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Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use

Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå Department of Rehabilitation, Lund University Hospital, Lund

Bengt H Sjölund

Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umea°, Sweden

Objective: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome.

Design: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers.

Setting: A university hospital rehabilitation department.

Participants: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb.

Intervention: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment.

Outcome measures: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log.

Results: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P B=0.001). However, no additional effect was seen from wearing a mitt for another three months.

Conclusion: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.

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