Constraint-induced Movement Therapy Group Research Articles

Effectiveness of Mirror Therapy, Electrical Stimulation, and CIMT in Restoring Upper Extremity Function after Stroke

Objective: This study aimed to compare the effectiveness of mirror therapy (MT), electrical stimulation (EMS) combined with MT, and Constraint-Induced Movement Therapy (CIMT) in improving upper extremity function among stroke survivors. Methodology: A randomized controlled trial was conducted involving n=45 stroke patients undergoing rehabilitation at Wah International Hospital. The inclusion criteria for the study required participants to be above 45 years of age, to have survived either an ischemic or haemorrhagic stroke, and to have at least 10° wrist extension. Participants were excluded if they had an implanted electrical device such as an artificial pacemaker, paresis instead of paralysis, hemiplegia due to causes other than ischemic or haemorrhagic stroke (such as trauma, tumor, or coordination problems), or impaired sensory integration. Participants were divided into three groups: EMS combined with MT, CIMT alone, and Mirror therapy alone. Treatment sessions were administered four times a week for three months. Outcome measures included the Fugl-Meyer Assessment Scale (FMA) and Motor Assessment Scale (MAS). Results: Analysis revealed significant improvements in upper extremity function across all groups. However, the CIMT group exhibited the most substantial enhancement, with a mean difference of -68.5 (p < 0.05) on the FMA and -24.1 (p < 0.05) on the MAS compared to the other groups. Conclusion: The findings highlight the superior efficacy of CIMT in improving upper extremity function among stroke survivors. Incorporating CIMT into rehabilitation protocols is crucial for optimizing outcomes in this patient population. Further research is warranted to explore the long-term benefits and optimal implementation strategies of CIMT in diverse rehabilitation settings

Effect of Constraint-Induced Movement Therapy (CIMT) on Upper Extremity Function in Stroke Patients

Background: Stroke is a leading cause of disability worldwide, with upper extremity impairments presenting significant rehabilitation challenges. Constraint-Induced Movement Therapy (CIMT) has emerged as a potential intervention for enhancing upper limb functionality, but its efficacy compared to traditional therapy methods requires further exploration. Objective: The study aimed to evaluate the effectiveness of CIMT versus traditional therapy in improving upper extremity function among stroke survivors. Methods: In this quasi-experimental study, 58 stroke patients from Aziz Fatima and Allied Hospital in Faisalabad were recruited and allocated to either the CIMT group (n=29) or the traditional therapy group (n=29). Eligible participants were those aged 30-50 years with ischemic or infarctive stroke and impaired use of their hemiparetic arm. The CIMT group received standard treatment plus CIMT, while the traditional group received only standard treatment, including manual therapy and TENS, for 8 weeks. Pre- and post-treatment assessments utilized the Upper Extremity Motor Activity Log (UEMAL) scales. Data analysis was conducted using SPSS version 25, employing independent t-tests. Results: The CIMT group showed a significant improvement in the UEMAL Amount Scale (pre-treatment: 1.64 ± 0.51, post-treatment: 3.04 ± 0.75; p=0.000) and the UEMAL How Well Scale (pre-treatment: 2.28 ± 0.57, post-treatment: 3.81 ± 0.55; p=0.000). The traditional therapy group also demonstrated gains but to a lesser extent (UEMAL Amount Scale pre-treatment: 1.08 ± 0.24, post-treatment: 1.69 ± 0.33; UEMAL How Well Scale pre-treatment: 1.47 ± 0.30, post-treatment: 2.11 ± 0.40; p=0.000 for both). Conclusion: CIMT provided significant functional improvements in upper extremity motor activity compared to traditional therapy, suggesting that CIMT may be a more effective approach for post-stroke rehabilitation of the upper limb.

Constraint-Induced Movement Therapy Promotes Myelin Remodeling and Motor Function by Mediating Sox2/Fyn Signals in Rats With Hemiplegic Cerebral Palsy.

