Abstract
Background Constraint-induced movement therapy (CIMT) is effective in improving motor outcomes after stroke. However, its existing protocols are resource-intensive and difficult to implement. The aim of this study is to design an easier CIMT protocol using number of repetitions of shaping practice. Method The study design was randomized controlled trial. Participants within 4 weeks after stroke were recruited at Murtala Muhammad Specialist Hospital. They were randomly assigned to groups A, B, C, and D. Group A received 3 hours of traditional therapy. Groups B, C, and D received modified CIMT consisting of 3 hours of shaping practice per session, 300 repetitions of shaping practice in 3 sessions, and 600 repetitions of shaping practice in 3 sessions per day, respectively, and constraint for 90% of the waking hours. All treatment protocols were administered 5 times per week for 4 weeks. The primary outcome was measured using upper limb Fugl-Meyer assessment, while the secondary outcome was measured using motor activity log, Wolf Motor Function Test, and upper limb self-efficacy test at baseline, 2 weeks, and 4 weeks after intervention. Result There were 48 participants 4 weeks after intervention. The result showed that there was no significant difference between groups at baseline (p > 0.05). Within-group improvements attained minimal clinically important difference (MCID) in modified CIMT and 300 repetitions and 600 repetitions groups. Conclusion Number of repetitions of shaping practice significantly improved motor function, real-world arm use, and upper limb self-efficacy after stroke. Therefore, it seems to be a simple alternative for the use of number of hours. Trial Registration This trial is registered with Pan African Clinical Trial Registry (registration number: PACTR201610001828172) (date of registration: 21/10/2016).
Highlights
Constraint-induced movement therapy (CIMT) is effective in improving motor outcomes after stroke
The effectiveness of CIMT is demonstrated in improving various outcomes after stroke such as laboratory and real-world arm use and changes in the brain activity and metabolism and movement precision, and quality has been reported in the literature [3,4,5,6]
In the existing protocols of CIMT, patients may have to spend between 0.5 and 6 hours per day practicing task or shaping coupled with wearing a constraint for several hours to 95% of the waking hours
Summary
Constraint-induced movement therapy (CIMT) is effective in improving motor outcomes after stroke. Number of repetitions of shaping practice significantly improved motor function, real-world arm use, and upper limb self-efficacy after stroke. It seems to be a simple alternative for the use of number of hours. In the existing protocols of CIMT, patients may have to spend between 0.5 and 6 hours per day practicing task or shaping coupled with wearing a constraint for several hours to 95% of the waking hours. These kinds of protocols seem to be resource-intensive [7] and may be difficult to adopt where there are constraints in the availability of staff and service affordability by the patients. It is difficult to know how much task or shaping the patients practiced when number of hours is used as a component of dose of task practice
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