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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.

Abstract：

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 < 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.

journal_name

Clin Rehabil

journal_title

Clinical rehabilitation

authors

Brogårdh C,Sjölund BH

doi

10.1191/0269215506cr937oa

subject

Has Abstract

pub_date

2006-03-01 00:00:00

pages

218-27

issue

eissn

0269-2155

issn

1477-0873

journal_volume

pub_type

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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.