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Mantri A, Harjpal P, Chavan N. Physiotherapy Approach to an Internal Capsule Infarct With Upper Motor Neuron Facial Nerve Palsy: A Case Report. Cureus 2024; 16:e55337. [PMID: 38562357 PMCID: PMC10982154 DOI: 10.7759/cureus.55337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
The internal capsule (IC) is a vital brain structure housing descending and ascending fiber tracts, with traditional assumptions about the corticobulbar and corticospinal tracts descending through the genu and anterior third of the posterior limb of internal capsule (PLIC), respectively. However, observations of IC infarctions reveal that symptoms often deviate from the expected fiber pattern, prompting a deeper exploration of these complexities. The posterior limb of the IC receives its blood supply from the lenticulostriate branches of the middle cerebral artery and the anterior choroidal artery (AChA). AChA infarctions present a diverse array of symptoms beyond the classic triad, reflecting the intricate vascular supply and lesion patterns within this region. We present a case of a 74-year-old male farmer with right-hand dominance, who experienced a fall resulting in head and right lower limb injuries. Subsequently, he developed weakness in his left upper and lower limbs, facial deviation, slurred speech, and swelling in the right lower limb. Following these symptoms, his family promptly brought him to the hospital on November 30, 2023. Extensive investigations, including magnetic resonance imaging (MRI), revealed a hyper-acute infarct in the posterior limb of the left IC. The patient was admitted to the intensive care unit (ICU) for three days and later shifted to the neurology ward where medical management was commenced, including physiotherapy protocol that was started on December 2, 2023. Physiotherapy interventions were designed to address the patient's weakness, altered sensation, and diminished reflexes. Therapeutic goals focused on preventing complications, improving posture, enhancing range of motion (ROM), and mitigating breathing difficulties and mobility issues. The physiotherapy aimed to enhance the patient's overall physical and mental well-being, emphasizing independence and improved quality of life. Regular assessments and adjustments to the therapeutic interventions were made based on the patient's progress. This case underscores the importance of tailored physiotherapy interventions in addressing the diverse manifestations of IC infarctions, contributing to a comprehensive understanding of rehabilitation strategies in neurologically compromised individuals.
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Affiliation(s)
- Achal Mantri
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitika Chavan
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kim B, Girnis J, Sweet V, Nobiling T, Agag T, Neville C. Impact of motor task conditions on end-point kinematics and trunk movements during goal-directed arm reach. Sci Rep 2024; 14:4520. [PMID: 38402209 PMCID: PMC10894230 DOI: 10.1038/s41598-024-54723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/15/2024] [Indexed: 02/26/2024] Open
Abstract
Task conditions significantly impact human motor control. We investigated how task type, difficulty, and constraints influence the kinematics of goal-directed arm reaching. Non-disabled young adults performed two distinct goal-directed arm reaching tasks: pointing and picking up an object with chopsticks. These tasks were carried out under various conditions, including constrained and unconstrained elbow extension and two different task difficulties. We collected kinematic data using a 3-D motion capture system and analyzed the effects of different task conditions on kinematic variables using linear mixed-effects regression analysis. Our findings revealed statistically significant differences in kinematics between the two tasks. Arm reaching during the picking-up task was slower and exhibited jerkier movements compared to the pointing task. Additionally, when arm reaching was performed with constrained elbow extension, it led to slower and jerkier movements, with an increased involvement of trunk movements compared to the unconstrained condition. These findings show that complex manipulative motor tasks requiring higher hand dexterity necessitate feedback-based control of arm reaching, but simple pointing tasks requiring less hand dexterity do not. In conclusion, our study sheds light on the influence of task conditions on goal-directed arm reaching kinematics and provides valuable insights into the motor control strategies involved in different tasks.
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Affiliation(s)
- Bokkyu Kim
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, 13066, USA.
| | - Jaimie Girnis
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, 13066, USA
| | - Vanessa Sweet
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, 13066, USA
- Jones Memorial Hospital, Wellsville, NY, USA
| | - Tobias Nobiling
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, 13066, USA
- University of Rochester Medical Center, Rochester, NY, USA
| | - Tarek Agag
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, 13066, USA
| | - Christopher Neville
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, Syracuse, NY, 13066, USA
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3
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Gao Q, Zhang Y, Long J, Pan M, Wang J, Yang F. Effect of different constraint-induced movement therapy protocols on recovery of stroke survivors with upper extremity dysfunction: a systematic review and network meta-analysis. Int J Rehabil Res 2023; 46:133-150. [PMID: 37039604 DOI: 10.1097/mrr.0000000000000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We aimed to assess and rank comparative efficacy of different constraint-induced movement therapy (CIMT) protocols on motor function of upper extremity and activities of daily living (ADL) in stroke survivors. A comprehensive search was conducted in PubMed, EMBASE, Web of Science and Cochrane Library to identify randomized controlled trials on CIMT. Included studies were evaluated using the revised Cochrane risk of bias tool. Then a random-effects network meta-analysis was performed within a frequentist framework using Stata v16.0. Of the 1150 studies retrieved, 44 studies with 1779 participants were included. In terms of motor recovery of upper extremity, CIMT combined with trunk restraint, in which the less affected arm was constrained at least 4 h but no more than 6 h per day, ranked as the most effective intervention for the improvement of the Fugl-Meyer Assessment-Upper Extremity and the Action Research Arm Test score. In terms of ADL improvement, constraining the less affected arm for at least 4 h but no more than 6 h per day in CIMT combined with trunk restraint, was found to significantly improve the Motor Activity Log of quality of movement scale and amount of use scale score. The protocol of CIMT combined with trunk restraint, in which the less affected arm was constrained at least 4 h but no more than 6 h per day, ranked the highest in this analysis and might be considered in practice.
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Affiliation(s)
- Qian Gao
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Henan, China
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Zhou M, Tu Y, Cui J, Gao P, Yi T, Wang J, Hao Q, Li H, Zhu T. Effect of constraint-induced movement therapy on lower extremity motor dysfunction in post-stroke patients: A systematic review and meta-analysis. Front Neurol 2022; 13:1028206. [DOI: 10.3389/fneur.2022.1028206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/01/2022] [Indexed: 11/22/2022] Open
Abstract
ObjectiveConstraint-induced movement therapy (CIMT) is a common treatment for upper extremity motor dysfunction after a stroke. However, whether it can effectively improve lower extremity motor function in stroke patients remains controversial. This systematic review comprehensively studies the current evidence and evaluates the effectiveness of CIMT in the treatment of post-stroke lower extremity motor dysfunction.MethodsWe comprehensively searched randomized controlled trials related to this study in eight electronic databases (PubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WAN FANG, and VIP). We evaluated CIMT effectiveness against post-stroke lower extremity motor dysfunction based on the mean difference and corresponding 95% confidence interval (95% CI). We assessed methodological quality based on the Cochrane Bias Risk Assessment Tool. After extracting the general information, mean, and standard deviation of the included studies, we conducted a meta-analysis using RevMan 5.3 and Stata 16.0. The primary indicator was the Fugl-Meyer Assessment scale on lower limbs (FMA-L). The secondary indicators were the Berg balance scale (BBS), 10-meter walk test (10MWT), gait speed (GS), 6-min walk test (6MWT), functional ambulation category scale (FAC), timed up and go test (TUGT), Brunnstrom stage of lower limb function, weight-bearing, modified Barthel index (MBI), functional independence measure (FIM), stroke-specific quality of life questionnaire (SSQOL), World Health Organization quality of life assessment (WHOQOL), and National Institute of Health stroke scale (NIHSS).ResultsWe initially identified 343 relevant studies. Among them, 34 (totaling 2,008 patients) met the inclusion criteria. We found that patients treated with CIMT had significantly better primary indicator (FMA-L) scores than those not treated with CIMT. The mean differences were 3.46 (95% CI 2.74–4.17, P < 0.01, I2 = 40%) between CIMT-treated and conventional physiotherapy-treated patients, 3.83 (95% CI 2.89–4.77, P < 0.01, I2 = 54%) between patients treated with CIMT plus conventional physiotherapy and patients treated only with conventional physiotherapy, and 3.50 (95% CI 1.08–5.92, P < 0.01) between patients treated with CIMT plus western medicine therapy and those treated only with western medicine therapy. The secondary indicators followed the same trend. The subgroup analysis showed that lower extremity CIMT with device seemed to yield a higher mean difference in FMA-L scores than lower extremity CIMT without device (4.52, 95% CI = 3.65–5.38, P < 0.01 and 3.37, 95% CI = 2.95–3.79, P < 0.01, respectively).ConclusionCIMT effectively improves lower extremity motor dysfunction in post-stroke patients; however, the eligible studies were highly heterogeneous.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277466.