Hypoxic-ischemic brain injury in infants often leads to hemiplegic motor dysfunction. The mechanism of their motor dysfunction has been attributed to deficiencies of the transcription factor sex-determining region (SRY) box 2 (Sox2) or the non-receptor-type tyrosine kinase Fyn (involved in neuronal signal transduction), which causes a defect in myelin formation. Constraint-induced movement therapy (CIMT) following cerebral hypoxia-ischemia may stimulate myelin growth by regulating Sox2/Fyn, Ras homolog protein family A (RhoA), and rho-associated kinase 2 (ROCK2) expression levels. This study investigated how Sox2/Fyn regulates myelin remodeling following CIMT to improve motor function in rats with hemiplegic cerebral palsy (HCP). To investigate the mechanism of Sox2 involvement in myelin growth and neural function in rats with HCP, Lentivirus (Lenti)-Sox2 adeno-associated virus and negative control-Lenti-Sox2 (LS) adeno-associated virus were injected into the lateral ventricle. The rats were divided into a control group and an HCP group with different interventions (CIMT, LS, or negative control-LS [NS] treatment), yielding the HCP, HCP plus CIMT (HCP + CIMT), HCP + LS, HCP + LS + CIMT, HCP + NS, and HCP + NS + CIMT groups. Front-limb suspension and RotaRod tests, Golgi-Cox staining, transmission electron microscopy, immunofluorescence staining, western blotting, and quantitative polymerase chain reaction experiments were used to analyze the motor function, dendrite/axon area, myelin ultrastructure, and levels of expression of oligodendrocytes and Sox2/Fyn/RhoA/ROCK2 in the motor cortex. The rats in the HCP + LS + CIMT group had better values for motor function, dendrite/axon area, myelin ultrastructure, oligodendrocytes, and Sox2/Fyn/RhoA/ROCK2 expression in the motor cortex than rats in the HCP and HCP + NS groups. The improvement of motor function and myelin remodeling, the expression of oligodendrocytes, and the expression of Sox2/Fyn/RhoA/ROCK2 in the HCP + LS group were similar to those in the HCP + CIMT group. CIMT might overcome RhoA/ROCK2 signaling by upregulating the transcription of Sox2 to Fyn in the brain to induce the maturation and differentiation of oligodendrocytes, thereby promoting myelin remodeling and improving motor function in rats with HCP. The pathway mediated by Sox2/Fyn could be a promising therapeutic target for HCP.

Comparative Efficacy of Constrained Induced Movement Therapy and Motor-Relearning Program in Post Stroke Upper Extremity Function

Background: Stroke often leads to significant impairments in motor function, particularly in the upper extremities. Constraint-Induced Movement Therapy (CIMT) and Motor Relearning Program (MRP) are two rehabilitation approaches that have shown potential in addressing these deficits. This study aimed to compare the effectiveness of these two therapies in improving upper extremity function in post-stroke hemiplegia. Objective: To evaluate and compare the efficacy of CIMT and MRP in enhancing motor recovery and functional performance of the upper extremity in patients with post-stroke hemiplegia. Methods: This randomized controlled trial included patients aged 35-60 years diagnosed with ischemic or hemorrhagic stroke, confirmed by CT scans and MRI. Patients were randomly assigned to either the CIMT group or the MRP group, each comprising 16 participants. Both groups underwent respective therapies for two hours daily, six days a week, for four weeks. The Motor Assessment Scale and the Functional Independence Measure (FIM) Scale were employed for pre-, post-, and follow-up evaluations. Results: Both groups showed significant improvements in motor function and daily living activities. The CIMT group exhibited greater advancements, with notable increases in upper extremity strength and active range of motion in the shoulder, elbow, and wrist joints. Quantitative improvements in the CIMT group included an average increase of 2 points in Motor Assessment Scale scores and a 15% improvement in FIM scores. The MRP group demonstrated an average increase of 1.5 points in Motor Assessment Scale scores and a 10% improvement in FIM scores. Conclusion: While both CIMT and MRP are effective in improving motor function and daily living activities in patients with post-stroke hemiplegia, CIMT showed a slight edge in enhancing upper extremity strength and range of motion. These findings suggest that CIMT could be a more efficacious approach in the rehabilitation of upper extremity function in stroke patients.

