacy study. J Rehabil Res Dev 2001; 38: 583-90.
Google Scholar
Page SJ, Sisto SA, Johnston MV, Levine P. Modified constraint-induced therapy after subacute stroke: a preliminary study . Neurorehabil Neural Repair 2002; 16: 290-95.
Google Scholar
Page SJ, Sisto SA, Levine P., McGrath RE Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Arch Phys Med Rehabil 2004; 85: 14-18.
Google Scholar
Sterr A., Elbert T., Berthold I., Kolbel S., Rockstroh B., Taub E. Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: an exploratory study. Arch Phys Med Rehabil 2002; 83: 1374-77.
Google Scholar
Suputtitada A., Suwanwela NC, Tumvitee S. Effectiveness of constraint-induced movement therapy in chronic stroke patients. J Med Assoc Thai 2004; 87: 1482-90.
Google Scholar
Wittenberg GF, Chen R., Ishii K. et al. Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation . Neurorehabil Neural Repair 2003; 17: 48-57.
Google Scholar
WHO MONICA Project. Monica Manual (1998 -1999). Part IV: Event Registration. Section 2: Stroke event registration data component. Available from http://www.ktl.fi/publications/monica/manual/part4/iv-2.htm
Google Scholar
Sulter G., Steen C., De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials . Stroke 1999; 30: 1538-41.
Google Scholar
Folstein MF, Folstein SE, McHugh PR ``Mini-mental state.'' A practical method for grading the cognitive state of patients for the clinician . J Psychiat Res 1975; 12: 189-98.
Google Scholar
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382-89.
Google Scholar
Plummer P., Morris ME, Dunai J. Assessment of unilateral neglect. Phys Ther 2003; 83: 732-40.
Google Scholar
Morris DM, Uswatte G., Crago JE, Cook EW III, Taub E. The reliability of the wolf motor function test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 2001; 82: 750-55.
Google Scholar
Wolf SL, Thompson PA, Morris DM et al. The EXCITE trial: attributes of the Wolf Motor Function Test in patients with subacute stroke. Neurorehabil Neural Repair 2005; 19: 194-205.
Google Scholar
Uswatte G., Taub E., Morris D., Light K., Thompson PA The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurology 2006; 67: 1189-94.
Google Scholar
Cohen ME, Marino RJ The tools of disability outcomes research functional status measures . Arch Phys Med Rehabil 2000; 81(Suppl 2): S21-S29.
Google Scholar
Duncan PW, Wallace D., Lai SM, Johnson D., Embretson S., Laster LJ The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke 1999; 30: 2131-40.
Google Scholar
Vickers AJ, Altman DG Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ 2001; 323: 1123-24.
Google Scholar
Pocock SJ, Assmann SE, Enos LE, Kasten LE Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat Med 2002; 21: 2917-30.
Google Scholar
van der Lee JH, Beckerman H., Knol DL, de Vet HCW, Bouter LM Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients . Stroke 2004; 35: 1410-14.
Google Scholar
Uswatte G., Taub E., Morris D., Vignolo M., McCulloch K. Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke 2005 ; 36: 2493-96.
Google Scholar
Dettmers C., Teske U., Hamzei F., Uswatte G., Taub E., Weiller C. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil 2005; 86: 204-09.
Google Scholar
Boylstein C., Rittman M., Gubrium J., Behrman A., Davis S. The social organization in constraint-induced movement therapy. J Rehabil Res Dev 2005; 42: 263-75.
Google Scholar
Brogardh C., Sjolund BH Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use. Clin Rehabil 2006; 20: 218-27.
Google Scholar
van Peppen RP, Kwakkel G., Wood-Dauphinee S., Hendriks HJ, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clin Rehabil 2004; 18: 833-62.
Google Scholar

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Published In

Volume 22, Issue 5
Pages: 436 - 447
Article first published online: May 1, 2008
Issue published: May 2008

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PubMed: 18441040

Authors

Affiliations

AE Dahl
The Stroke Unit, Department of Medicine and Clinical Services, St. Olavs Hospital, Trondheim University Hospital, [email protected]
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T. Askim
Department of Public Health and General Practice, Norwegian University of Science and Technology and Clinical Services, St. Olavs Hospital, Trondheim University Hospital
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R. Stock
Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital
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E. Langørgen
Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital
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S. Lydersen
Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology
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B. Indredavik
The Stroke Unit, Department of Medicine, St. Olavs Hospital, Trondheim University Hospital, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
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