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Paci M, Prestera C, Ferrarello F. Generalizability of Results from Randomized Controlled Trials in Post-Stroke Physiotherapy. Physiother Can 2020; 72:382-393. [PMID: 35110812 PMCID: PMC8781507 DOI: 10.3138/ptc-2018-0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose: The randomized controlled trial (RCT) is considered a reliable experimental design, able to detect the effect of an intervention. However, a criticism frequently levelled at RCTs by clinicians is their lack of generalizability. This study aimed to evaluate the generalizability of findings from RCTs of physiotherapy interventions for individuals with stroke. Method: A sample of RCTs of physiotherapy interventions after stroke indexed in the PEDro database was selected, and the reported inclusion and exclusion criteria were analyzed. Results: We reviewed 100 articles, which included 7,366 participants (41.6% women, with a mean weighted age of 65.5 years). The most frequent criteria for exclusion were comorbidity (83%), cognitive impairments (69%), communication skills (55%), recurrent stroke (53%), low functional level (47%) and being elderly (25%). Conclusions: A variety of cohorts of individuals who have had a stroke are excluded from RCTs published in the field of physiotherapy. Because they represent a substantial proportion of the real-world population with stroke, and consequently treated in clinical practice, more vulnerable cohorts of participants should be included in RCTs.
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Affiliation(s)
- Matteo Paci
- Unit of Functional Recovery, Azienda USL Toscana Centro, Florence
| | - Claudia Prestera
- Rehabilitation Center, Fondazione Filippo Turati Onlus, Gavinana, Pistoia, Italy
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Dodzo W, Grant R, Forsyth L, Ramdharry GM. A randomised controlled feasibility trial of the Graded Repetitive Arm Strengthening Programme delivered to survivors of stroke at home. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2017.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims This randomised controlled feasibility trial evaluated the recruitment, engagement and effect of the Graded Repetitive Arm Strengthening Programme in a community rehabilitation setting in London, UK. Methods A parallel design was used to ascertain the effect of the Graded Repetitive Arm Strengthening Programme plus standard care compared to standard care only over four weeks. Eleven participants were randomised using permuted blocks randomisation following discharge, with six participants allocated to the Graded Repetitive Arm Strengthening Programme (study) group and five to the standard care (control) group. The primary outcome was the Wolf Motor Function Test. Secondary outcomes were the Motor Activity Log and grip strength. Results A total of five participants in each group were analysed as one person withdrew from the study group. Participants in the study group gave more time to supplementing their exercise time independently (160% more vs 42% more). Most Wolf Motor Function Test tasks' time and function data showed a small difference in favour of the Graded Repetitive Arm Strengthening Programme. Results were re-examined using a Bayesian structural equation model to quantify changes in the underlying impairment. This showed significant differences: 40% faster task completion (P<0.001, 95% confidence level [CI] 30–49%), mean improvement of 0.54 on the five-point functional ability score (P<0.001, 95% CI 0.39–0.68), odds ratio of 0.05 for non-completion of task (P<0.001, 95% CI 0.02–0.14). Conclusions This study has shown that implementing the Graded Repetitive Arm Strengthening Programme is feasible and may have a greater effect on outcomes when delivered as part of care in a community rehabilitation setting. The analysis of the Wolf Motor Function Test was also critiqued.
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Affiliation(s)
- Wilson Dodzo
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Leigh Forsyth
- Leadership & Quality Improvement Team, NHS Improvement, London, UK
| | - Gita M Ramdharry
- Queen Square Centre for Neuromuscular Diseases, University College Hospitals NHS Foundation Trust, London, UK
- Institute of Neurology, University College London, London, UK
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Liang L, Hu R, Luo X, Feng B, Long W, Song R. Reduced Complexity in Stroke with Motor Deficits: A Resting-State fMRI Study. Neuroscience 2020; 434:35-43. [PMID: 32194224 DOI: 10.1016/j.neuroscience.2020.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 01/02/2023]
Abstract
Recently, alterations of complexity due to brain disorders have been demonstrated using brain entropy (BEN), while the changes of brain complexity in stroke, a common cerebrovascular disease, remain unclear. In this research, resting-state functional magnetic resonance imaging (fMRI) was performed to explore the alterations of brain complexity using BEN in twenty stroke patients with motor deficits and nineteen matched healthy controls. The sample entropy (SampEn) was applied to build the BEN mapping for each participant. Compared with healthy controls, stroke patients exhibited lower BEN values in the contralesional precentral gyrus (preCG), bilateral dorsolateral frontal gyrus (SFGdor) and bilateral supplementary motor area (SMA). Moreover, significantly positive correlations between BEN values and Fugl-Meyer Assessment scores were detected in the ipsilesional SFGdor and ipsilesional SMA. Mutual information independence was observed between BEN and regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), respectively, in the stroke patients. Our findings implied that brain complexity had been impacted after stroke, and also suggested that BEN could be a complementary tool for evaluating the motor impairment after stroke.
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Affiliation(s)
- Liuke Liang
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510006, China
| | - Rongliang Hu
- Department of Rehabilitation Medicine, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Xuemao Luo
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Bao Feng
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou 510006, China; Shenzhen Research Institute of Sun Yat-sen University, Shenzhen, Guangdong, China.
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Bani-Ahmed AA. Post-stroke motor recovery and cortical organization following Constraint-Induced Movement Therapies: a literature review. J Phys Ther Sci 2019; 31:950-959. [PMID: 31871384 PMCID: PMC6879401 DOI: 10.1589/jpts.31.950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This review synthesizes findings from studies on two forms of Constraint-Induced Movement Therapies: the original Constraint-Induced Movement Therapy and the modified Constraint-Induced Movement Therapy, in adult stroke patients including the evidence, current limitations and future directions. [Methods] We critically reviewed studies evaluating the effectiveness of Constraint-Induced Movement Therapies in chronic stoke focusing on the functional (i.e. motor recovery) and the neural (i.e. cortical organization) levels. [Results] Constraint-Induced Movement Therapies seemed to improve the upper limb functional usage in chronic stoke with no reliable neurophysiological underlying mechanisms. The Motor Activity Log was the common outcome measuring motor recovery. The work that has been done on modified Constraint-Induced Movement Therapy was far less than the work done on the original Constraint-Induced Movement Therapy. [Conclusion] Evident lack of understanding of the association between changes in motor recovery and the underlying neural mechanisms in-terms of measures of assessing and defining functional recovery (i.e Motor Activity Log) that lacks sufficient sensitivity to characterize changes in movement strategies and thereby lack of distinction between recovery and behavioral compensation. Future studies should employ using kinematic metrics to quantify and explain the training-related changes in behavior following Constraint-Induced Movement Therapies in chronic stroke.