The Effectiveness of Constraint-Induced Movement Therapy versus Traditional Occupational Therapy on Upper Limb Function after Stroke

Background: Stroke significantly impacts upper limb function, necessitating effective rehabilitation strategies. Constraint-Induced Movement Therapy (CIMT) and Traditional Occupational Therapy (OT) are widely used, yet their comparative effectiveness in improving upper limb function remains to be fully established. Objective: The aim was to compare the effectiveness of CIMT and traditional OT in enhancing upper limb function in stroke survivors. The comparison was based on changes in the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and the Stroke Impact Scale (SIS). Methods: This randomized clinical trial involved 40 adult stroke survivors, who were assigned to either CIMT (n=20) or traditional OT (n=20). Assessments using FMA-UE and SIS were conducted before and after the intervention. Data analysis was conducted using SPSS 22.0, included within-group and between-group comparisons using repeated-measures ANOVA and paired t-tests. Results: Both CIMT and traditional OT groups showed significant improvements in FMA-UE and SIS scores. The CIMT group's FMA-UE scores improved from a mean of 43.26 to 47.36 (p=0.006), and SIS scores from 43.99 to 49.03 (p=0.009). The traditional OT group displayed more substantial improvements, with FMA-UE scores increasing from 42.71 to 48.89 (p=0.001), and SIS scores from 44.31 to 50.04 (p=0.007). Between-group analysis revealed no significant differences at baseline, but post-intervention, traditional OT showed significantly better outcomes compared to CIMT. Conclusion: Both CIMT and traditional OT are effective in improving upper limb function and reducing stroke impact. Traditional OT, however, demonstrated a slightly greater improvement. These findings underscore the importance of incorporating diverse therapeutic approaches in stroke rehabilitation, tailored to individual patient needs.

Constraint therapy promotes motor cortex remodeling and functional improvement by regulating c-Jun/miR-182–5p/Nogo – A signals in hemiplegic cerebral palsy mice

BackgroundOur previous study has confirmed that constraint-induced movement therapy (CIMT) could promote neural remodeling in hemiplegic cerebral palsy (HCP) mice through Nogo-A/NgR/RhoA/ROCK signaling, however, the upstream mechanism was still unclear. Therefore, the present study aimed to further explore the mechanism of CIMT regulating the expression of Nogo-A in HCP mice. MethodHCP mice were well established through ligating the left common carotid artery of 7-day-old pups and being placed in a hypoxic box which was filled with a mixture of 8% oxygen and 92% nitrogen. CIMT intervention was conducted by taping to fix the entire arm of the contralateral side (left) to force the mice to use the affected limb (right). Bioinformatics prediction and luciferase experiment were performed to confirm that miR-182–5p was targeted with Nogo-A. The beam test and grip test were applied to examine the behavioral performance under the intervention of c-Jun and CIMT. Also, immunofluorescence, Golgi staining, and transmission electron microscopy were conducted to show that the lenti-expression of c-Jun could increases the expression of myelin, and downregulates the expression of Nogo-A under the CIMT on HCP mice. Result(1) The beam walking test and grip test experiment results showed that compared with the control group, the HCP + nCIMT group's forelimb grasping ability and balance coordination ability were decreased (P < 0.05). (2) The results of Golgi staining, and transmission electron microscopy showed that the thickness of myelin sheath and the density of dendritic spines in the HCP + nCIMT group were lower than those in the control group (P < 0.05). Compared with the HCP + nCIMT group, the cerebral cortex myelin sheath thickness, dendrite spine density and nerve filament expression were increased in HCP + CIMT group (P < 0.05). (3) Immunofluorescence staining showed that the expression of Nogo-A in the cerebral cortex of the HCP + nCIMT group was higher than that of the HCP + CIMT group (P < 0.05). Compared with the HCP + CIMT group, the expression of Nogo-A in the HCP + LC + CIMT group was decreased and, in the HCP, + SC + CIMT group was significantly increased (P < 0.05). Compared with the HCP + nCIMT group, the expression of c-Jun in the control, HCP + CIMT, HCP + LC + nCIMT and HCP + LC + CIMT groups was significantly increased, and in the HCP + SC + CIMT was decreased (P < 0.05). (4) Real-time quantitative polymerase chain reaction (RT-qPCR) results showed that the expression level of miR-182–5p in the HCP + LC + CIMT group was more increased than that in the HCP + nCIMT group (P < 0.05). The expression level of miR-182–5p in the HCP + LC + CIMT group was higher than that in the HCP + LC + nCIMT group and the HCP + SC + CIMT group (P < 0.05). ConclusionThese data identified that CIMT might stimulate the remodeling of neurons and myelin in the motor cortex by partially inhibiting the c-Jun/miR-182–5p/Nogo-A pathway, thereby facilitating the grasping performance and balance function of HCP mice.

