Limited dose response to Constraint-Induced Movement Therapy in patients with chronic stroke

Abstract

Objective: To compare outcomes in motor skill, perceived amount of use and ability of the paretic arm in daily activities between traditional Constraint-Induced Movement Therapy, consisting of 6 hours of in-clinic, therapist-guided task practice, and a shortened Constraint-Induced Movement Therapy, consisting of 1 hour of in clinic, therapist-guided task practice coupled with 5 hours of unsupervised practice at home. Design: A secondary analysis of two previous randomized, controlled, double-blind, parallel group studies. Setting: A research clinic. Participants: Thirty-nine individuals with hemiparesis from a chronic unilateral stroke who were able to extend the wrist 10° and the fingers and thumb 10° from a flexed position and were participants in one of the two studies examining the efficacy of adding neuroplasticity adjuvants to Constraint-Induced Movement Therapy. Main outcome measures: The Wolf Motor Function Test was used to assess motor skill and the Motor Activity Log amount of use and quality of movement scales were used to assess perceived amount of use and ability respectively. Interventions: Constraint-Induced Movement Therapy plus donepezil in the CIMT-6 study (the traditional 6 hours of in-clinic task practice) and Constraint-Induced Movement Therapy plus repetitive transcranial magnetic stimulation in the CIMT-1 study (1 hour of in-clinic task practice). Results: Motor skill gains after two weeks of therapy were equivalent for both groups (n=39; mean difference=2.81, P>0.22), but gains were not maintained six months later with either intervention protocol. Despite this, participants in the CIMT-6 group reported greater use (mean difference=1.52, P<0.001) and movement quality (mean difference=0.95, P<0.004) than those with less therapist-guided practice. Both groups had regressed somewhat in use and ability at the six-month follow-up. Conclusion: These results suggest that 6 hours of therapist-guided practice may not be necessary to facilitate motor skill gains, but may influence patterns of use.