Induced Movement Therapy Research Articles

Comparison Of Bobath Technique And Constraint Induced Movement Therapy In Stroke Rehabilitation: A Systematic Review

Comparison Of Bobath Technique And Constraint Induced Movement Therapy In Stroke Rehabilitation: A Systematic Review

Constraint Induced Movement Therapy Confers only a Transient Behavioral Benefit but Enduring Functional Circuit-Level Changes after Experimental TBI.

Although the behavioral outcome of Constraint-Induced Movement Therapy (CIMT) is well known, and that a combination of CIMT and arm use training potentiates the effect, there has been limited study of the brain circuits involved that respond to therapy. An understanding of CIMT from a brain network level would be useful for guiding the duration of effective therapy, the type of training regime to potentiate the outcome, as well as brain regional targets that might be amenable for direct neuromodulation. Here we investigated the effect of CIMT therapy alone unconfounded by additional rehabilitation training in order to determine the impact of intervention at the circuit level. Adult rats were injured by controlled cortical impact injury and studied before and then after 2wks of CIMT or noCIMT at 1-3wks post-injury using a combination of forelimb behavioral tasks and task-based and resting state functional magnetic resonance imaging at 3 and 7wks post-injury and compared to sham rats. There was no difference in behavior or functional imaging between CIMT and noCIMT after injury before intervention so that data are unlikely to be confounded by differences in injury severity. CIMT produced only a transient reduction in limb deficits compared to noCIMT immediately after the intervention, but no difference thereafter. However, CIMT resulted in a persistent reduction in contralesional limb-evoked activation and a corresponding ipsilesional cortical plasticity compared to noCIMT that endured 4wks after intervention. This was associated with a significant amelioration of intra and inter-hemispheric connectivity present in the noCIMT group at 7wks post-injury.

An Effect of Modified Constraint Induced Movement Therapy Versus Bobath Therapy on Upper Extremity Motor Control and Performance in Subjects with Chronic Stroke

An Effect of Modified Constraint Induced Movement Therapy Versus Bobath Therapy on Upper Extremity Motor Control and Performance in Subjects with Chronic Stroke

Effects of modified-constraint induced movement therapy based telerehabilitation on upper extremity motor functions in stroke patients.

The aim of this study is to investigate the effects of Modified-Constraint Induced Movement Therapy (m-CIMT) based telerehabilitation on upper extremity motor functions in stroke patients. Eighteen stroke patients were included and randomly allocated into two groups. The Tele-CIMT (modified-constraint induced movement therapy-based telerehabilitation) (n=10) group received m-CIMT based telerehabilitation for 90 min a day, 5 weekdays for 3weeks at home. Additionally, both the Tele-CIMT group and the control group (CG) (n=8) underwent the home exercise program aimed at improving range of motion, active movement, balance, and walking every weekday for 3weeks at home. The outcome measures were the Stroke Rehabilitation Assessment of Movement Scale (STREAM), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FM-UE), Wolf Motor Function Test (WMFT), 9-Hole Peg Test (9-HPT), grip strengths, pinch strengths, Motor Activity Log-28 (MAL-28), and Functional Independence Measure (FIM). Significant group-by-time interactions on STREAM, FM-UE, WMFT, grip strength, pinch strengths, MAL-28, and FIM were found to be in favor of the Tele-CIMT group. Additionally, post hoc analyses revealed that the Tele-CIMT group significantly improved in terms of these parameters (p>.05). This is the first randomized controlled trial showing that Tele-CIMT improved upper extremity motor functions and activities of daily living in stroke patients. Tele-CIMT can help improve the upper extremities in stroke survivors who have difficulties reaching rehabilitation clinics.