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Affiliation(s)
- Ali Ahmed Bani-Ahmed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk: 71491 Tabuk, KSA
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Morioka S, Osumi M, Nishi Y, Ishigaki T, Ishibashi R, Sakauchi T, Takamura Y, Nobusako S. Motor-imagery ability and function of hemiplegic upper limb in stroke patients. Ann Clin Transl Neurol 2019; 6:596-604. [PMID: 30911582 PMCID: PMC6414480 DOI: 10.1002/acn3.739] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/24/2018] [Accepted: 01/31/2019] [Indexed: 01/26/2023] Open
Abstract
Objectives We quantitatively examined the motor‐imagery ability in stroke patients using a bimanual circle‐line coordination task (BCT) and clarified the relationship between motor‐imagery ability and motor function of hemiplegic upper limbs and the level of use of paralyzed limbs. Methods We enrolled 31 stroke patients. Tasks included unimanual‐line (U‐L)—drawing straight lines on the nonparalyzed side; bimanual circle‐line (B‐CL)—drawing straight lines with the nonparalyzed limb while drawing circles with the paralyzed limb; and imagery circle‐line (I‐CL)—drawing straight lines on the nonparalyzed side during imagery drawing on the paralyzed side, using a tablet personal computer. We calculated the ovalization index (OI) and motor‐imagery ability (image OI). We used the Fugl–Meyer motor assessment (FMA), amount of use (AOU), and quality of motion (QOM) of the motor activity log (MAL) as the three variables for cluster analysis and performed mediation analysis. Results Clusters 1 (FMA <26 points) and 2 (FMA ≥26 points) were formed. In cluster 2, we found significant associations between image OI and FMA, AOU, and QOM. When AOU and QOM were mediated between image OI and FMA, we observed no significant direct association between image OI and FMA, and a significant indirect effect of AOU and QOM. Interpretation In stroke patients with moderate‐to‐mild movement disorder, image OI directly affects AOU of hemiplegic upper limbs and their QOM in daily life and indirectly influences the motor functions via those parameters.
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Affiliation(s)
- Shu Morioka
- Neurorehabilitation Research Center Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan.,Department of Neurorehabilitation Graduate School of Health Sciences Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan.,Department of Neurorehabilitation Graduate School of Health Sciences Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan
| | - Yuki Nishi
- Department of Neurorehabilitation Graduate School of Health Sciences Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan
| | - Tomoya Ishigaki
- Department of Neurorehabilitation Graduate School of Health Sciences Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan
| | - Rintaro Ishibashi
- Department of Rehabilitation Murata Hospital 4-2-1Tashima, Ikuno Osaka 544-0011 Japan
| | - Tsukasa Sakauchi
- Department of Physical Therapy Honjyo Orthopedic Surgery Clinic 5-5-15, Inadera Amagasaki Hyogo 661-0981 Japan
| | - Yusaku Takamura
- Department of Neurorehabilitation Graduate School of Health Sciences Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan
| | - Satoshi Nobusako
- Neurorehabilitation Research Center Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan.,Department of Neurorehabilitation Graduate School of Health Sciences Kio University 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun Nara 635-0832 Japan
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Christie LJ, McCluskey A, Lovarini M. Constraint-induced movement therapy for upper limb recovery in adult neurorehabilitation: An international survey of current knowledge and experience. Aust Occup Ther J 2019; 66:401-412. [PMID: 30714621 DOI: 10.1111/1440-1630.12567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Constraint-induced movement therapy (CIMT) is an effective intervention for upper limb recovery following stroke and traumatic brain injury. Despite strong evidence, the use of CIMT in practice is limited. The aim of this study was to investigate clinician knowledge and experience of delivering CIMT protocols internationally in neurorehabilitation. METHODS A cross-sectional survey was conducted online. The survey was distributed through occupational therapy and physiotherapy associations, neurological interest groups and list serves in 11 countries. Passive snowball sampling was used to recruit participants. Descriptive and inferential statistics were used for analysis. RESULTS Complete surveys were returned by 169 respondents (64.5% occupational therapists; 34.3% physiotherapists; 1.2% other). Most respondents were from the United Kingdom (36.1%), Australia (28.4%) and Denmark (7.7%). Most participants delivered CIMT to individuals (79.3%) rather than in groups. A modified version of CIMT was used most often (74.6%), with one hour sessions per day (30.2%), provided to stroke survivors (96.4%) and people with traumatic brain injury (37.3%). Most respondents (88.8%) used intensive graded practice as a component of a CIMT program, but only 43.2% reported using a mitt restraint for most waking hours, and only 38.5% used a transfer package. CONCLUSION These findings suggest that CIMT is being used globally but not always with fidelity to the original trials. A range of strategies are needed for improving clinicians' knowledge and skills to increase the frequency of program delivery and enhance program delivery with fidelity.
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Affiliation(s)
- Lauren J Christie
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Liverpool Hospital Brain Injury Rehabilitation Unit, South Western Sydney Local Health District (SWSLHD), Liverpool, NSW, Australia.,Brain Injury Rehabilitation Research Group (BIRRG), The Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,The StrokeEd Collaboration, Sydney, NSW, Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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12
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Llorens R, Noé E, Alcañiz M, Deutsch JE. Time since injury limits but does not prevent improvement and maintenance of gains in balance in chronic stroke. Brain Inj 2017; 32:303-309. [PMID: 29278927 DOI: 10.1080/02699052.2017.1418905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the influence of time since injury on the efficacy and maintenance of gains of rehabilitation of balance after stroke. METHOD Forty-seven participants were assigned to a least (6-12 months), a moderate (12-24 months), or a most chronic (>24 months) group. Participants trained for 20 one-hour sessions, administered three to five times a week, combining conventional physical therapy and visual feedback-based exercises that trained the ankle and hip strategies. Participants were assessed before, after the intervention, and one month later with a posturography test (Sway Speed and Limits of Stability) and clinical scales. RESULTS In contrast to other subjects, the most chronic participants failed to improve their sway and to maintain the benefits detected in the Limits of Stability after the intervention. Although all the participants improved in those clinical tests that better matched the trained skills, time since injury limited the improvement, and over all, the maintenance of gains. CONCLUSION Time since injury limits but does not prevent improvement in chronic stages post-stroke, and this effect appears to be more pronounced with maintaining gains. These findings support that training duration and intensity as well as type of therapy may need to be adjusted based on time post-stroke.
