Induced Movement Therapy Research Articles

Repetitive Transcranial Magnetic Stimulation/Behavioral Intervention Clinical Trial: Long-Term Follow-Up of Outcomes in Congenital Hemiparesis.

The purpose of this study was to examine long-term outcomes of nonpharmacological intervention in children and adolescents with stroke utilizing repetitive transcranial magnetic stimulation (rTMS) to the primary motor cortex combined with constraint- induced movement therapy (CIMT) to improve motor function in the paretic hand. Outcome measures included function, satisfaction, and medical status review. Fourteen of the original 19 participants (74%) from our rTMS/CIMT clinical trial (real rTMS+CIMT, n = 8; and sham rTMS+CIMT, n = 6) were evaluated. The median age of the subjects at follow up was 13.4 years (range 11-20 years old, 50% male). Median time to follow-up was 47.5 months (range 21-57 months). Descriptive statistics were conducted using frequencies and counts. Motor performance was measured using the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM). Satisfaction was reported with use of the COPM and TMS Tolerance Survey. Open-ended interview was conducted for feedback on study experience and subjective perspectives of current functional status. Overall, seven of eight individuals who received real rTMS and five of six individuals who received sham rTMS maintained or improved AHA scores. Six of 14 participants reported new onset of co-occurring conditions (four individuals in the real rTMS group, two individuals in the sham rTMS group). The majority (86%) of participants reported study satisfaction. Review of medical status revealed co-occurring conditions including: Epilepsy, obsessive-compulsive disorder, anxiety, depression, unspecified mood disorder, and undiagnosed inattentiveness. Long-term outcomes of rTMS/CIMT in pediatric stroke were investigated. Variability in performance and unattributed symptoms were noted. Considering the prevalence of co-occurring conditions in children and adolescents with stroke, new-onset symptoms were not attributed to original intervention. With the small sample size, the impact of rTMS on long-term outcomes cannot be fully determined from these data. Characterizing long-term outcomes through performance, participant perspectives, and medical status allows comprehensive assessment of rTMS/CIMT intervention efficacy.

Effectiveness of Modified Constraint Induced Movement Therapy and Bilateral Arm Training on Upper Extremity Function after Chronic Stroke: A Comparative Study

Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001); while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.

The Role of Caregiver in Modified Constraint Induced Movement Therapy in Uasin-Gishu County, Kenya

Constraint induced movement therapy (CIMT) is an effective rehabilitative intervention for motor recovery of the affected upper extremity in post stroke patients. However, this concept is not directly applicable in a resource scarce setting. Using the principle of CIMT in the patients' home utilizing a trained caregiver can modify this. The aim of this study was therefore to determine the role of the caregiver in modified Constraint Induced Movement Therapy in a patient with sub-acute stroke Methodology: The study was conducted at the patient's home in Uasin-Gishu County, Kenya. A 52-year-old woman, with a medical history of hypertension, and presented with left-sided hemiplegia. The unaffected hand was constrained in a mitten during working hours, except for bathing and toileting. For 6 weeks, patient spent 4.30 hours performing supervised tasks with paretic arm. Wolf Motor Function Test and the Motor Activity Log were used for data collection. Result: All except two tasks of the timed component of the WMFT had scores above the Minimal Detectable Change; however, the patient could not complete 2 tasks. The Factional Ability Scale and MAL indicated improvement. Conclusion: Support from caregiver increased therapy time, and was a significant factors in improved upper-limb functions.

Efficacy of Modified Constraint Induced Movement Therapy in the Treatment of Hemiparetic Upper Limb in Stroke Patients: A Randomized Controlled Trial.

Paretic upper limb in stroke patients has a significant impact on the quality of life. Modified Constraint Induced Movement Therapy (mCIMT) is one of the treatment options used for the improvement of the function of the paretic limb. To investigate the efficacy of four week duration mCIMT in the management of upper extremity weakness in hemiparetic patients due to stroke. Prospective single blind, parallel randomized controlled trial in which 30 patients received conventional rehabilitation programme (control group) and 30 patients participated in a mCIMT programme in addition to the conventional rehabilitation programme (study group). The mCIMT included three hours therapy sessions emphasizing the affected arm use in general functional tasks, three times a week for four weeks. Their normal arm was also constrained for five hours per day over five days per week. All the patients were assessed at baseline, one month and three months after completion of therapy using Fugl-Meyer Assessment (FMA) score for upper extremity and Motor Activity Log (MAL) scale comprising of Amount of Use (AOU) score and Quality of Use (QOU) score. All the 3 scores improved significantly in both the groups at each follow-up. Post-hoc analysis revealed that compared to conventional rehabilitation group, mCIMT group showed significantly better scores at 1 month {FMA1 (p-value <0.0001, es0.2870), AOU1 (p-value 0.0007, es0.1830), QOU1 (p-value 0.0015, es0.1640)} and 3 months {FMA3 (p-value <.0001, es0.4240), AOU3 (p-value 0.0003, es 0.2030), QOU3 (p-value 0.0008, es 0.1790)}. Four weeks duration for mCIMT is effective in improving the motor function in paretic upper limb of stroke patients.

