Application Of Constraint-induced Movement Therapy Research Articles

The Mechanism and Clinical Application of Constraint-Induced Movement Therapy in Stroke Rehabilitation.

Constraint-induced movement therapy (CIMT) has been widely applied in stroke rehabilitation, and most relevant studies have shown that CIMT helps improve patients’ motor function. In practice, however, principal issues include inconsistent immobilization durations and methods, while incidental issues include a narrow application scope and an emotional impact. Although many studies have explored the possible internal mechanisms of CIMT, a mainstream understanding has not been established.

Online Survey on Clinical Application of Constraint-Induced Movement Therapy in Children with Hemiplegic Cerebral Palsy in Korea

Online Survey on Clinical Application of Constraint-Induced Movement Therapy in Children with Hemiplegic Cerebral Palsy in Korea

A web-based carepartner-integrated rehabilitation program for persons with stroke: study protocol for a pilot randomized controlled trial

BackgroundFamily carepartner management and support can improve stroke survivor recovery, yet research has placed little emphasis on how to integrate families into the rehabilitation process without increasing negative carepartner outcomes. Our group has developed creative approaches for engaging family carepartners in rehabilitation activities to improve physical and psychosocial health for both the carepartner and stroke survivor. The purpose of this study is to explore a novel, web-based intervention (Carepartner and Constraint-Induced Therapy; CARE-CITE) designed to facilitate positive carepartner involvement during a home-based application of constraint-induced movement therapy (CIMT) for the upper extremity.MethodsThe primary aim of the study is to determine feasibility of CARE-CITE for both stroke survivors and their carepartners. Carepartner mental health, family conflict surrounding stroke recovery, and stroke survivor upper extremity function will be evaluated using an evaluator blinded, two-group experimental design (blocked randomization protocol according to a 2:1 randomization schema) with 32 intervention dyads and 16 control dyads (who will receive CIMT without structured carepartner involvement). CARE-CITE consists of online education modules for the carepartner to review in parallel to the 30-h CIMT that the stroke survivor receives. The intent of CARE-CITE is to enhance the home-based intervention of CIMT, by helping the carepartner support the therapy and create a therapeutic home environment encouraging practice of the weaker arm in functional tasks.DiscussionThe CARE-CITE study is testing the feasibility of a family-integrated rehabilitation approach applied in the home environment, and results will provide the foundation for larger clinical studies. The overall significance of this research plan is to increase the understanding and further development of interventions that may serve as models to promote family involvement in the rehabilitation process.Trial registrationClinicalTrials.gov, NCT02703532. Registered 9 March 2016

Feasibility of application of constraint-induced movement therapy in a child with hemiplegic cerebral palsy: A single-case study

Children suffering from hemiplegic cerebral palsy (CP) develop developmental disregard (DD). In addition, they fail to comprehend the consequences of nonuse. The utility of affected upper limb is jeopardized. Current evidence supports the use of constraint-induced movement therapy (CIMT) for upper limb function in individuals with hemiplegia. This single-case study attempts to identify feasibility of application of pediatric CIMT on a child with hemiplegic CP. The aim of this study is to identify the benefits and feasibility of application of CIMT for improving quality of the upper limb movement in a child with hemiplegic CP. A 2½-year-old girl with hemiplegic CP visited the outpatient department (OPD) with the problem of lack of use of the right upper limb for activities and play along with the poorer quality of the upper limb movement. Disregard index was calculated to identify the presence of DD. CIMT was chosen as the child had above minimal ability to open fingers and extend the wrist. A 2-week intervention was designed based on the goal-oriented, ability-specific, child-specific practice of functional tasks. A rigid tape was used to provide constraint. The child was motivated to play with the affected hand for 2 h in the OPD and 2 h at home. Tasks of incremental difficulty were utilized as shaping method. The improvement in the quality of movement was measured using quality of upper extremity skilled test (QUEST) and Assisting Hand Assessment (AHA). The score on QUEST improved from 66.35 to 72.1, AHA improved from 66 to 73, and the disregard index score improved from 42.75 to 26.3 in 2 weeks. The treatment was adjusted to accommodate the behavior of the child.