Freely available, online videos to support neurological physiotherapists and students in task-specific training skill acquisition: a scoping review

BackgroundVideos to support learning of clinical skills are effective; however, little is known about the scope and educational quality of the content of freely available online videos demonstrating task-specific training (TST). This review aimed to determine the extent, characteristics of freely available online videos, and whether the content is suitable to guide skill acquisition of task-specific training for neurological physiotherapists and students.MethodsA scoping review was conducted. Google video and YouTube were searched in December 2022. Videos that met our eligibility criteria and were explicitly designed for (TST) skill acquisition were included in the report.ResultsTen videos met the inclusion criteria and were difficult to find amongst the range of videos available. Most were presented by physiotherapists or occupational therapists, originated from the USA, featured stroke as the condition of the person being treated, and involved a range of interventions (upper limb, constraint induced movement therapy, balance, bicycling). Most videos were created by universities or private practices and only two used people with a neurological condition as the participant. When the content of videos and their presentation (instruction and/or demonstration), was assessed against each key component of TST (practice structure, specificity, repetition, modification, progression, feedback), five of the videos were rated very suitable and five moderately suitable to guide skill acquisition. Most videos failed to demonstrate and provide instruction on each key component of TST and were missing at least one component, with feedback most frequently omitted.ConclusionsThere are many freely available online videos which could be described as demonstrating TST; very few are suitable to guide skill acquisition. The development of a standardised and validated assessment tool, that is easy to use and assesses the content of TST videos is required to support learners to critically evaluate the educational quality of video content. Guidelines based on sound teaching theory and practice are required to assist creators of online videos to provide suitable resources that meet the learning needs of neurological physiotherapists and students.

Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity – Constraint Induced Movement Therapy: a randomized controlled clinical trial

ABSTRACT Objective To evaluate the effects of Lower Extremity – Constraint Induced Movement Therapy on gait function and balance in chronic hemiparetic patients. Methods Randomized, controlled, single-blinded study. We recruited chronic post stroke patients and allocated them to Lower Extremity – Constraint Induced Movement Tharapy (LE-CIMT) or Control Group. The LE-CIMT group received this protocol 2.5 hour/day for 15 followed days, including: 1) intensive supervised training, 2) use of shaping as a strategy for motor training, and 3) application of a transfer package. The control group received conventional physiotherapy for 2.5 hours/day for 15 followed days. Outcomes were assessed at baseline, after the interventions, and after 6 months, through 6-minute walk test and Mini-Balance Evaluation Systems Test; 10-meter walk test, Timed Up and Go, 3-D gait analysis, and Lower Extremity – Motor Activity Log. Results LE-CIMT was superior on the Assistance and confidence subscale of Lower Extremity – Motor Activity Log, Mini-BESTest and 6-minute walk test. The effect size for all outcomes was small when comparing both groups. LE-CIMT showed clinically significant differences in daily activities, balance, and gait capacity, with no clinically significant difference for spatiotemporal parameters. Conclusion The LE-CIMT protocol had positive outcomes on balance, performance, and confidence perception.

Effectiveness of Modified Constraint Induced Movement Therapy in Improving Functional Activities of Hand in Sub Acute Stroke Subjects

BACKGROUND: In stroke, upper limb hemi paresis is a commonly seen impairment and challenging for activities of daily living that have a significant impact on one's quality of life. The majority of studies used both occupational therapy and physiotherapy to improve hand functions in subjects who had chronic strokes. Stroke patients often under-utilizes their paretic limb despite sufficient residual motor function. We hypothesize that acquired non-use can be overcome by reinforcement-based training strategies. The goal of this study is to analyze the efficacy of modified constraint induced movement therapy (m CIMT), to improve functional activities of hand in sub acute Stroke subjects. AIM: The Objective of this study was to analyze the effectiveness of Modified constraint induced movement therapy in improving hand functions in Sub acute stroke subjects. Methodology: This study was an Experimental study and the type of sampling was convenient sampling. The sample size was 30 subjects with unilateral hemiplegia with duration of more than 3 months and the study was conducted in outpatient PT Department. Results: The results were obtained using FMA and MAL on the basis of Pre and Post treatment data and comparing the Control and experimental groups. The statistical analysis showed significant difference between the experimental group and the control group. This shows that subjects in the experimental group who received Modified Constraint induced movement therapy have shown significant improvement than control Group who received only Conventional Physiotherapy. Conclusion: Modified constraint induced movement therapy can be added in stroke rehabilitation for improvement of activities of daily living and functional independence of stroke patients. Keywords: Hemi paresis, CIMT, m CIMT

Pairing taVNS and CIMT is feasible and may improve upper extremity function in infants.