Effect of Constraint Induced Movement Therapy v/s Motor Relearning Program for Upper Extremity Function in Sub Acute Hemiparetic Patients-a Randomized Clinical Trial

Effect of Constraint Induced Movement Therapy v/s Motor Relearning Program for Upper Extremity Function in Sub Acute Hemiparetic Patients-a Randomized Clinical Trial

Does Context Matter? Mastery Motivation and Therapy Engagement of Children with Cerebral Palsy

ABSTRACTAims: To determine if mastery motivation at baseline predicts engagement in two goal-directed upper limb (UL) interventions for children with unilateral cerebral palsy (UCP). Methods: Participants were 44 children with UCP, mean age 7 years 10 months, Manual Ability Classification System level I (N = 23) or II (N = 21). Twenty-six children received intensive novel group-based intervention (Hybrid Constraint Induced Movement Therapy, hCIMT) and 18 received distributed individual occupational therapy (OT). Caregivers completed the Dimensions of Mastery Questionnaire (DMQ) parent-proxy report at baseline. Children's engagement was independently rated using the Pediatric Volitional Questionnaire (PVQ). Associations between children's mastery motivation and engagement were examined using linear regression. Results: Children who received hCIMT had lower DMQ persistence at baseline (p = .05) yet higher PVQ volitional (p = .04) and exploration (p = .001) scores. Among children who received hCIMT, greater object-oriented persistence was associated with task-directedness (β 0.25, p = .05), seeking challenges (β = 0.51, p = .02), exploration (β = 0.10, p = .03), and volitional scores (β = 0.23, p = .01). Conclusion: Despite having lower levels of persistence prior to engaging in UL interventions, children who received hCIMT demonstrated greater engagement in goal-directed tasks than children who received individual OT. Within hCIMT, children's motivational predisposition to persist with tasks manifested in their exploration and engagement in therapy.

Effectiveness of modified constraint induced movement therapy on the quality and quantity of upper extremity movement recovery after stroke

Effectiveness of modified constraint induced movement therapy on the quality and quantity of upper extremity movement recovery after stroke

Constraint Induced Movement Therapy in Patients with Incomplete Tetraplegia After Spinal Cord Injury

Constraint Induced Movement Therapy in Patients with Incomplete Tetraplegia After Spinal Cord Injury

Application of constraint induced movement therapy protocol: effectiveness on the quality and quantity of upper extremity movement recovery after stroke

Application of constraint induced movement therapy protocol: effectiveness on the quality and quantity of upper extremity movement recovery after stroke

The Effects of the Constraint Induced Movement Therapy in Adults with Cerebral Palsy

The Effects of the Constraint Induced Movement Therapy in Adults with Cerebral Palsy

Influence of the Dominant Hand in the Effectiveness of Constraint Induced Movement Therapy

Influence of the Dominant Hand in the Effectiveness of Constraint Induced Movement Therapy

Investigating sensory plasticity in hemiplegic cerebral palsy following modified constraint‐ induced movement therapy (mCIMT)

Investigating sensory plasticity in hemiplegic cerebral palsy following modified constraint‐ induced movement therapy (mCIMT)

The actimetry as assessment method of patients’ compliance and effectiveness of constraint induced movement therapy

To assess the pertinence of actimeters (Actisleep ® ) in verifying patients’ compliance to the constraint induced movement therapy (CIMT). First we assessed initial motors potentials by using the actimeter on healthy upper limbs and damaged ones. This was carried out before the CIMT program. This initial phase defines the activity temporal asymmetry between the damaged and healthy side. The patients are assessed again over two weeks during CIMT. The activity reduction of the healthy side allows us to evaluate the patients’ commitment and motivation. For obvious reasons, all subjects with low compliance were excluded. During the final phase, after 4 weeks of CIMT, the actimeters was kept in place for an extra week in order to observe the treatments’ efficiency. So, we can now quantify the new balance of bimanuality. In this study, we recruited seven patients. Six of them showed a compliance of 20 to 60%. The last patient was excluded for non-compliance to the protocol. The six subjects showed evidence of a higher level of activation of the injured side. This preliminary study shows that actimeters allow to verify patients’ compliance to CIMT and also to quantify the efficiency of the treatment after it ends.

Intensive upper limb intervention with self-management training is feasible and promising for older children and adolescents with unilateral cerebral palsy

This study explored the feasibility and preliminary effectiveness of a short (one week) intensive intervention combining Constraint Induced Movement Therapy (CIMT) and bimanual training (BiT) to improve upper limb capacity and bimanual performance guided by individual goal setting in children and adolescents with unilateral cerebral palsy aged 8–18 years. Self-management training was added to the intervention to maximize the effect of training and to empower the participants in self-monitoring the effective use of their affected hand. Functional goals (Canadian Occupational Performance Measure), unimanual capacity (Box and Block Test), bimanual performance (ABILHAND-Kids, Children's Hand-use Experience Questionnaire (CHEQ)) and amount of use (Video Observation Aarts and Aarts – determine developmental disregard (VOAA-DDD-R)) were measured at baseline, one week and four months post intervention. Twenty children (mean age 9.5 years) participated. Repeated measures ANOVA was used to measure effects over time. Compared to baseline, there were significant improvements on all outcome measures. The largest effect sizes were found for the COPM-performance and COPM-satisfaction (Cohen's d=2.09 and d=2.42, respectively). The effect size was large for the ABILHAND-Kids (d=0.86), moderate for the CHEQ (d=0.70) and Box and Block Test (d=0.56), and small for the VOAA-DDD-R (d=0.33). All effects were retained at the four months post intervention assessment. The results of this study indicate that one-week (36h) intensive CIMT-BiT combined with self-management training is a feasible and promising intervention for improving the capacity of the upper limb and its use in bimanual activities in older children and adolescents with unilateral CP.