Development of Hand Use with and Without Intensive Training Among Children with Unilateral Cerebral Palsy in Scandinavia

ABSTRACT Aim To describe hand use development in children with unilateral cerebral palsy who did/did not participate in constraint-induced movement therapy (CIMT) before 7 years of age. Method The study included 334 participants (18 months–12 years) who were assessed with 1,565 Assisting Hand Assessments (AHAs) and categorized into no intensive training (NIT), CIMT (18 months–7 years), and Baby-CIMT (<18 months) groups. Results AHA performance at 18 months (AHA-18) was positively associated with development regardless of training. The CIMT group had lower AHA-18 performance than the NIT group (p = .028), but higher stable limit (p = .076). The age when 90% of development was reached was highest in the CIMT group (p = .014). Although non-significant, the Baby-CIMT group had higher mean curve than NIT and CIMT combined (AHA-18 p = .459, limit p = .477). Conclusion The CIMT group improved more over time than the NIT group. Intensive training extended the window of development, and Baby-CIMT might promote early development.

Effects of constraint induced movement therapy in patients with multiple sclerosis: A systematic review.

Multiple sclerosis (MS) is a chronic neurodegenerative disorder of the central nervous system (CNS) that commonly affects young and middle-aged adults. Neurodegeneration of the CNS affects its functions such as sensorimotor, autonomic and cognitive functions. Affectation of motor function can result in disability in performance of daily life activities. Thus, effective rehabilitation interventions are needed to help prevent disability in patients with MS. One of these interventions is the constraint induced movement therapy (CIMT). The CIMT is used to improve motor function in patients with stroke and other neurological conditions. Recently, its use in patients with MS is gaining ground. The aim of this study is to carry out a systematic review and meta-analysis to determine from the literature, the effects of CIMT on upper limb function in patients with MS. PubMED, Embase, Web of Science (WoS), PEDro, and CENTRAL were searched until October 2022. Randomized controlled trials in patients with MS who were 18 years and above were included. Data on the characteristics of the study participants such as disease duration, type of MS, the mean scores of the outcomes of interest such as motor function and use of the arm in daily activities, and white matter integrity were extracted. Methodological quality and risks of bias of the included studies were assessed using PEDro scale and Cochrane risks of bias tool. The data was analysed using both narrative and quantitative syntheses. In the quantitative synthesis, random effect model meta-analysis of the mean and standard deviation of the scores on the outcomes of interest and the study sample size (for both the CIMT and the control group) post intervention was carried out. In addition, percentage of variation across the studies due to heterogeneity (I2) was considered significant when it is between 50% and 90% at p < 0.05. Two studies comprising of 4 published articles with good methodological quality were included in the study. The results showed that, CIMT is safe and improved white matter integrity, motor function, muscle strength, dexterity, real-world arm use and biomechanical parameters post intervention. However, although there was a trend towards better improvement in the CIMT group in all the outcomes, there was no statistically significant difference between groups in motor function (SMD=0.44, 95% CI=-0.20 to 1.07, p=0.18) and quality of movement (SMD=0.96, -1.15 to 3.07, p=0.37). CIMT can be used in patients with MS since it is safe as well as effective at improving functional outcomes. However, more studies are required to confirm its safety and effectiveness.