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Affiliation(s)
- Roberto Llorens
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain.,b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Enrique Noé
- b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Mariano Alcañiz
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain
| | - Judith E Deutsch
- c Rivers Lab, Department of Movement and Rehabilitation Sciences , Rutgers University-School of Professions , Newark , USA
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Stock R, Thrane G, Anke A, Gjone R, Askim T. Early versus late-applied constraint-induced movement therapy: A multisite, randomized controlled trial with a 12-month follow-up. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 23. [PMID: 28686338 DOI: 10.1002/pri.1689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/26/2017] [Accepted: 05/06/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE A direct comparison between the effects of constraint-induced movement therapy (CIMT) applied early after stroke and that of CIMT applied in the chronic phase has not been conducted. This study aimed to compare the long-term effects of CIMT applied 6 months after stroke with the results of CIMT applied within 28 days post-stroke. METHODS This study was a single-blinded, multicentre, randomized controlled trial with a crossover design. Forty-seven patients received CIMT either early (within 28 days) or 6 months after stroke. Both groups received standard rehabilitation and were tested at 5 time points. The primary outcome measure was Wolf Motor Function Test (WMFT); the secondary measures were Nine-Hole Peg Test (NHPT), the Fugl-Meyer Assessment (FMA) of the upper extremity, Stroke Impact Scale, and Modified Rankin Scale (MRS). RESULTS Compared with baseline data, both groups showed significant improvements in the primary and secondary outcome measures after 12 months. No significant differences between the 2 treatment groups were found before and after the delayed intervention group received CIMT at 6 months and during the 12-month follow-up. Both groups recovered considerably and showed only minor impairment (median FMA score of 64) after 6 months. The early intervention group showed an initially faster recovery curve of WMFT, NHPT, and MRS scores. DISCUSSION In contrast to most CIMT studies, our study could not find an effect of CIMT applied 6 months after stroke. Our results indicate that commencing CIMT early is as good as delayed intervention in the long term, specifically in this group of patients who might have reached a ceiling effect during the first 6 months after stroke. Nevertheless, the early CIMT intervention group showed a faster recovery curve than the delayed intervention group, which can be a clinically important finding for patients in the acute phase.
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Affiliation(s)
- Roland Stock
- Department of Physical Medicine and Rehabilitation, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ragna Gjone
- Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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14
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Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis. Int J Rehabil Res 2017; 39:197-210. [PMID: 27123790 DOI: 10.1097/mrr.0000000000000169] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique designed to improve upper extremity motor functions after stroke. This review aimed to investigate evidence of the effect of CIMT on upper extremity in stroke patients and to identify optimal methods to apply CIMT. Four databases (MEDLINE, EMBASE, CINHAL, and PEDro) and reference lists of relevant articles and reviews were searched. Randomized clinical trials that studied the effect of CIMT on upper extremity outcomes in stroke patients compared with other rehabilitative techniques, usual care, or no intervention were included. Methodological quality was assessed using the PEDro score. The following data were extracted for each trial: patients' characteristics, sample size, eligibility criteria, protocols of CIMT and control groups, outcome measurements, and the PEDro score. A total of 38 trials were identified according to the inclusion criteria. The trials included were heterogeneous in CIMT protocols, time since stroke, and duration and frequency of treatment. The pooled meta-analysis of 36 trials found a heterogeneous significant effect of CIMT on upper extremity. There was no significant effect of CIMT at different durations of follow-up. The majority of included articles did not fulfill powered sample size and quality criteria. The effect of CIMT changed in terms of sample size and quality features of the articles included. These meta-analysis findings indicate that evidence for the superiority of CIMT in comparison with other rehabilitative interventions is weak. Information on the optimal dose of CIMT and optimal time to start CIMT is still limited.
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15
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Andrade SM, Santos NA, Fernández-Calvo B, Boggio PS, Oliveira EA, Ferreira JJ, Sobreira A, Morgan F, Medeiros G, Cavalcanti GS, Gadelha ID, Duarte J, Marrocos J, Silva MA, Rufino T, Nóbrega SR. Stroke Treatment Associated with Rehabilitation Therapy and Transcranial DC Stimulation (START-tDCS): a study protocol for a randomized controlled trial. Trials 2016; 17:56. [PMID: 26822418 PMCID: PMC4731905 DOI: 10.1186/s13063-016-1186-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/19/2016] [Indexed: 11/16/2022] Open
Abstract
Background Traditional treatment for motor impairment after stroke includes medication and physical rehabilitation. The transcranial direct current stimulation associated with a standard physical therapy program may be an effective therapeutic alternative for these patients. Methods This study is a sham-controlled, double-blind, randomized clinical trial aiming to evaluate the efficacy of transcranial direct current stimulation in activities of daily living and motor function post subacute stroke. In total there will be 40 patients enrolled, diagnosed with subacute, ischemic, unilateral, non-recurring stroke. Participants will be randomized to two groups, one with active stimulation and the other with a placebo current. Patients and investigators will be blinded. Everyone will receive systematic physical therapy, based on constraint-induced movement therapy. The intervention will be applied for 10 consecutive days. Patients will undergo three functional assessments: at baseline, week 2, and week 4. Neuropsychological tests will be performed at baseline and week 4. Adverse effects will be computed at each session. On completion of the baseline measures, randomization will be conducted using random permuted blocks. The randomization will be concealed until group allocation. Discussion This study will investigate the combined effects of transcranial direct current stimulation and physical therapy on functional improvement after stroke. We tested whether the combination of these treatments is more effective than physical therapy alone when administered in the early stages after stroke. Trial registration NCT02156635 - May 30, 2014. Randomization is ongoing (40 participants randomized as of the end of December 2015).
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Affiliation(s)
- Suellen M Andrade
- Cognitive Neuroscience and Behavior Program, Federal University of Paraíba, João Pessoa, Brazil.
| | - Natanael A Santos
- Perception, Neurosciences and Behavior Laboratory, Federal University of Paraíba, João Pessoa, Brazil.
| | | | - Paulo S Boggio
- Cognitive Neuroscience Laboratory and Developmental Disorders Program, Mackenzie Presbyterian University, São Paulo, Brazil.
| | - Eliane A Oliveira
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - José J Ferreira
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Amanda Sobreira
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Felipe Morgan
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Germana Medeiros
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Gyovanna S Cavalcanti
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Ingrid D Gadelha
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Jader Duarte
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Joercia Marrocos
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Michele A Silva
- Center for Research in Human Movement Sciences, Federal University of Paraíba, João Pessoa, Brazil.
| | - Thatiana Rufino
- Study Group of Human Movement, Federal University of Paraíba, João Pessoa, Brazil.
| | - Sanmy R Nóbrega
- Neuromuscular Adaptations Laboratory, Federal University of São Carlos, São Carlos, Brazil.
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Batool S, Soomro N, Amjad F, Fauz R. To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke. Pak J Med Sci 2015; 31:1167-71. [PMID: 26649007 PMCID: PMC4641276 DOI: 10.12669/pjms.315.7910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke. Method: A sample of 42 patients was recruited from the Physiotherapy Department of IPM&R and Neurology OPD of Civil Hospital Karachi through non probability purposive sampling technique. Twenty one patients were placed to each experimental and control groups. Experimental group was treated with Constraint Induced Movement Therapy (CIMT) and control group was treated with motor relearning programme (MRP) for three consecutive weeks. Pre and post treatment measurements were determined by upper arm section of Motor Assessment Scale (MAS) and Self Care item of Functional Independence Measure (FIM) Scale. Results: Intra group analysis showed statistically significant results (p-value<0.05) in all items of MAS in both groups. However, advanced hand activities item of MAS in MRP group showed insignificant result (p-value=0.059). Self-care items of FIM Scale also showed significant result (p-value< 0.05) in both groups except dressing upper body item (p-value=0.059) in CIMT group and grooming and dressing upper body items (p-value=0.059 & 0.063) in MRP group showed insignificant p-values. Conclusion: CIMT group showed more significant improvement in motor function and self-care performance of hemiplegic upper extremity as compared to MRP group in patients with sub-acute stroke assessed by the MAS and FIM scales. Thus CIMT is proved to be more statistically significant and clinically effective intervention in comparison to motor relearning programme among the patients aged between 35-60 years. Further studies are needed to evaluate CIMT effects in acute and chronic post stroke population.