The Effect of Different Occupational Therapy Techniques on Post-stroke Patients

Abstract. Aim: To evaluate the effect of constraint-induced movement and mirror therapy on stroke patients’ arm function, independence, and cognitive functions during occupational therapy. Materials and methods: The study included 36 ischemic stroke patients. The subjects were randomly distributed into two groups: group 1 consisted of 18 patients who underwent constraint-induced movement therapy, and group 2 consisted of 18 patients who underwent mirror therapy. The function of the affected arm in the subjects was evaluated by applying the Frenchay Arm Test, and the patients’ independence level was evaluated by using the Functional Independence Measure. The Mini-Mental State Examination was applied for the evaluation of changes in the subjects’ cognitive functions. Results: A significant improvement in the function of the affected arm, independence, and cognitive functions was observed in both patient groups. The comparison of the results between the groups showed that group 2 patients demonstrated statistically significantly better results of the changes in the arm function when performing Frenchay Arm Test tasks. Conclusion: The application of mirror therapy in stroke patients during inpatient rehabilitation proved to be more effective in restoring the function of the affected arm (when evaluating the task performance speed), compared to the application of constraint-induced movement therapy.

EFFECT OF THE APPLICATION OF CONSTRAINT- INDUCED MOVEMENT THERAPY ON THE RECOVERY OF AFFECTED HAND FUNCTION AFTER STROKE

Background. Research aim was to evaluate the effect of the application of constraint-induced movement therapy on the recovery of affected hand function after stroke. Research hypothesis: The application of constraint-induced movement therapy on the recovery of affected hand function after stroke would be more effective than the application of conventional physiotherapy. Methods. The study employed the Mini Mental State Examination (MMSE), Lovett’s test, Modified Movement Assessment Scale (MMAS) hydraulic dynamometer, and Wolf Motor Function Test. Results. Results showed that constraint – induced movement therapy for patients after stroke helps to recover injured hand movement more effectively (p < .05), enhances performance of functional tasks (p < .05) and also increases muscle strength (p < .05) compared to conventional physiotherapy. Conclusions. After the application of the conventional physiotherapy for patients after stroke affected hand movements and functional task performance improved and the hand grip strength increased statistically significantly. Applying the constraint-induced movement therapy for patients after stroke affected hand movements and functional task performance improved and the hand grip strength increased statistically significantly. The application of constraint-induced movement therapy for patients after stroke statistically significantly more improved the affected hand function than the application of conventional physiotherapy.

Application of Constraint-Induced Movement Therapy in Clinical Practice: An Online Survey

ObjectiveTo investigate current knowledge and application in practice of constraint-induced movement therapy (CIMT) by therapists within the United Kingdom. DesignAn online 19-item survey. SettingNeurological rehabilitation. ParticipantsOccupational therapists and physiotherapists (N=489) currently working or within 3 months of working with the adult acquired brain injury population were recruited from 2 specialist interest groups. InterventionsDatabase administrators of 2 specialist interest groups circulated an e-mail to all therapists on the database to invite them to complete the online survey. Main Outcome MeasuresNot applicable. ResultsMost therapists (62.9%, n=306) had not used CIMT. Those who had used it were only using 2 or 3 components of the core 7-component CIMT protocol. Therapists identified 2 main barriers to the implementation of CIMT: lack of resources (staffing; 20.7%, n=63) and lack of training (20%, n=61). ConclusionsAdoption into practice remains limited. Despite a significant evidence base in support of CIMT, most therapists are not using CIMT in practice. This article indicates how concerns and barriers related to CIMT may be minimized to translate this robust intervention from research into clinical practice.

Application of constraint-induced movement therapy in hemiplegic subjects—EMG analysis of muscle recruitment

Application of constraint-induced movement therapy in hemiplegic subjects—EMG analysis of muscle recruitment

Application of Constraint-induced Movement Therapy for People with Severe Chronic Plegic Hand

Application of Constraint-induced Movement Therapy for People with Severe Chronic Plegic Hand

Evidence-based therapies for upper extremity dysfunction

The diversity of interventions aimed at improving upper extremity dysfunction is increasing. This article reviews the effectiveness of different therapeutic approaches that have been published in 2009 and 2010. Evidence is based on randomized controlled trials, systematic reviews, and meta-analyses. Application of constraint-induced movement therapy in acute stroke patients was not more effective than a control intervention, and a more intense therapy may even be harmful. Botulinum toxin injections do not only reduce spasticity but, in children, also improve motor functions if combined with occupational therapy. Strength training improves arm function but not necessarily activities of daily living. Bilateral arm training is as effective as other interventions. Extrinsic feedback and sensory training may further improve motor functions. Mirror therapy was particularly effective for patients with initial hand plegia. For some interventions (e.g. constraint-induced movement therapy, botulinum toxin), efficacy is evident, for others (e.g. mental practice, virtual reality), well designed studies with sufficient numbers of patients are needed. The ultimate goal still is to develop evidence-based therapies for all different degrees of motor impairment.