Effects of Intensive Versus Distributed Constraint-Induced Movement Therapy for Children With Unilateral Cerebral Palsy: A Quasi-Randomized Trial

Background Previous studies have compared the effectiveness of constraint-induced movement therapy (CIMT) by different training doses. However, whether the dosing schedule, that is, intensive or distributed, influences the effectiveness of CIMT in children with unilateral cerebral palsy (CP) is unknown. Objective To investigate the effectiveness of intensive and distributed CIMT for children with unilateral CP. Methods Fifty children with unilateral CP were assigned to intensive or distributed CIMT group with a total of 36 training hours. The intensive CIMT was delivered within 1 week, and the distributed CIMT was delivered twice a week for 8 weeks. The outcomes were the Melbourne Assessment 2, Box and Block Test, Pediatric Motor Activity Log-Revised (PMAL-R), Bruininks–Oseretsky test of motor proficiency 2, ABILHAND-Kids and Parenting Stress Index—Short Form. The intensive group was assessed at the initiation of treatment (week 0), at the end of 1 week treatment (week 1), and 8 weeks after the initiation of treatment (week 8). The distributed group was assessed at week 0 and week 8. Results The within-group analyses demonstrated significant differences on all motor outcomes. There were no significant between-group differences at post-treatment, while the intensive CIMT demonstrated larger improvements than the distributed CIMT did on quality of use of the more-affected hand, as rated by parents on the PMAL-R at week 8. Conclusions The 2 dosing schedules of CIMT had similar effectiveness for children with unilateral CP. The intensive CIMT yielded additional improvement on parent rated motor quality of the more-affected hand at 8 weeks after the initiation of treatment. Trial registration: ClinicalTrials.gov (ID: NCT03128385)

Retrospective Analysis of Task-Specific Effects on Brain Activity After Stroke: A Pilot Study.

BackgroundEvidence supports cortical reorganization in sensorimotor areas induced by constraint-induced movement therapy (CIMT). However, only a few studies examined the neural plastic changes as a function of task specificity. This retrospective analysis aims to evaluate the functional brain activation changes during a precision and a power grasp task in chronic stroke survivors who received 2-weeks of CIMT compared to a no-treatment control group.MethodsFourteen chronic stroke survivors, randomized to CIMT (n = 8) or non-CIMT (n = 6), underwent functional MRI (fMRI) before and after a 2-week period. Two behavioral measures, the 6-item Wolf Motor Function Test (WMFT-6) and the Motor Activity Log (MAL), and fMRI brain scans were collected before and after a 2-week period. During scan runs, participants performed two different grasp tasks (precision, power). Pre to post changes in laterality index (LI) were compared by group and task for two predetermined motor regions of interest: dorsal premotor cortex (PMd) and primary motor cortex (MI).ResultsIn contrast to the control group, the CIMT group showed significant improvements in the WMFT-6. For the MAL, both groups showed a trend toward greater improvements from baseline. Two weeks of CIMT resulted in a relative increase in activity in a key region of the motor network, PMd of the lesioned hemisphere, under precision grasp task conditions compared to the non-treatment control group. No changes in LI were observed in MI for either task or group.ConclusionThese findings provide preliminary evidence for task-specific effects of CIMT in the promotion of recovery-supportive cortical reorganization in chronic stroke survivors.

The Effect of Constraint-Induced Movement Therapy Combined With Repetitive Transcranial Magnetic Stimulation on Hand Function in Preschool Children With Unilateral Cerebral Palsy: A Randomized Controlled Preliminary Study.

Constraint-induced movement therapy (CIMT) combined with repetitive transcranial magnetic stimulation (rTMS) have shown great potential in improving function in schoolchildren with unilateral cerebral palsy attributed to perinatal stroke. However, the prospect of application in preschool children with unilateral cerebral palsy (UCP) attributed to various brain disorders remains unclear. In this prospective, assessor-blinded, randomized controlled study, 40 preschool children with UCP (aged 2.5–6 years) were randomized to receive 10 days of CIMT combined with active or sham rTMS. Assessments were performed at baseline, 2 weeks, and 6 months post-intervention to investigate upper limb extremity, social life ability, and perceived changes by parents and motor-evoked potentials. Overall, 35 participants completed the trial. The CIMT plus active stimulation group had greater gains in the affected hand function (range of motion, accuracy, and fluency) than the CIMT plus sham stimulation group (P < 0.05), but there was no significant difference in muscular tone, social life ability, and perceived changes by parents between the two groups (P > 0.05). In addition, there was no significant difference in hand function between children with and without motor-evoked potential (P > 0.05). No participants reported severe adverse events during the study session. In short, the treatment of CIMT combined with rTMS is safe and feasible for preschool children with UCP attributed to various brain disorders. Randomized controlled studies with large samples and long-term effects are warranted.