In this study we combined non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) with 40 h of constraint induced movement therapy (CIMT) in infants. All infants completed the full intervention with no adverse events. Therapists were able to maintain high treatment fidelity and reported high ratings for ease of use and child tolerance. Preliminary results show promising gains on motor outcomes: Mean QUEST increase 19.17 (minimal clinically important difference, MCID 4.89); Mean GMFM increase 13.33 (MCID 1%-3%). Infants also exceeded expectations on Goal Attainment Scores (+1). Early data is promising that taVNS paired with intensive motor CIMT is feasible, reliable, and safe in young infants with hemiplegia, and may help harness activity-dependent plasticity to enhance functional movement.

To Study the Effect of Jigsaw Puzzle versus Modified Constraint Induced Movement Therapy on Fine Motor Abilities of Upper Extremities in Individuals with Subacute Stroke - An Experimental Study

To Study the Effect of Jigsaw Puzzle versus Modified Constraint Induced Movement Therapy on Fine Motor Abilities of Upper Extremities in Individuals with Subacute Stroke - An Experimental Study

Effectiveness of Constraint Induced Movement Therapy and Proprioceptive Neuromuscular Facilitation on Upper Extremity Functions in Stroke

Background: Stroke is the quickly developing clinical indication of a focal disruption of brain function that lastsmore than 24 hours or results in death, with no discernible cause other than vascular origin. Despite the fact thatthe majority of patients are able to walk again, 30% to 60% of survivors are no longer able to use the arm that wasinjured. CIMT aims at improves both the motor and functional capacities of a paretic arm. PNF exercises alter theorder in which muscles are stimulated, increases the efficiency of joint movement.Purpose: To compare the effectiveness of Constraint Induced Movement Therapy and ProprioceptiveNeuromuscular Facilitation for treating upper extremity functions in stroke.Materials and Methods: A total of 30 participants were selected from Sree Annai Physiotherapy Clinic Chennai.According to the inclusion and exclusion criteria. Subjects willing to participate were allocated into two groupsConstraint Induced Movement Therapy group and Proprioceptive Neuromuscular Facilitation group. Theparticipants underwent Pre-test measurement with Fugl-Meyer Assessment Upper Extremity FMA-UE and wererepeated for Post-test measurement. Study period : November 2022 to April 2023.Results: When comparing the mean differences of the two groups, Constraint Induced Movement Therapygroup displays a greater difference than Proprioceptive Neuromuscular Facilitation group. Therefore, it can besaid that Constraint Induced Movement Therapy is more advantageous for the upper extremity functions thanProprioceptive Neuromuscular Facilitation.Conclusion: The study concluded that Constraint Induced Movement Therapy is found to be more effective thanProprioceptive neuromuscular facilitation technique for upper extremity function recovery.

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.

Research hotspots and trends of brain-computer interface technology in stroke: a bibliometric study and visualization analysis.

The incidence and mortality rates of stroke are escalating due to the growing aging population, which presents a significant hazard to human health. In the realm of stroke, brain-computer interface (BCI) technology has gained considerable attention as a means to enhance treatment efficacy and improve quality of life. Consequently, a bibliometric visualization analysis was performed to investigate the research hotspots and trends of BCI technology in stroke, with the objective of furnishing reference and guidance for future research. This study utilized the Science Citation Index Expanded (SCI-Expanded) within the Web of Science Core Collection (WoSCC) database as the data source, selecting relevant literature published between 2013 and 2022 as research sample. Through the application of VOSviewer 1.6.19 and CiteSpace 6.2.R2 visualization analysis software, as well as the bibliometric online analysis platform, the scientific knowledge maps were constructed and subjected to visualization display, and statistical analysis. This study encompasses a total of 693 relevant literature, which were published by 2,556 scholars from 975 institutions across 53 countries/regions and have been collected by 185 journals. In the past decade, BCI technology in stroke research has exhibited an upward trend in both annual publications and citations. China and the United States are high productivity countries, while the University of Tubingen stands out as the most contributing institution. Birbaumer N and Pfurtscheller G are the authors with the highest publication and citation frequency in this field, respectively. Frontiers in Neuroscience has published the most literature, while Journal of Neural Engineering has the highest citation frequency. The research hotspots in this field cover keywords such as stroke, BCI, rehabilitation, motor imagery (MI), motor recovery, electroencephalogram (EEG), neurorehabilitation, neural plasticity, task analysis, functional electrical stimulation (FES), motor impairment, feature extraction, and induced movement therapy, which to a certain extent reflect the development trend and frontier research direction of this field. This study comprehensively and visually presents the extensive and in-depth literature resources of BCI technology in stroke research in the form of knowledge maps, which facilitates scholars to gain a more convenient understanding of the development and prospects in this field, thereby promoting further research work.

Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice.

Stroke results in impairment of motor function of both the upper and lower limbs. However, although it is debatable, motor function of the lower limb is believed to recover faster than that of the upper limb. The aim of this paper is to propose some hypotheses to explain the reasons for that, and discuss their implications for research and practice. We searched PubMED, Web of Science, Scopus, Embase and CENTRAL using the key words, stroke, cerebrovascular accident, upper extremity, lower extremity, and motor recovery for relevant literature. The search generated a total of 2,551 hits. However, out of this number, 51 duplicates were removed. Following review of the relevant literature, we proposed four hypotheses: natural instinct for walking hypothesis, bipedal locomotion hypothesis, central pattern generators (CPGs) hypothesis and role of spasticity hypothesis on the subject matter. We opine that, what may eventually account for the difference, is the frequency of use of the affected limb or intensity of the rehabilitation intervention. This is because, from the above hypotheses, the lower limb seems to be used more frequently. When limbs are used frequently, this will result in use-dependent plasticity and eventual recovery. Thus, rehabilitation techniques that involve high repetitive tasks practice such as robotic rehabilitation, Wii gaming and constraint induced movement therapy should be used during upper limb rehabilitation.

Efficacy of Modified Constraint Induced Movement Therapy in Post-Surgical Ulnar and/or Median Nerve Repair Patients

Background: After upper extremity nerve repair, there occurs impairment in hand functions which representsa major problem in activities of daily living (ADL) for the patient. Therefore, the patients after peripheral nerverepair needs rehabilitation to improve their functional status. This study was conducted to determine the efficacyof modified constraint-induced movement therapy in subjects after nerve repair in upper extremity.Methodology: 27 post-surgical subjects of ulnar and/or median nerve repair, aged 18-60 years, were included inthe study as per the selection criteria. The subjects were randomly divided into two groups, Group A (n=14) andGroup B (n=13) and were assessed for functional disability, integrated hand function, pain and muscle strengthusing DASH questionnaire, SHFT, VAS and BMRC muscle strengthening grading system respectively. GroupA received Modified constraint-induced movement therapy along with conventional therapy. Group B receivedConventional therapy alone. The subjects were given a total duration of intervention of 8 weeks, with 5 weeklysessions and were reassessed after 8 weeks.Conclusion: The results of this study conclude that modified constraint induced movement therapy combinedwith Conventional physiotherapy is more effective when compared to Conventional therapy alone in improvingmuscle strength and integrated hand function, reducing pain and disability in subjects with nerve repair in upperextremity.

Evaluation of a computer game-assisted rehabilitation program for manual dexterity of children with cerebral palsy: Feasibility randomized control trial.