Constraint-induced movement therapy in stroke rehabilitation: Perspectives on future clinical applications

Results from studies supporting the application of constraint-induced movement therapy (CI therapy) in patients with stroke have steadily increased over the past decade. The exploration of this intervention has provided a broad foundation from which to build further development of evidence-based practice in neurorehabilitation. This article first provides an update on CI therapy efficacy based on the relative chronicity of stroke and the functional levels of participants from whom data have been acquired. A review of current considerations is discussed, including guidelines for screening criteria, the role of the patient and family during the intervention, options for various delivery modes and suggestions to monitor outcomes. Finally, future directions are explored through identification of integrated approaches with CI therapy including: robotics, virtual environments, mental imagery, pharmaceutical manipulations and cortical stimulation. Clinical application of a research based intervention should not occur in isolation. CI therapy researchers should be charged to define the critical aspects of this therapy and appropriate adjunctive interventions that augment its applicability and effectiveness.

Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke

This study explored relationships between upper-limb (UL) functional limitations and self-reported disability in stroke patients with relatively pure motor hemiparesis who were enrolled in an acute rehabilitation treatment trial. All participants were enrolled in the VECTORS (Very Early Constraint Treatment for Recovery from Stroke) study. VECTORS is a single-center pilot clinical trial of early application of constraint-induced movement therapy (CIMT). All 39 subjects who completed 90 days of VECTORS were included in this analysis. Trained study personnel who were blinded to the treatment type performed all evaluations. Data in this article examine relationships between assessments performed 90 days after stroke. Functional limitation measures included the Action Research Arm (ARA) test and Wolf Motor Function Test (WMFT), and self-reported disability measures included the Functional Independence Measure (FIM) and Motor Activity Log (MAL) (by telephone). Mean plus or minus standard deviation time from stroke onset to randomization was 9.4 plus or minus 4.3 days, and median time to follow-up was 99 days (range 68-178). Subjects with perfect or near-perfect scores on the ARA test or WMFT reported residual disability on the FIM and MAL. Quality of movement on the WMFT (functional ability score) was not strongly associated with self-reported frequency, and speed of movement on the WMFT (timed score) was not associated with self-reported frequency (MAL amount of use). In this early UL intervention trial, we found that perceived disability measures captured information that was not assessed by functional limitation and impairment scales. Our results indicate that excellent motor recovery as measured by functional limitation and impairment scales did not equal restoration of everyday productive UL use and speed of task completion did not translate to actual use. Our results confirm the need for a measurement strategy that is sensitive to change, assesses a broad performance range, and detects meaningful clinical improvements in early rehabilitation intervention trials.

Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia

Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.

Does the Application of Constraint-Induced Movement Therapy During Acute Rehabilitation Reduce Arm Impairment After Ischemic Stroke?

Motor dysfunction after unilateral deafferentation in primates can be overcome by restraining the unaffected limb. We asked whether a constraint-induced movement (CIM) program could be implemented within 2 weeks after stroke and whether CIM is more effective than traditional upper-extremity (UE) therapies during this period. Twenty-three persons were enrolled in a pilot randomized, controlled trial that compared CIM with traditional therapies. A blinded observer rated the primary end point, the Action Research Arm Test (ARA). Inclusion criteria were the following: ischemic stroke within 14 days, persistent hemiparesis, evidence of preserved cognitive function, and presence of a protective motor response. Differences between the groups were compared by using Student's t tests, ANCOVA, and Mann-Whitney U: tests. Twenty subjects completed the 14-day treatment. Two adverse outcomes, a recurrent stroke and a death, occurred in the traditional group; 1 CIM subject met rehabilitation goals and was discharged before completing 14 inpatient days. The CIM treatment group had significantly higher scores on total ARA and pinch subscale scores (P:<0.05). Differences in the mean ARA grip, grasp, and gross movement subscale scores did not reach statistical significance. UE activities of daily living performance was not significantly different between groups, and no subject withdrew because of pain or frustration. A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatment. Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies.

An Application of Upper-Extremity Constraint-Induced Movement Therapy in a Patient With Subacute Stroke

The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a "learned nonuse phenomenon." The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). For the Wolf Motor Function Test, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both "how well" and "how much" the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.