EFFICACY OF MIRROR THERAPY AND CONSTRAINT INDUCED MOVEMENT THERAPY ON UPPER EXTREMITY FUNCTION AND ACTIVITIES OF DAILY LIVING IN STROKE

<h2>ABSTRACT</h2><h3>Background</h3> Stroke has been identified as an epidemic and an important cause of morbidity and mortality globally, and at least 85% of stroke survivors experience hemiplegia and upper-extremity function of at least 69% of patients are affected. Over 50% of stroke survivors have impairment of motor function of the upper extremity; therefore there is pertinent need to use functional rehabilitation approaches such as; mirror therapy and constraint induced movement therapy for stroke survivors to regain upper extremity motor function. <h3>Aims</h3> To compare the efficacy of mirror therapy (MT) with constraint induced movement therapy (CIMT) on the upper extremity motor function and activities of daily living (ADL) in chronic stroke survivors. <h3>Methods</h3> 30 stroke survivors were recruited for this study. They were randomized into three groups, the MT plus conventional therapy group, CIMT plus conventional therapy group and control group. Upper extremity motor function and ADL were assessed. Participants were assessed at baseline and after seven weeks of intervention. <h3>Results</h3> The MT and CIMT groups' intervention both had significant improvement on upper extremity motor function and ADL, however, there was no significant difference on upper motor function (p=0.503) and ADL (p=0.133) across the three groups. <h3>Conclusion</h3> This study concluded that neither of MT nor CIMT had an additional significant improvement compared to conventional therapy alone on recovery of motor function in the upper extremity and performance of ADL.

Comparison of outcome between operative treatment and constraint-induced movement therapy for forearm and wrist deformities in cerebral palsy. A randomized controlled trial

Several treatment strategies for upper extremity deformities in cerebral palsy have been studied for their effectiveness in terms of function and quality of life. There are a few comparative studies between nonoperative and operative management for upper extremity deformities. This study aimed to compare the outcomes between conservative methods using constraint-induced movement therapy (CIMT) and operative methods using pronator teres rerouting, flexor carpi ulnaris transfer to extensor carpi radialis brevis (FCU transfer to ECRB) and fractional lengthening in cerebral palsy patients with forearm pronation and wrist flexion contracture. A total of 19 participants aged 7-15 years were randomized to either CIMT or surgery. The primary endpoint was changes in Shriners Hospital Upper Extremity Evaluation (SHUEE) functional score. Secondary endpoints comprised range of motion, Volkmann’s angle, and the Pediatric Outcomes Data Collection Instrument (PODCI). At 1-year follow-up, there was no significant difference between the nonoperative and operative groups in any SHUEE dimensions, range of motion or PODCI. However, there was significant improvement in Volkmann’s angle in the operative group compared to the CIMT group: CIMT = 11.11 ± 9.92, surgery = -13.00 ± 4.72: p = 0.04 (95% CI = 1.68-46.54). Operative treatment provided more improvement in wrist posture, represented by Volkmann’s angle, in cerebral palsy patients. However, SHUEE, range of motions and PODCI were comparable between the CIMT and operative groups.

The Effect of the Modified Constraint-Induced Movement Therapy on the Upper Extremity Functions of Obstetric Brachial Plexus Palsy Patients.

