Constraint-induced motor relearning after stroke: a naturalistic case report

Effect of Physical Guidance on Learning a Tracking Task in Children with Cerebral Palsy

The purpose of this study was to investigate the effect of physical guidance (PG) frequency on learning a tracking task in children with hemiplegic spastic cerebral palsy (CP). For this purpose, 25 children, aged 7–15 years with CP affecting the left side of the body, who were classified in levels II–III of Manual Abilities Classification System (MACS) and levels III–IV of Gross Motor Function Classification System (GMFCS), were recruited from 10 clinical centers. A pre-test including two blocks of 12 trials of the tracking task without any PG was performed by all participants, after that they were assigned into five homogenous groups (with 100%, 75%, 50%, 25%, and 0% of PG) through blocked randomization according to their age. All participants involved in an intervention consisted of eight sessions (four blocks of 12 trials in each session) practicing a tracking task. The 0% PG group received no PG, the 25% PG group received PG for three trials, the 50% PG group received PG for six trials, the 75% PG group received PG for nine trials, and the 100% PG group received PG for all twelve trials. PG consisted of placing the experimenter’s hand around the child’s less-involved hand guiding to stay on the track and complete the task. Learning was inferred by acquisition and delayed retention tests. The results showed that the higher frequency of PG led to more accurate performance during practice phase. However, the group that received 75% PG had significantly better performance compared to the other groups in the retention phase. It is concluded that optimum level of PG, about 75% of trials, can be helpful for learning a tracking task in children with spastic hemiplegic CP, supporting the challenge point framework.

A Low-Cost Soft Robotic Hand Exoskeleton for Use in Therapy of Limited Hand–Motor Function

We present the design and validation of a low-cost, customizable and 3D-printed anthropomorphic soft robotic hand exoskeleton for rehabilitation of hand injuries using remotely administered physical therapy regimens. The design builds upon previous work done on cable actuated exoskeleton designs by implementing the same kinematic functionality, but with the focus shifted to ease of assembly and cost effectiveness as to allow patients and physicians to manufacture and assemble the hardware necessary to implement treatment. The exoskeleton was constructed solely from 3D-printed and widely available off-the-shelf components. Control of the actuators was realized using an Arduino microcontroller, with a custom-designed shield to facilitate ease of wiring. Tests were conducted to verify that the range of motion of the digits and the forces exerted at the fingertip coincided with those of a healthy human hand.

Constraint-induced therapy for moderate chronic upper extremity impairment after stroke

PRIMARY OBJECTIVE

To explore the effectiveness of constraint-induced therapy (CIT) in the treatment of individuals with moderate chronic upper extremity paresis.

RESEARCH DESIGN

Multiple case reports, pre-post-treatment comparisons as well as long-term follow-ups at 1 and 6 months after intervention.

METHODS AND PROCEDURES

Seven subjects, each greater than 12 months post-stroke, participated in an intensive 3 weeks CIT programme. The Wolf Motor Function Test (WMFT), Motor Activity Log (MAL) and Fugl-Meyer Evaluation (FM) were used to measure outcomes.

MAIN OUTCOMES AND RESULTS

Subjects exhibited notable improvements in mean WMFT scores (0.25 point increase post-treatment, 0.38 point increase at 1-month follow-up, 0.44 point increase at 6-month follow-up). Similarly, improvements were seen for mean MAL (1.71 points for AS, 1.77 points for HW) and FM scores (6 points FM-UE, 6 points FM-TOT) post-treatment. Additional improvements were seen at some follow-up assessments.

CONCLUSIONS

Subjects demonstrated gains in objective measures, however, did not regain normal functional ability of their paretic upper extremities. Further investigation of the effects of CIT in this population, as well the functional significance of the objective measures used is warranted.

The effectiveness of constraint-induced therapy as a stroke intervention: a meta-analysis

Stroke is one of the most disabling conditions affecting adults today. Much research has been performed on rehabilitation interventions targeting hemiparesis after stroke. Constraint-induced therapy is a treatment technique that focuses on restraining the unaffected upper extremity while forcing use of the affected extremity to promote purposeful movement. This study presents a meta-analysis of applicable current literature on this treatment approach. It is concluded that constraint-induced therapy may be an effective treatment option for hemiparesis experienced after stroke.