Functional Composite Movement Scale: Comparison of Before and After Photos of Participants in a Modified Constraint Induced Movement Therapy (mCIMT) Pediatric Day Camp

Abstract Date Presented 4/18/2015 The Functional Composite Movement Scale (FCMS) is a promising clinical tool to assess quantitative changes in upper-extremity function. FCMS scores may be generalizable to the performance of activities of daily living (ADLs). When tested, the FCMS showed one statistically significant difference in functional movement of children with cerebral palsy (CP) after modified constraint induced movement therapy (mCIMT) intervention.

Constraint induced movement therapy in hemiplegic cerebral palsy: are we ready for a guideline? A Review of the literature

Constraint induced movement therapy in hemiplegic cerebral palsy: are we ready for a guideline? A Review of the literature

A STUDY ON THE EFFECTIVENESS OF BOBATH APPROACH VERSUS CONSTRAINT INDUCED MOVEMENT THERAPY (CIMT) TO IMPROVE THE ARM MOTOR FUNCTION AND THE HAND DEXTERITY FUNCTION IN POST STROKE PATIENTS

A STUDY ON THE EFFECTIVENESS OF BOBATH APPROACH VERSUS CONSTRAINT INDUCED MOVEMENT THERAPY (CIMT) TO IMPROVE THE ARM MOTOR FUNCTION AND THE HAND DEXTERITY FUNCTION IN POST STROKE PATIENTS Bushra Rehman 1, Praveen Rawat 2 , Vaibhav Agarwal *3, Shiv Kumar Verma 4. 1 Physiotherapist, Max Hospital, Dehradun, India. 2 Assistant Lecturer, Physiotherapy Department, Swami Rama Himalayan University, HIMS, Jolly Grant , Dehradun, India. *3,4 Lecturer Physiotherapy Department Swami Rama Himalayan University, HIMS, Jolly Grant, Dehradun, India.

Effects of Modified Constrained Induced Movement Therapy to Improve the Upper Limb Functional Activities and Gross Manual Dexterity on Hemiparetic Cerebral Palsy Children

Background: cerebral palsy is a neuro developmental disorder. It has various types. Hemiparetic cerebral palsy is a type in which the children have limitations in capacity to use the impaired upper limb on daily life activities. This study aims to find out the effects of modified Constraint induced Movement therapy (modified CIMT) to improve the upper limb functional activities and gross manual dexterity among the children with hemiparetic cerebral palsy. Methods: 10 children with hemiparetic cerebral palsy were undergone to modified CIMT. Interventions lasted for 4weeks, 4hrs/day, Peadiatric Motor Activity Log(PMAL) to assess the children's upper limb functional activities and box and block to assess gross manual dexterity were used before and after intervention. Results: The results showed significant improvements on functional measures of PMAL and gross manual dexterity of box and block. Conclusion: modified CIMT is an effective therapy to improve the upper limb functional activities and gross manual dexterity on the children with hemiparetic cerebral palsy.

To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke.

Objective:To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke.Method:A sample of 42 patients was recruited from the Physiotherapy Department of IPM&R and Neurology OPD of Civil Hospital Karachi through non probability purposive sampling technique. Twenty one patients were placed to each experimental and control groups. Experimental group was treated with Constraint Induced Movement Therapy (CIMT) and control group was treated with motor relearning programme (MRP) for three consecutive weeks. Pre and post treatment measurements were determined by upper arm section of Motor Assessment Scale (MAS) and Self Care item of Functional Independence Measure (FIM) Scale.Results:Intra group analysis showed statistically significant results (p-value<0.05) in all items of MAS in both groups. However, advanced hand activities item of MAS in MRP group showed insignificant result (p-value=0.059). Self-care items of FIM Scale also showed significant result (p-value< 0.05) in both groups except dressing upper body item (p-value=0.059) in CIMT group and grooming and dressing upper body items (p-value=0.059 & 0.063) in MRP group showed insignificant p-values.Conclusion:CIMT group showed more significant improvement in motor function and self-care performance of hemiplegic upper extremity as compared to MRP group in patients with sub-acute stroke assessed by the MAS and FIM scales. Thus CIMT is proved to be more statistically significant and clinically effective intervention in comparison to motor relearning programme among the patients aged between 35-60 years. Further studies are needed to evaluate CIMT effects in acute and chronic post stroke population.

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 &lt; .05), enhances performance of functional tasks (p &lt; .05) and also increases muscle strength (p &lt; .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.