Functional limitation of the upper extremity (UE) in obstetrical brachial plexus paralysis (OBPP) restricts a child's participation in daily living and social activities. In treatment, the participation of UE in rehabilitation is important. Constraint-induced movement therapy (CIMT) is a promising rehabilitation approach that is used to improve the UE functions of patients with neurological dysfunctions. This single-blinded randomized controlled clinical trial includes 30 pediatric patients diagnosed with chronic OBPP aged between 2 and 12 years. The patients were divided into two groups as a modified CIMT group and a control group. Patients in both groups underwent classical rehabilitation treatment 4 times a week for 8 weeks. Range of motion (ROM), stretching, strengthening, and proprioceptive exercises were given to both control and CIMT group. The patients in the CIMT group had to wear constraining arm slings 2 h per day and 4 days a week for 8 weeks. The patients were evaluated both before and after treatment using the Mallet classification system and the Melbourne unilateral upper limb assessment-2 (The MA2) scale. In both groups, the Mallet and MA2 scores significantly increased after the treatment process. However, the percentage of improvement was higher for the CIMT group. Modified CIMT improves the joint ROM and the functional use of the extremity among OBPP-diagnosed children. This improvement is greater in the CIMT group compared to the improvement in the control group. Implementation of CIMT in a routine rehabilitation process may be helpful.

Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial.

With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT). CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures. Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O'Brien's rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment). CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.

A study to compare task-based mirror therapy versus constraint induced movement therapy for hand function in hemiplegic subjects

Introduction and Aim:To find the effectiveness of task-based mirror therapy when compared with constraint-induced movement therapy for hand function in hemiplegic subjects. Stroke is a major health problem in the world. According to various researches, 70%-80% of the patients have the upper extremity impairment then lower extremity. Task-based mirror therapy can be an effective management for premotor cortex impairment. Constraint-induced movement therapy forms the new neural pathway when used properly.&#x0D; &#x0D; Materials and Methods:30 patients with subacute CVA (cerebrovascular attack) were enrolled and randomly divided into two groups: constraint-induced movement therapy (CIMT) and task-based mirror therapy (TMBT). The full-Meyer motor function assessment was evaluated 4 weeks after treatment.&#x0D; &#x0D; Results: The results showed that mean value of TMBT (pre-test – 5.733, post-test- 9.86) and SD of (pre-test- 1.67, post-test- 1.92) and in CIMT(pre-test-6.3, post-test-11.13) and SD (Pre-test-1.45,Post-test -1.36).&#x0D; &#x0D; Conclusion:This study shows that CIMT group showed more improvement than TMBT group.

Improving Quality of Life for Children With Cerebral Palsy in Vietnam: Implementation of Intensive Models of Rehabilitation

Abstract Date Presented 04/8/21 Vietnamese therapists developed constraint-induced movement therapy (CIMT) models and completed a prospective nonrandomized study at two hospitals in Vietnam. Therapists at Hanoi Rehab Hospital delivered a low-dose (30-hour) CIMT protocol, and therapists in Ho Chi Minh City Children's Hospital delivered a high-dose (72-hour) CIMT protocol. Children in both low- and high-dose CIMT groups showed improvements in everyday activities and individual therapy goals. This study advances the delivery of evidence-based practice in Vietnam. Primary Author and Speaker: Patricia Coker-Bolt Additional Authors and Speakers: Katherine Breithaupt Contributing Authors: Lauren Williams

Corpus Callosum Integrity Relates to Improvement of Upper-Extremity Function Following Intensive Rehabilitation in Children With Unilateral Spastic Cerebral Palsy