Constraint-Induced Movement Therapy After Stroke: Efficacy for Patients With Minimal Upper-Extremity Motor Ability

OBJECTIVE

To examine the effects of constraint-induced movement therapy (CIMT) on chronic moderate-to-severe upper-extremity motor impairment after stroke.

DESIGN

Within-subjects design; pre- and posttesting as well as 1-month follow-up.

SETTING

Outpatient clinic within a rehabilitation hospital.

PARTICIPANTS

Twenty participants, each greater than 12 months poststroke.

INTERVENTION

Three weeks of CIMT including restraint of the nonparetic upper extremity and 6 hours of training a day.

MAIN OUTCOME MEASURES

Fugl-Meyer Assessment (FMA), Graded Wolf Motor Function Test (GWMFT), and Motor Activity Log (MAL).

RESULTS

There was a statistically significant effect of treatment on upper-extremity motor impairment as assessed by the FMA, the MAL, and the functional ability scale of the GWMFT. There was a trend toward an effect of CIMT on mean speed of performance on the GWMFT. Post hoc analysis showed significant differences between motor impairment scores between pretreatment and posttreatment assessments, and improvements in motor impairment scores remained stable 1 month after completion of formal treatment. Improvements appeared to be mostly in the use of the involved upper extremity for bimanual activities.

CONCLUSIONS

CIMT conferred significant changes in objective measures in subjects with chronic moderate-to-severe impairments after stroke. Additional studies of long-term benefits of this treatment on poststroke motor impairments and related functional disabilities are warranted.

Client-Centered Occupational Therapy Using Constraint-Induced Therapy

Constraint-induced therapy (CIT) is a rehabilitation intervention designed to promote increased use of a weak or paralyzed arm, most commonly in patients who sustained a stroke. CIT involves constraining the unaffected arm in a sling or mitt, forcing the use of the weaker or paralyzed arm in daily activities. The aim of this study was to determine whether immobilizing the uninvolved arm of persons who experienced a stroke while participating in meaningful activities of daily living would increase their satisfaction and performance in life roles. Nine clients participated in a pilot study consisting of 2 weeks of individualized occupation-based CIT. This pilot study combined therapy in the clinic with therapy in the individual's home environment and incorporated meaningful daily activities chosen by the client into treatment. Results revealed a significant change in reported satisfaction and performance postintervention; however, a decline in satisfaction at follow-up despite continued motor improvement. Even though voluntary movements demonstrated improvement, participants were not satisfied with their performance in functional goal-related activities in their natural environment. Motor improvement can be repeated; however, at follow-up, participants were not satisfied with the improvement in meaningful activities that they identified. This may have to do with participants wanting or expecting their affected upper extremity to function better despite the deficits. It is also possible that participants expected their function to improve at the rate that it did during treatment. Further investigation using meaningful activity is needed to identify integration of the affected upper extremity into individuals' own environments and determine how it affects overall life roles and satisfaction over time.

Repetitive task practice: a critical review of constraint-induced movement therapy in stroke

BACKGROUND

Constraint-induced (CI) movement therapy (also called forced use by some investigators and clinicians) has gained increasing popularity as a treatment mode for restoring function in the upper extremities of patients with stroke. The purpose of this article is to review the concept of constraint-induced movement therapy and provide a critical analysis of the existing data.

REVIEW SUMMARY

The evidence to date offers encouragement for the application of this procedure for patients who have some movement recovery out of synergy. Success may be contingent on patient cooperation and intense repetitive use with applications of retraining through practice and shaping. The extent to which each of the latter elements influences the magnitude of recovery is still unclear. However, task novelty and challenge seem important to recovery of function. There are several methods used to map cortical changes after stroke. At this time, transcranial magnetic stimulation is the primary vehicle used to assess motor cortical reorganization after CI therapy in humans.

CONCLUSIONS

Accumulating data indicate that the size of a cortical area representative of a muscle does expand and its center of gravity does change with CI therapy.