Comparison of Constraint Induced Movement Therapy and Neuromuscular Electrical Simulation on Clinical Outcomes in Chronic Stroke

Abstract

Background and Purpose: Stroke is a leading cause of functional impairment. A wide range of therapeutic techniques for post stroke rehabilitation exist, however methodology, cost and modes of action vary and no evidence based guidelines exist for their use. A direct comparison of these techniques would help in the development of the same. In this study, we compare the disability outcomes of Constraint Induced Movement Therapy (CIMT) and Neuromuscular Electrical Stimulation (NMES) in chronic stroke. Methods: It was a prospective non-randomized clinical trial. One hundred twenty six patients who met the inclusion criteria were alternatively assigned to either the CIMT group (n=63) or the NMES group (n=63). Both therapies were given for 8 weeks duration. Patients were assessed using Modified Rankin Scale (mRS), Barthel Index(BI), Fugl-Meyer Scale(FMA) and Motor Assessment Scale at baseline and at two and four month of treatment. Results: Both CIMT and NMES groups showed significant improvement from baseline (p<0.001). The CIMT group showed catch up improvement in BI (p<0.001) and FMA scales (p<0.001) at the two month follow up visit. At the four month follow up visit, there was no significant difference in scores between the groups across all scales. Conclusion: CIMT and NMES are effective techniques for post stroke rehabilitation. Although CIMT may show a greater improvement in initial stages, there is no difference in clinical outcomes at a later stage. KeywordsStroke, Rehabilitation, Constraint Induced Movement Therapy, Neuromuscular Electrical Stimulation