|
Sign In to gain access to subscriptions and/or personal tools.
|
Clinical Rehabilitation, Vol. 20, No. 12,
1066-1074 (2006)
DOI: 10.1177/0269215506071263
Limited dose response to Constraint-Induced Movement Therapy in patients with chronic stroke
Lorie Richards
Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System and Occupational Therapy Department, University of Florida
Leslie J Gonzalez Rothi
Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System and Neurology Department, University of Florida
Sandra Davis
Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System
Samuel S Wu
Brain Rehabilitation Research Center and Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System and Biostatistics Division, University of Florida
Stephen E Nadeau
Brain Rehabilitation Research Center, Geriatric Education, Research, and Clinical Center, and Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System and Neurology Department, University of Florida, Gainesville, Florida, USA
Objective: To compare outcomes in motor skill, perceived amount of use and ability of the paretic arm in daily activities between traditional Constraint-Induced Movement Therapy, consisting of 6 hours of in-clinic, therapist-guided task practice, and a shortened Constraint-Induced Movement Therapy, consisting of 1 hour of in clinic, therapist-guided task practice coupled with 5 hours of unsupervised practice at home.
Design: A secondary analysis of two previous randomized, controlled, double-blind, parallel group studies.
Setting: A research clinic.
Participants: Thirty-nine individuals with hemiparesis from a chronic unilateral stroke who were able to extend the wrist 10° and the fingers and thumb 10° from a flexed position and were participants in one of the two studies examining the efficacy of adding neuroplasticity adjuvants to Constraint-Induced Movement Therapy.
Main outcome measures: The Wolf Motor Function Test was used to assess motor skill and the Motor Activity Log amount of use and quality of movement scales were used to assess perceived amount of use and ability respectively.
Interventions: Constraint-Induced Movement Therapy plus donepezil in the CIMT-6 study (the traditional 6 hours of in-clinic task practice) and Constraint-Induced Movement Therapy plus repetitive transcranial magnetic stimulation in the CIMT-1 study (1 hour of in-clinic task practice).
Results: Motor skill gains after two weeks of therapy were equivalent for both groups (n=39; mean difference=2.81, P>0.22), but gains were not maintained six months later with either intervention protocol. Despite this, participants in the CIMT-6 group reported greater use (mean difference=1.52, P<0.001) and movement quality (mean difference=0.95, P<0.004) than those with less therapist-guided practice. Both groups had regressed somewhat in use and ability at the six-month follow-up.
Conclusion: These results suggest that 6 hours of therapist-guided practice may not be necessary to facilitate motor skill gains, but may influence patterns of use.
References
- American Heart Association. 2004 Heart and stroke statistical update . American Heart Association, 2004.
- Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study . Arch Phys Med Rehabil 1994; 75: 394-398 .[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Kunkel A, Kopp B, Muller G, Villringer K, Villringer A, Taub E, Flor H. Constraint-induced movement therapy for motor recovery in chronic stroke patients . Arch Phys Med Rehabil 1999; 80: 624-628 .[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication . Stroke 1999; 30: 586-592 .[Medline]
[Order article via Infotrieve]
- Taub E, Wolf SL. Constraint induced movement techniques to facilitate upper extremity use in stroke patients . Top Rehabil 1997; 3: 38-61 .
- Taub E, Miller NE, Novack TA et al. Technique to improve chronic motor deficit after stroke . Arch Phys Med Rehabil 1993; 74: 347-354 .[ISI][Medline]
[Order article via Infotrieve]
- Page SJ, Levine P, Sisto S, Bond Q, Johnston MV. Stroke patients' and therapists' opinions of constraint-induced movement therapy . Clin Rehabil 2002; 16: 55-60 .[Abstract/Free Full Text]
- 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: 1374-1377 .[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Lum PS, Taub E, Schwandt D, Postman M, Hardin P, Uswatte G. Automated Constraint-Induced Therapy Extension (AutoCITE) for movement deficits after stroke . J Rehabil Res Dev 2004; 41: 249-258 .[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Taub E, Lum PS, Hardin P, Mark VW, Uswatte G. AutoCITE: automated delivery of CI therapy with reduced effort by therapists . Stroke 2005; 36: 1301-1304 .[Abstract/Free Full Text]
- Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf motor function test as outcome measure for research in patients after stroke . Stroke 2001; 32: 1635-1639 .[Abstract/Free Full Text]
- 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: 204-209 .[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Page SJ, Sisto S, 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 .[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Nadeau SE, Behrman AL, Davis SE et al. Donepezil as an adjuvant to constraint-induced therapy for upper-limb dysfunction after stroke: an exploratory randomized clinical trial . J Rehabil Res Dev 2004; 41: 525-534 .[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Malcolm MP, Triggs WJ, Light KE et al. Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial. Am J Phys Med Rehabil (in press).
- Richards L, Stoker-Yates J, Pohl P, Wallace D, Duncan P. Reliability and validity of two tests of upper extremity motor function post-stroke . Occup Ther J Res 2001; 21: 201-219 .
- 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: 2493-2496 .[Abstract/Free Full Text]
- Uswatte G, Taub E, Morris D, Light KE, Thompson PA. The Motor Activity Log-28: assessing daily use of the hemiparetic arm. Neurology (in press).
- 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: 1410-1414 .[Abstract/Free Full Text]
- Page SJ, Levine P, Leonard AC. Modified constraint-induced therapy in acute stroke: a randomized controlled pilot study . Neurorehabil Neural Repair 2005; 19: 27-32 .[Abstract]
- Page SJ, Sisto S, Johnston MV, Levine P. Modified constraint-induced therapy after subacute stroke: a preliminary study . Neurorehabil Neural Repair 2002; 16: 290-295 .[Abstract]
- Mark VW, Taub E. Constraint-induced movement therapy for chronic stroke hemiparesis and other disabilities . Restor Neurol Neurosci 2004; 22: 317-336 .[ISI][Medline]
[Order article via Infotrieve]
- Liepert J, Bauder H, Wolfgang HR, Miltner WH, Taub E, Weiller C. Treatment-induced cortical reorganization after stroke in humans . Stroke 2000; 31: 1210-1216 .[Abstract/Free Full Text]
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
|
