Abstract
Background: Constraint-induced movement therapy (CIMT) promotes upper extremity recovery post stroke, however, it is difficult to implement clinically due to its high resource demand and safety of the restraint. Therefore, we propose that modified CIMT (mCIMT) be used to treat individuals with acute subcortical infarction.Objective: To evaluate the therapeutic effects of mCIMT in patients with acute subcortical infarction, and investigate the possible mechanisms underlying the effect.Methods: The role of mCIMT was investigated in 26 individuals experiencing subcortical infarction in the preceding 14 days. Patients were randomly assigned to either mCIMT or standard therapy. mCIMT group was treated daily for 3 h over 10 consecutive working days, using a mitt on the unaffected arm for up to 30% of waking hours. The control group was treated with an equal dose of occupational therapy and physical therapy. During the 3-month follow-up, the motor functions of the affected limb were assessed by the Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL). Altered cortical excitability was assessed via transcranial magnetic stimulation (TMS).Results: Treatment significantly improved the movement in the mCIMT group compared with the control group. The mean WMF score was significantly higher in the mCIMT group compared with the control group. Further, the appearance of motor-evoked potentials (MEPs) were significantly higher in the mCIMT group compared with the baseline data. A significant change in ipsilesional silent period (SP) occurred in the mCIMT group compared with the control group. However, we found no difference between two groups in motor function or electrophysiological parameters after 3 months of follow-up.Conclusions: mCIMT resulted in significant functional changes in timed movement immediately following treatment in patients with acute subcortical infarction. Further, early mCIMT improved ipsilesional cortical excitability. However, no long-term effects were seen.
Highlights
MATERIALS AND METHODSStroke significantly increases the mortality and morbidity in the developed as well as developing world (Sudlow and Warlow, 1997; Terént, 2003; Truelsen et al, 2003; Mehndiratta et al, 2015)
One patient refused the 3-month follow-up, and another patient was lost to follow-up in the modified CIMT (mCIMT) group
Normal distribution variables were compared by one way of variance analysis. abnormal distribution variables were compared by Mann-Whitney U-test
Summary
MATERIALS AND METHODSStroke significantly increases the mortality and morbidity in the developed as well as developing world (Sudlow and Warlow, 1997; Terént, 2003; Truelsen et al, 2003; Mehndiratta et al, 2015). 80% of stroke survivors manifest motor impairments associated with the upper limb (Langhorne et al, 2009; Momosaki et al, 2016). Constraint-induced movement therapy (CIMT) promotes movement of upper extremities affected by paralytic stroke. Original CIMT protocol need constraint of the unaffected hand for approximately 90% of waking hours, but some individuals with hemiplegia cannot tolerate this long limit, and there are some security issues, especially in acute stroke patients. Compared with original CIMT protocol, the modified CIMT (mCIMT) protocols were feasible and well tolerated in acute stroke patients (Souza et al, 2015). Constraint-induced movement therapy (CIMT) promotes upper extremity recovery post stroke, it is difficult to implement clinically due to its high resource demand and safety of the restraint. We propose that modified CIMT (mCIMT) be used to treat individuals with acute subcortical infarction
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