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Affiliation(s)
- Sana Batool
- Sana Batool, MSPT. Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Nabila Soomro
- Dr. Nabila Soomro, FCPS. Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Fareeha Amjad
- Fareeha Amjad, MSPT. Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Rabia Fauz
- Rabia Fauz, MSc. PT. Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
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The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke. BIOMED RESEARCH INTERNATIONAL 2015; 2015:175719. [PMID: 26649295 PMCID: PMC4663281 DOI: 10.1155/2015/175719] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/21/2015] [Indexed: 01/15/2023]
Abstract
Objective. Gait performance is an indicator of mobility impairment after stroke. This study evaluated changes in balance, lower extremity motor function, and spatiotemporal gait parameters after receiving body weight supported treadmill training (BWSTT) and conventional overground walking training (CT) in patients with subacute stroke using 3D motion analysis. Setting. Inpatient department of rehabilitation medicine at a university-affiliated hospital. Participants. 24 subjects with unilateral hemiplegia in the subacute stage were randomized to the BWSTT (n = 12) and CT (n = 12) groups. Parameters were compared between the two groups. Data from twelve age matched healthy subjects were recorded as reference. Interventions. Patients received gait training with BWSTT or CT for an average of 30 minutes/day, 5 days/week, for 3 weeks. Main Outcome Measures. Balance was measured by the Brunel balance assessment. Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale. Kinematic data were collected and analyzed using a gait capture system before and after the interventions. Results. Both groups improved on balance and lower extremity motor function measures (P < 0.05), with no significant difference between the two groups after intervention. However, kinematic data were significantly improved (P < 0.05) after BWSTT but not after CT. Maximum hip extension and flexion angles were significantly improved (P < 0.05) for the BWSTT group during the stance and swing phases compared to baseline. Conclusion. In subacute patients with stroke, BWSTT can lead to improved gait quality when compared with conventional gait training. Both methods can improve balance and motor function.
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Corbetta D, Sirtori V, Castellini G, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev 2015; 2015:CD004433. [PMID: 26446577 PMCID: PMC6465192 DOI: 10.1002/14651858.cd004433.pub3] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In people who have had a stroke, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitative interventions. Despite preserving or recovering movement ability after stroke, sometimes people do not fully realise this ability in their everyday activities. Constraint-induced movement therapy (CIMT) is an approach to stroke rehabilitation that involves the forced use and massed practice of the affected arm by restraining the unaffected arm. This has been proposed as a useful tool for recovering abilities in everyday activities. OBJECTIVES To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in people with hemiparesis after stroke. SEARCH METHODS We searched the Cochrane Stroke Group trials register (last searched June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library Issue 1, 2015), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), CINAHL (1982 to January 2015), and the Physiotherapy Evidence Database (PEDro; January 2015). SELECTION CRITERIA Randomised control trials (RCTs) and quasi-RCTs comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none. DATA COLLECTION AND ANALYSIS One author identified trials from the results of the electronic searches according to the inclusion and exclusion criteria, three review authors independently assessed methodological quality and risk of bias, and extracted data. The primary outcome was disability. MAIN RESULTS We included 42 studies involving 1453 participants. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little, if at all. The majority of studies were underpowered (median number of included participants was 29) and we cannot rule out small-trial bias. Eleven trials (344 participants) assessed disability immediately after the intervention, indicating a non-significant standard mean difference (SMD) 0.24 (95% confidence interval (CI) -0.05 to 0.52) favouring CIMT compared with conventional treatment. For the most frequently reported outcome, arm motor function (28 studies involving 858 participants), the SMD was 0.34 (95% CI 0.12 to 0.55) showing a significant effect (P value 0.004) in favour of CIMT. Three studies involving 125 participants explored disability after a few months of follow-up and found no significant difference, SMD -0.20 (95% CI -0.57 to 0.16) in favour of conventional treatment. AUTHORS' CONCLUSIONS CIMT is a multi-faceted intervention where restriction of the less affected limb is accompanied by increased exercise tailored to the person's capacity. We found that CIMT was associated with limited improvements in motor impairment and motor function, but that these benefits did not convincingly reduce disability. This differs from the result of our previous meta-analysis where there was a suggestion that CIMT might be superior to traditional rehabilitation. Information about the long-term effects of CIMT is scarce. Further trials studying the relationship between participant characteristics and improved outcomes are required.
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Affiliation(s)
- Davide Corbetta
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Valeria Sirtori
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Greta Castellini
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
| | - Lorenzo Moja
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanItaly20133
| | - Roberto Gatti
- University Vita‐Salute San RaffaeleSchool of PhysiotherapyVia Olgettina, 58MilanItaly20132
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Kwakkel G, Veerbeek JM, van Wegen EEH, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol 2015; 14:224-34. [PMID: 25772900 DOI: 10.1016/s1474-4422(14)70160-7] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for the rehabilitation of patients. Original CIMT includes constraining of the non-paretic arm and task-oriented training. Modified versions also apply constraining of the non-paretic arm, but not as intensive as original CIMT. Behavioural strategies are mostly absent for both modified and original CIMT. With forced use therapy, only constraining of the non-paretic arm is applied. The original and modified types of CIMT have beneficial effects on motor function, arm-hand activities, and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas there is no evidence for the efficacy of constraint alone (as used in forced use therapy). The type of CIMT, timing, or intensity of practice do not seem to affect patient outcomes. Although the underlying mechanisms that drive modified and original CIMT are still poorly understood, findings from kinematic studies suggest that improvements are mainly based on adaptations through learning to optimise the use of intact end-effectors in patients with some voluntary motor control of wrist and finger extensors after stroke.