There is a need for innovation to improve the engagement and compliance of rehabilitation programs for children with upper extremity (UE) motor impairments due to cerebral palsy (CP); a computer games-based rehabilitation platform (GRP) was developed to address this need. The GRP provides engaging task-specific exercises targeting manual dexterity (object handling and manipulation). To evaluate the therapeutic value and treatment effect size of an exercise program using the GRP in children with CP. A total of 63 children with CP, aged 4 to 10 years, were recruited. The Peabody Developmental Motor Scale-2 (PDMS-2) Grasp and Visual-Motor Integration (VMI) subscores and Computer game-based Upper Extremity (CUE) assessment of manual dexterity were used to assess participants before and after a 16-week intervention program, delivered three times per week. The experimental group (XG) received a computer games-based exercise program targeting object manipulation tasks. The active control arm (CG) consisted of task-specific training similar to the tasks used in constrained induced movement therapy. There were only a few dropouts during the 16-week program, and compliance was high. Both groups showed significant improvements with medium to large effect sizes. Improvements in the PDMS-2 Grasp and VMI subscores observed in the XG were significantly greater than that in the CG. There were significant improvements (p < .01) in PDMS-2 grasp and VMI subscores for XG with moderate to large effect sizes (0.5-0.8). For CG, the Grasp and VMI subscores did improve but these changes were not statistically significant. There was a significant improvement observed in the majority of CUE object manipulation test scores for XG (p < .01) with moderate to large effect sizes (0.50-1.2) Although CG did show improvements in all CUE object manipulation test scores, the changes did not reach statistical significance (p < .01). This study demonstrates the utility of the GRP to practice a broad range of object manipulation tasks in children with CP. The present findings are positive and support further research and development. The long-term effects of the GRP program in children with CP will need to be confirmed in a future randomized controlled trial. In addition to measures of structure and function, future trials should also include outcome measures such as health-related quality of life and level of participation to validate the findings.

"Comparative Effect of Modified Constraint Induced Movement Therapy, Proprioceptive Training and Task-Oriented Training on Functions of Upper Extremity among Stroke Patients"

"Comparative Effect of Modified Constraint Induced Movement Therapy, Proprioceptive Training and Task-Oriented Training on Functions of Upper Extremity among Stroke Patients"

Brain Stimulation and Constraint Induced Movement Therapy in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial

Background There is a crucial need to devise optimum rehabilitation programs for children with cerebral palsy (CP). Objective This study aimed to assess the feasibility, safety, and efficacy of combining 6-Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT) in improving upper limb function in children with unilateral CP. Methods Children aged 5 to 18 years with unilateral CP were randomized (23 in each arm) to receive 10 sessions of mCIMT with real rTMS (intervention arm) or mCIMT with sham rTMS (control arm), on alternate weekdays over 4 weeks. The primary outcome was the difference in mean change in Quality of Upper Extremity Skills Test (QUEST) scores. Secondary outcomes were changes in QUEST domain scores, speed and strength measures, CP quality of life (CP-QOL) scale scores, and safety of rTMS. Results All 46 children completed the trial except one. At 4 weeks, the mean change in total QUEST scores was significantly higher in the intervention arm as compared to the control arm (11.66 ± 6.97 vs 6.56 ± 4.3, d = 5.1, 95% CI 1.7-8.5, P = .004). Change in “weight bearing” and “protective extension” domain score was significantly higher for children in the intervention arm. These improvements were sustained at 12 weeks (P = .028). CP-QOL scores improved at 12 weeks. No serious adverse events were seen. Conclusion A 6-Hz primed rTMS combined with mCIMT is safe, feasible, and superior to mCIMT alone in improving the upper limb function of children with unilateral CP. Trial Registration: ClinicalTrials.gov Identifier: NCT03792789.

Review of Literature on the Effect of Constraint induced Movement Therapy along with Proprioceptive Neuromuscular Facilitation in Upper Limb Fine Motor Skills in Chronic Stroke Patients

Review of Literature on the Effect of Constraint induced Movement Therapy along with Proprioceptive Neuromuscular Facilitation in Upper Limb Fine Motor Skills in Chronic Stroke Patients

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.

Hybrid Telehealth Pediatric Constraint Induced Movement Therapy Compared to In-person Intervention: A Case Series.

Constraint induced movement therapy is an established, evidence-based intervention for children with hemiplegia. This case series describes the feasibility and clinical opportunities of using a hybrid telehealth and onsite model to deliver pediatric constraint induced movement therapy during the COVID-19 pandemic. These cases support that a hybrid model had a similar effect on upper extremity improvement compared to a traditional, in-person model and may be an option when access to in-person care is not available.