Background The corpus callosum (CC) plays an important role in upper extremity (UE) function. The impact on UE function in children with unilateral spastic cerebral palsy (USCP) and improvements following intensive interventions remain unknown. Objectives To examine the (1) relationship between UE function and CC integrity and (2) relationship between CC integrity and changes in UE function following intensive interventions. Methods We retrospectively analyzed clinical and neuroimaging data from a sample of convenience of 44 participants (age 9.40 ± 3.10 years) from 2 larger trials. Participants received 90 hours of Hand-Arm Bimanual Intensive Therapy (HABIT) or Constraint-Induced Movement Therapy (CIMT). Unimanual dexterity (Jebsen-Taylor Test of Hand Function [JTTHF]) and bimanual performance (Assisting Hand Assessment [AHA]) were assessed preintervention and postintervention. CC tractography was reconstructed with diffusion tensor imaging (DTI) and segmented into 3 regions (genu, midbody, splenium). Pearson correlations and regression were used to assess the relationship between outcomes and DTI parameters (ie, fractional anisotropy [FA], number of streamlines, and mean, radial, and axial diffusivity). Results Both groups improved in bimanual performance (P < .01). The CIMT group improved in unimanual dexterity (P < .01). Baseline unimanual dexterity and bimanual performance correlated with FA and number of streamlines for most CC regions (P < .05). Following CIMT, pre-post changes in JTTHF were negatively correlated with axial and radial diffusivity of the CC, and AHA with splenium and number of streamlines for the CC, midbody, and splenium (all P < .05). Following HABIT, midbody FA was positively correlated with pre-post AHA changes (r = 0.417; P = .042). Conclusions CC integrity is important for UE function in children with USCP.

Combination of constraint-induced movement therapy with fasudil amplifies neurogenesis after focal cerebral ischemia/reperfusion in rats

Purpose Spontaneous axonal plasticity and functional restoration after stroke may be limited by Nogo-A, a myelin-associated inhibitor, via activation of the Rho/Rho-associated protein kinase (ROCK) pathway. Constraint-induced movement therapy (CIMT) is a rehabilitation technique based on neuroplasticity and neural recombination. We recently reported that CIMT promoted neurogenesis after cerebral ischemia/reperfusion in part by inhibiting the Nogo-A–RhoA–ROCK pathway. Here, we examine the hypothesis that CIMT combined with the ROCK inhibitor fasudil further amplifies neurogenesis during stroke recovery. Methods Four groups of rats were randomized as follows: Cerebral ischemia-reperfusion (IR), Fasudil, CIMT and CIMT + Fasudil. Seven days after stroke, CIMT and/or intraperitoneal infusion of fasudil were initiated and continued for 3 weeks. The behavioral outcomes and immunohistochemical markers of neurogenesis were quantified. Results Compared with other groups, the combination of CIMT with fasudil after IR significantly improved motor and memory function recovery. In addition, BrdU, BrdU/doublecortin and BrdU/GFAP all increased significantly in the brain tissue of the combined treatment group compared to the CIMT or Fasudil group. Conclusion These results suggest that the effects of CIMT on neurogenesis are amplified by fasudil during the recovery phase after stroke.

Effect of constraint-induced movement therapy on persons-reported outcomes of health status after stroke: a systematic review and meta-analysis.

Constraint-induced movement therapy (CIMT) is used for the rehabilitation of motor function after stroke. The aim of this review was to investigate its effect on persons-reported outcomes of health status (PROsHS) compared with conventional therapy. The study was a systematic review and meta-analysis registered in PROSPERO (CRD42019142279). Five databases PubMED, PEDro, OTSeeker, CENTRAL and Web of Science were searched. Randomized controlled trials were included if they assessed PROsHS. Mean scores of PROsHS, sample size and dose of CIMT and control groups interventions were extracted. The result was analyzed using qualitative and quantitative syntheses. Nine studies (n = 558) were included in the review. From the result, CIMT significantly improved PROsHS postintervention. However, postintervention, there was no statistically significant difference between groups for the upper limb [Mean difference (MD) = 6.67, 95% confidence interval (CI) = -2.09 to 15.44, P = 0.14] and the lower limb (MD = -1.86, 95% CI = -16.29 to 12.57, P = 0.80). Similarly, there was no statistically significant percentage of variation across studies, upper limb (I2 = 0%, P = 0.92) and lower limb (I2 = 0%, P = 0.86). For the lower limb at follow-up, there was no statistically significant difference between groups (MD = 0.97, 95% CI = -13.59 to 15.53, P = 0.90). When upper and lower limbs studies were pooled, there was no statistically significant difference between groups postintervention (MD = 0.22, 95% CI = -0.15 to 0.58, P = 0.24) and at follow-up (MD = 0.03, 95% CI = -0.43 to 0.49, P = 0.90). CIMT improves PROsHS after stroke. However, it is not superior to conventional therapy based on the current literature.