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Affiliation(s)
- Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands; Amsterdam Rehabilitation Research Center, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands.
| | - Janne M Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
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Charlotte Brunner I, Sture Skouen J, Inger Strand L. Recovery of Upper Extremity Motor Function Post Stroke with Regard to Eligibility for Constraint-Induced Movement Therapy. Top Stroke Rehabil 2015; 18:248-57. [DOI: 10.1310/tsr1803-248] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Castellini G, Gianola S, Banzi R, Corbetta D, Gatti R, Sirtori V, Gluud C, Moja L. Constraint-induced movement therapy: trial sequential analysis applied to Cochrane collaboration systematic review results. Trials 2014; 15:512. [PMID: 25542215 PMCID: PMC4307139 DOI: 10.1186/1745-6215-15-512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 12/10/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Trial sequential analysis (TSA) may establish when firm evidence about the efficacy of interventions is reached in a cumulative meta-analysis, combining a required information size with adjusted thresholds for conservative statistical significance. Our aim was to demonstrate TSA results on randomized controlled trials (RCTs) included in a Cochrane systematic review on the effectiveness of constraint-induced movement therapy (CIMT) for stroke patients. METHODS We extracted data on the functional independence measure (FIM) and the action research arm test (ARAT) from RCTs that compared CIMT versus other rehabilitative techniques. Mean differences (MD) were analyzed using a random-effects model. We calculated the information size and the cumulative Z-statistic, applying the O'Brien-Fleming monitoring boundaries. RESULTS We included data from 14 RCTs. In the conventional meta-analysis (seven trials, 233 patients), the effect of CIMT on FIM was reported as significant (MD 2.88, 95% CI 0.08 to 5.68; P = 0.04). The diversity-adjusted required information size was 142 patients, and the cumulative Z-score did not cross the trial sequential monitoring boundary for benefit (adjusted 95% CI -0.02 to 5.78). The effect of CIMT on ARAT (nine trials, 199 patients) was reported as significant (MD 7.78, 95% CI 1.19 to 14.37; P = 0.02). However, the diversity-adjusted required information size was 252 patients, and the Z-score did not cross the trial sequential monitoring boundary for benefit (adjusted 95% CI -0.06 to 15.62). CONCLUSIONS Although conventional meta-analyses of CIMT reached statistical significance, their overall results remain inconclusive and might be spurious. Researchers should not be overconfident on CIMT efficacy based on the results of meta-analyses and derived recommendations.
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Affiliation(s)
- Greta Castellini
- />Health Professional Science of Rehabilitation, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Silvia Gianola
- />Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Rita Banzi
- />IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, 19, 20156 Milan, Italy
| | - Davide Corbetta
- />Unit of Functional Recovery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Roberto Gatti
- />Unit of Functional Recovery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- />School of Physiotherapy, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Valeria Sirtori
- />Unit of Functional Recovery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Christian Gluud
- />Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Lorenzo Moja
- />Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
- />Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36, 20133 Milano, Italy
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Treger I, Aidinof L, Lehrer H, Kalichman L. Modified Constraint-Induced Movement Therapy Improved Upper Limb Function in Subacute Poststroke Patients: A Small-Scale Clinical Trial. Top Stroke Rehabil 2014; 19:287-93. [DOI: 10.1310/tsr1904-287] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Farmer SE, Durairaj V, Swain I, Pandyan AD. Assistive Technologies: Can They Contribute to Rehabilitation of the Upper Limb After Stroke? Arch Phys Med Rehabil 2014; 95:968-85. [DOI: 10.1016/j.apmr.2013.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/29/2013] [Accepted: 12/08/2013] [Indexed: 11/16/2022]
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Aloraini SM, Mackay-Lyons M, Boe S, McDonald A. Constraint-induced movement therapy to improve paretic upper-extremity motor skills and function of a patient in the subacute stage of stroke. Physiother Can 2014; 66:56-9. [PMID: 24719510 DOI: 10.3138/ptc.2012-51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Saleh M Aloraini
- School of Physiotherapy, Dalhousie University ; College of Applied Medical Sciences, Qassim University, Saudi Arabia
| | | | - Shaun Boe
- School of Physiotherapy, Dalhousie University
| | - Alison McDonald
- Acquired Brain Injury Program, QEII Health Sciences Centre, Halifax, N.S
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Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014; 9:e87987. [PMID: 24505342 PMCID: PMC3913786 DOI: 10.1371/journal.pone.0087987] [Citation(s) in RCA: 684] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. METHODS AND FINDINGS Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. CONCLUSIONS There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
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Affiliation(s)
- Janne Marieke Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland van Peppen
- Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Philip Jan van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marc Rietberg
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
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Stevenson T, Thalman L, Christie H, Poluha W. Constraint-Induced Movement Therapy Compared to Dose-Matched Interventions for Upper-Limb Dysfunction in Adult Survivors of Stroke: A Systematic Review with Meta-analysis. Physiother Can 2013; 64:397-413. [PMID: 23997396 DOI: 10.3138/ptc.2011-24] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To summarize the existing literature examining constraint-induced movement therapy (CIMT), relative to dose-matched control interventions, for upper-limb (UL) dysfunction in adult survivors of stroke. METHODS CINAHL, Cochrane Library, Embase, NARIC/CIRRIE-Rehabdata, PEDro, PubMed, Scopus, and Web of Science were searched from their inception to February 2011. Trial quality was described using the PEDro scale. The findings were summarized with meta-analysis. RESULTS For the 22 trials identified, the mean (SD) PEDro score was 6.4 (1.2). Meta-analysis showed CIMT to be superior to dose-matched interventions based on indicators of UL motor capacity (15 trials, n=432; standardized mean difference [SMD]=0.47, 95% CI, 0.27-0.66) and UL ability (14 trials, n=352; SMD=0.80, 95% CI, 0.57-1.02); Functional Independence Measure scores (6 trials, n=182; mean difference [MD]=5.05, 95% CI, 2.23-7.87); and Motor Activity Log scores (Amount of Use: 12 trials, n=318; MD=1.05, 95% CI, 0.85-1.24; Quality of Movement: 11 trials, n=330; MD=0.89, 95% CI, 0.69-1.08). CONCLUSIONS Compared to control interventions of equal duration and dose, CIMT produced greater improvements in a variety of indicators of UL function in adult survivors of a stroke with residual movement of their upper limb.
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Affiliation(s)
- Ted Stevenson
- Department of Rehabilitation Services, St. Boniface Hospital
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Simpson LA, Eng JJ. Functional recovery following stroke: capturing changes in upper-extremity function. Neurorehabil Neural Repair 2012; 27:240-50. [PMID: 23077144 DOI: 10.1177/1545968312461719] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Augmenting changes in recovery is core to the rehabilitation process following a stroke. Hence it is essential that outcome measures are able to detect change as it occurs, a property known as responsiveness. This article critically reviewed the responsiveness of functional outcome measures following stroke, specifically examining tools that captured upper-extremity (UE) functional recovery. METHODS A systematic search of the literature was undertaken to identify articles providing responsiveness data for 3 types of change (observed, detectable, and important). RESULTS Data from 68 articles for 14 UE functional outcome measures were retrieved. Larger percentage changes were required to be considered important when obtained through anchor-based methods (eg, based on patient opinion or comparative measure) compared with distribution methods (eg, statistical estimates). Larger percentage changes were required to surpass the measurement error for patient-perceived functional measures (eg, Motor Activity Log) compared with laboratory-based performance measures (eg, Action Research Arm Test). The majority of rehabilitation interventions have similar effect sizes on patient-perceived UE function and laboratory-based UE function. CONCLUSIONS The magnitude of important change or change that surpasses measurement error can vary substantially depending on the method of calculation. Rehabilitation treatments can affect patient perceptions of functional change as effectively as laboratory-based functional measures; however, larger sample sizes may be required to account for the larger measurement error associated with patient-perceived functional measures.
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Brunner IC, Skouen JS, Strand LI. Is modified constraint-induced movement therapy more effective than bimanual training in improving arm motor function in the subacute phase post stroke? A randomized controlled trial. Clin Rehabil 2012; 26:1078-86. [DOI: 10.1177/0269215512443138] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Iris Charlotte Brunner
- Department of Public Health and Primary Health Care, Unit for Neurorehabilitation, University of Bergen, Bergen, Norway
| | - Jan Sture Skouen
- Department of Public Health and Primary Health Care, Unit for Neurorehabilitation, University of Bergen, Bergen, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Liv Inger Strand
- Department of Public Health and Primary Health Care, Unit for Neurorehabilitation, University of Bergen, Bergen, Norway
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Constraint-Induced Movement Therapy (CIMT): Current Perspectives and Future Directions. Stroke Res Treat 2012; 2012:159391. [PMID: 22577601 PMCID: PMC3345246 DOI: 10.1155/2012/159391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 11/17/2022] Open
Abstract
Constraint-induced movement therapy (CIMT) has gained considerable popularity as a treatment technique for upper extremity rehabilitation among patients with mild-to-moderate stroke. While substantial evidence has emerged to support its applicability, issues remain unanswered regarding the best and most practical approach. Following the establishment of what can be called the "signature" CIMT approach characterized by intense clinic/laboratory-based practice, several distributed forms of training, collectively known as modified constraint therapy (mCIMT), have emerged. There is a need to examine the strengths and limitations of such approaches, and based upon such information, develop the components of a study that would compare the signature approach to the best elements of mCIMT, referred to here as "alternative" CIMT. Based upon a PEDro review of literature, limitations in mCIMT studies for meeting criteria were identified and discussed. A suggestion for a "first effort" at a comparative study that would both address such limitations while taking practical considerations into account is provided.
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Peurala SH, Kantanen MP, Sjögren T, Paltamaa J, Karhula M, Heinonen A. Effectiveness of constraint-induced movement therapy on activity and participation after stroke: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2011; 26:209-23. [DOI: 10.1177/0269215511420306] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To examine the effect of constraint-induced movement therapy and modified constraint-induced movement therapy on activity and participation of patients with stroke (i.e. the effect of different treatment durations and frequency) by reviewing the results of randomized controlled trials. Data sources: A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, PEDro, OTSeeker, CENTRAL and by manual search. Review methods: Randomized controlled trials for patients over 18 years old with stroke and published in Finnish, Swedish, English or German were included. Studies were collected up to the first week in May 2011. The evidence was high, moderate, low or no evidence according to the quality of randomized controlled trial and the results of meta-analyses. Results: Search resulted in 30 papers reporting constraint-induced movement therapy, including 27 randomized controlled trials published between 2001 and 2011. Constraint-induced movement therapy practice for 60–72 hours over two weeks produced better mobility (i.e. ability to carry, move and handle objects) with high evidence compared to control treatment. Constraint-induced movement therapy for 20–56 hours over two weeks, 30 hours over three weeks and 15–30 hours over 10 weeks improved mobility of the affected upper extremity. However, with self-care as an outcome measure, only 30 hours of constraint-induced movement therapy practice over three weeks demonstrated an improvement. Conclusion: Constraint-induced movement therapy and modified constraint-induced movement therapy proved to be effective on affected hand mobility and to some extent self-care on the World Health Organization’s International Classification of Functioning, Disability and Health activity and participation component, but further studies are needed to find out the optimal treatment protocols for constraint-induced movement therapy.
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Affiliation(s)
- Sinikka H Peurala
- Department of Health Sciences, Gerontology Research Centre, University of Jyväskylä, Finland
- Department of Psychology, Intervention and Brain University Alliance, University of Jyväskylä, Finland
| | - Mari P Kantanen
- Department of Health Sciences, Gerontology Research Centre, University of Jyväskylä, Finland
- Jyväskylä University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
- Department of Physical Medicine and Rehabilitation, Central Hospital, Jyväskylä, Finland
| | - Tuulikki Sjögren
- Lahti University of Applied Sciences, Faculty of Social and Health Care, Finland
- Department of Health Sciences, University of Jyväskylä, Finland
| | - Jaana Paltamaa
- Jyväskylä University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
- Department of Physical Medicine and Rehabilitation, Central Hospital, Jyväskylä, Finland
- Department of Health Sciences, University of Jyväskylä, Finland
| | - Maarit Karhula
- Department of Health Sciences, University of Jyväskylä, Finland
- Foundation for Research and Development GeroCenter, Jyväskylä, Finland
| | - Ari Heinonen
- Department of Health Sciences, Gerontology Research Centre, University of Jyväskylä, Finland
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Shindo K, Fujiwara T, Hara J, Oba H, Hotta F, Tsuji T, Hase K, Liu M. Effectiveness of Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy in Patients With Subacute Stroke. Neurorehabil Neural Repair 2011; 25:830-7. [DOI: 10.1177/1545968311408917] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and objective. Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy was devised to facilitate the use of the hemiparetic upper extremity in daily life by combining assistive neuromuscular electrical stimulation, referred to as the integrated volitional electrical stimulator (IVES), with a splint. The aim of this study is to assess the effectiveness of HANDS therapy for patients with subacute stroke. Methods. The participants were 24 inpatients receiving rehabilitation for hemiparetic stroke within 60 days of onset. Entry criteria included inability to individuate finger extension. Patients were randomly assigned to 2 groups. The HANDS group (n = 12) used the IVES combined with a wrist splint for 8 hours a day for 3 weeks, and the control group (n = 12) wore a wrist splint alone. All patients received the same daily dose and length of standard poststroke multidisciplinary rehabilitation. Outcome measures were the upper extremity portion of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log-14 (MAL). Results. In all, 10 patients in each group completed the interventions. Compared with the control group, the HANDS group showed significantly greater gains in distal (wrist/hand) portion of the FMA ( P < .01) and improvement of the ARAT ( P < .05). The gains in the MAL did not differ. No adverse effects occurred and the HANDS therapy was well accepted. Conclusion. HANDS therapy in addition to conventional therapy may improve hand function in patients with moderate to severe hand impairment during early rehabilitation.
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Affiliation(s)
- Keiichiro Shindo
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
- Keio University School of Medicine, Tokyo, Japan
| | | | - Joji Hara
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Hideki Oba
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Fujiko Hotta
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | | | | | - Meigen Liu
- Keio University School of Medicine, Tokyo, Japan
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Abstract
Sensory and motor representations embedded in topographic cortical maps are use-dependent, dynamically maintained, and self-organizing functional mosaics that constitute idiosyncratic entities involved in perceptual and motor learning abilities. Studies of cortical map plasticity have substantiated the view that local reorganization of sensory and motor areas has great significance in recovery of function following brain damage or spinal cord injury. In addition, the transfer of function to distributed cortical areas and subcortical structures represents an adaptive strategy for functional compensation. There is a growing consensus that subject-environment interactions, by continuously refining the canvas of synaptic connectivity and reshaping the anatomical and functional architecture of neural circuits, promote adaptive behavior throughout life. Taking advantage of use-dependent neural plasticity, early initiated rehabilitative procedures improve the potential for recovery.
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Affiliation(s)
- Christian Xerri
- Integrative and Adaptive Neurosciences, University of Provence/CNRS, Marseille, France
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Effects of Sensory Cueing on Voluntary Arm Use for Patients With Chronic Stroke: A Preliminary Study. Arch Phys Med Rehabil 2011; 92:15-23. [DOI: 10.1016/j.apmr.2010.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/04/2010] [Indexed: 11/18/2022]
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Tariah HA, Almalty AM, Sbeih Z, Al-Oraibi S. Constraint induced movement therapy for stroke survivors in Jordon: a home-based model. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.12.638] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hashem Abu Tariah
- Assistant professor, Vice Dean, Faculty of Allied Health Sciences, Chairman, Department of Occupational Therapy, Hashemite University, Jordan
| | - Abdul-Majeed Almalty
- Assistant Professor, Allied Health Faculty, and Chairman, Department of Physical Therapy, Hashemite University, Jordan
| | - Ziad Sbeih
- Consultant of Physical Medicine and Rehabilitation, and Chairman of the Department of Physical Medicine and Rehabilitation, Al-Bashir Hospital, Jordan
| | - Saleh Al-Oraibi
- Assistant Professor, Allied Health Faculty, Physiotherapy Department, Hashemite University, Jordan
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Leung DPK, Ng AKY, Fong KNK. Effect of small group treatment of the modified constraint induced movement therapy for clients with chronic stroke in a community setting. Hum Mov Sci 2009; 28:798-808. [PMID: 19837473 DOI: 10.1016/j.humov.2009.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 03/05/2009] [Accepted: 04/18/2009] [Indexed: 10/20/2022]
Abstract
This study investigated the effects of the group treatment component of the modified constraint induced movement therapy (mCIMT) protocol for clients with chronic stroke in a community setting. A within-subjects longitudinal study was conducted to which eight participants with chronic stroke being treated in a community setting in Hong Kong were recruited. Ten 3-h group sessions were conducted on two occasions within a four-week period, with four participants per group. Participants' less-affected hands were restrained in a mitt, with a target of wearing it for 4h per weekday. Laboratory based tests and the Motor Activity Log (MAL) were used repeatedly to measure participants' hemiparetic upper extremity functions and the use of the limb in real-life on four measurement occasions: at baseline (four weeks before training), pre-test (one day before training), post-test (one day after training), and follow-up (four weeks after training). The Wilcoxon signed-rank test showed participants' baselines were stable four weeks before the intervention. The Friedman test found significant differences between pre-test, post-test and follow-up in the Box and Block Test (BBT), the total score, grasp and pinch subscores of the Action Research Arm Test (ARAT), and the Hong Kong Version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK), the Wolf Motor Function Test (WMFT), and the MAL. All these gains were maintained during the 1-month follow-up. The small group treatment component of the mCIMT was found to be effective, feasible, and capable of improving both motor performance and functional use of the affected upper extremity for patients with chronic stroke in a community setting.
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Affiliation(s)
- Daniel P K Leung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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36
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Sirtori V, Corbetta D, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in stroke patients. Cochrane Database Syst Rev 2009:CD004433. [PMID: 19821326 DOI: 10.1002/14651858.cd004433.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In stroke patients, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitation programmes for hemiparetic patients. Constraint-induced movement therapy (CIMT) is a current approach to stroke rehabilitation that implies the forced use and the massed practice of the affected arm by restraining the unaffected arm. OBJECTIVES To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in hemiparetic patients. SEARCH STRATEGY We searched the Cochrane Stroke Group trials register (last searched June 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), MEDLINE (1966 to June 2008), EMBASE (1980 to June 2008), CINAHL (1982 to June 2008), and the Physiotherapy Evidence Database (PEDro) (June 2008). SELECTION CRITERIA Randomised control trials (RCTs) and quasi-RCTs (qRCTs) comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none. DATA COLLECTION AND ANALYSIS Two review authors independently classified the identified trials according to the inclusion and exclusion criteria, assessed methodological quality and extracted data. The primary outcome was disability. MAIN RESULTS We included 19 studies involving 619 participants. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little if at all. Only five studies had adequate allocation concealment. The majority of studies were underpowered (median number of included patients was 15) and we cannot rule out small-trial bias. Six trials (184 patients) assessed disability immediately after the intervention, indicating a significant standard mean difference (SMD) of 0.36, 95% confidence interval (CI) 0.06 to 0.65. For the most frequently reported outcome, arm motor function (11 studies involving 373 patients), the SMD was 0.72 (95% CI 0.32 to 1.12). There were only two studies that explored disability improvement after a few months of follow up and found no significant difference, SMD -0.07 (95% CI -0.53 to 0.40). AUTHORS' CONCLUSIONS CIMT is a multifaceted intervention: the restriction to the normal limb is accompanied by a certain amount of exercise of the appropriate quality. It is associated with a moderate reduction in disability assessed at the end of the treatment period. However, for disability measured some months after the end of treatment, there was no evidence of persisting benefit. Further randomised trials, with larger sample sizes and longer follow up, are justified.
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Affiliation(s)
- Valeria Sirtori
- Unita Operativa di Recupero e Rieducazione Funzionale, Fondazione Centro San Raffaele del Monte Tabor, via Olgettina, 58, Milan, Lombardia, Italy, 20132
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Abstract
Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed. In this Review, we aimed to provide an overview of the available evidence on interventions for motor recovery after stroke through the evaluation of systematic reviews, supplemented by recent randomised controlled trials. Most trials were small and had some design limitations. Improvements in recovery of arm function were seen for constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, and robotics. Improvements in transfer ability or balance were seen with repetitive task training, biofeedback, and training with a moving platform. Physical fitness training, high-intensity therapy (usually physiotherapy), and repetitive task training improved walking speed. Although the existing evidence is limited by poor trial designs, some treatments do show promise for improving motor recovery, particularly those that have focused on high-intensity and repetitive task-specific practice.
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Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med 2009; 52:269-93. [DOI: 10.1016/j.rehab.2008.10.003] [Citation(s) in RCA: 231] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 10/06/2008] [Indexed: 11/27/2022]
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Hammer A, Lindmark B. Is forced use of the paretic upper limb beneficial? A randomized pilot study during subacute post-stroke recovery. Clin Rehabil 2009; 23:424-33. [PMID: 19321522 DOI: 10.1177/0269215508101734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of two weeks of forced use of the paretic upper limb, as a supplement to the rehabilitation programme in the subacute phase after stroke, on self-rated use of that limb. DESIGN A randomized, non-blind, parallel group, clinical, before-and-after trial. A forced use group and a conventional group were followed up one and three months after intervention. SETTING In- and outpatient units of rehabilitation at a University Hospital. SUBJECTS Thirty patients were allocated to two groups, 15 in each, 1-6 months (mean 2.4) after stroke onset. Twenty-six patients completed the study. INTERVENTIONS The patients of both groups participated in two weeks of daily training on weekdays. In addition, the forced use group wore a restraining sling on the non-paretic arm for up to 6 hours per weekday. MAIN MEASURE The Motor Activity Log; patients scored 0-5 for 30 daily tasks concerning both amount of use and quality of movement. RESULTS The forced use group tended to achieve larger improvements immediately post-intervention, but this was not clearly demonstrated. The small differences also levelled out up to the three-month follow-up, with both groups earning an approximately 1.0 score point on both scales of the Motor Activity Log. CONCLUSIONS This pilot study did not reveal any additional benefit of forced use on self-rated performance in daily use of the paretic upper limb. Both groups performed fairly extensive, active training with a similar duration, amount and content.
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Affiliation(s)
- Ann Hammer
- Department of Rehabilitation Medicine, Orebro University Hospital, School of Health and Medical Sciences, Orebro University, Orebro.
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Ng AK, Leung DP, Fong KN. Clinical Utility of the Action Research Arm Test, the Wolf Motor Function Test and the Motor Activity Log for Hemiparetic Upper Extremity Functions After Stroke: A Pilot Study. Hong Kong J Occup Ther 2008. [DOI: 10.1016/s1569-1861(08)70009-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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