Movement Therapy Group Research Articles

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.

Effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy.

[Purpose] The purpose of this study was to determine the effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. [Subjects and Methods] Thirty-two right-handed patients with cerebral palsy (18 male, 14 female) whose ages ranged from 8 to 48 years participated in this experiment. Their cerebral palsy levels ranged from 1 to 3. The participants were assigned to one of three groups according to the experimental conditions: an assisted aquatic movement therapy group, a horseback riding therapy group, or a control group. Electroencephalograms, the Feeling Scale and the Felt Arousal Scale were examined as dependent variables. [Results] Analysis of self-reported data demonstrated a significant positive improvement in the emotions of participants in the assisted aquatic movement therapy group in comparison with the control group. With regard to the electroencephalogram analysis, the results of this study showed increased alpha power in the assisted aquatic movement therapy group compared with the horseback riding and control groups. [Conclusion] The results of this study suggest that professionals can consider assisted aquatic movement therapy as an effective therapeutic intervention for the improvement of mental health and brain activation.

Muscle Recruitment and Coordination following Constraint-Induced Movement Therapy with Electrical Stimulation on Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial.

ObjectiveTo investigate changes of muscle recruitment and coordination following constraint-induced movement therapy, constraint-induced movement therapy plus electrical stimulation, and traditional occupational therapy in treating hand dysfunction.MethodsIn a randomized, single-blind, controlled trial, children with hemiplegic cerebral palsy were randomly assigned to receive constraint-induced movement therapy (n = 22), constraint-induced movement therapy plus electrical stimulation (n = 23), or traditional occupational therapy (n = 23). Three groups received a 2-week hospital-based intervention and a 6-month home-based exercise program following hospital-based intervention. Constraint-induced movement therapy involved intensive functional training of the involved hand during which the uninvolved hand was constrained. Electrical stimulation was applied on wrist extensors of the involved hand. Traditional occupational therapy involved functional unimanual and bimanual training. All children underwent clinical assessments and surface electromyography (EMG) at baseline, 2 weeks, 3 and 6 months after treatment. Surface myoelectric signals were integrated EMG, root mean square and cocontraction ratio. Clinical measures were grip strength and upper extremity functional test.ResultsConstraint-induced movement therapy plus electrical stimulation group showed both a greater rate of improvement in integrated EMG of the involved wrist extensors and cocontraction ratio compared to the other two groups at 3 and 6 months, as well as improving in root mean square of the involved wrist extensors than traditional occupational therapy group (p<0.05). Positive correlations were found between both upper extremity functional test scores and integrated EMG of the involved wrist as well as grip strength and integrated EMG of the involved wrist extensors (p<0.05).ConclusionsConstraint-induced movement therapy plus electrical stimulation is likely to produce the best outcome in improving muscle recruitment and coordination in children with hemiplegic cerebral palsy compared to constraint-induced movement therapy alone or traditional occupational therapy.Trial registrationchictr.org ChiCTR-TRC-13004041

A dance movement therapy group for depressed adult patients in a psychiatric outpatient clinic: effects of the treatment.

We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) included in the study received treatment as usual (TAU). Twenty-one patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES) were medium in favor for the DMT group (d = 0.60–0.79). In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15–0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.

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.

Randomized, Multicenter, Comparative Study of NEURO versus CIMT in Poststroke Patients with Upper Limb Hemiparesis: The NEURO-VERIFY Study

Many poststroke patients suffer functional motor limitation of the affected upper limb, which is associated with diminished health-related quality of life. The aim of this study is to conduct a randomized, multicenter, comparative study of low-frequency repetitive transcranial magnetic stimulation combined with intensive occupational therapy, NEURO (NovEl intervention Using Repetitive TMS and intensive Occupational therapy) versus constraint-induced movement therapy in poststroke patients with upper limb hemiparesis. In this randomized controlled study of NEURO and constraint-induced movement therapy, 66 poststroke patients with upper limb hemiparesis were randomly assigned at 2:1 ratio to low-frequency repetitive transcranial magnetic stimulation plus occupational therapy (NEURO group) or constraint-induced movement therapy (constraint-induced movement therapy group) for 15 days. Fugl-Meyer Assessment and Wolf Motor Function Test and Functional Ability Score of Wolf Motor Function Test were used for assessment. No differences in patients' characteristics were found between the two groups at baseline. The Fugl-Meyer Assessment score was significantly higher in both groups after the 15-day treatment compared with the baseline. Changes in Fugl-Meyer Assessment scores and Functional Ability Score of Wolf Motor Function Test were significantly higher in the NEURO group than in the constraint-induced movement therapy group, whereas the decrease in the Wolf Motor Function Test log performance time was comparable between the two groups (changes in Fugl-Meyer Assessment score, NEURO: 5·39 ± 4·28, constraint-induced movement therapy: 3·09 ± 4·50 points; mean ± standard error of the mean; P < 0·05) (changes in Functional Ability Score of Wolf Motor Function Test, NEURO: 3·98 ± 2·99, constraint-induced movement therapy: 2·09 ± 2·96 points; P < 0·05). The results of the 15-day rehabilitative protocol showed the superiority of NEURO relative to constraint-induced movement therapy; NEURO improved the motion of the whole upper limb and resulted in functional improvement in activities of daily living.

The effects of mothers’ participation in movement therapy on the emotional functioning of their school-age children in Israel

The aim of the current study was to employ a quantitative methodology to examine the influence of mothers’ participation in a children's movement therapy group. The theoretical model underlying this study combined the principals of both dyadic therapy (Harel, Avimeir-Patt, & Ben-Aaron, 2006) and movement therapy (Loman & Merman, 1999), to obtain a creative healing method to be used in a group setting. Participants in the study included 26 children, 17 boys and 9 girls, ages 6–8, whose mothers consented to have the children participate. The design that was adopted to this research is a randomized control trial. It was hypothesized that in the experimental group (intervention with mothers), improvement in children's self-image and behaviors would be greater than that of children in the control group (intervention without mothers), and that mothers who participated in the intervention would demonstrate improvement in parental functioning compared to mothers who did not participate in the intervention. The independent variables were assessed at two different times: before the beginning of the therapeutic intervention and after the completion of 16 therapy sessions. Findings of the study indicate (1) improvement in the children's self-image, in both groups, (2) a greater improvement in children's behavior in the experimental group than in the control group, (3) improvement in the functioning and efficacy of parental functioning in both groups (with a higher degree of improvement in the experimental group). This study paves the way for future research, which could further substantiate the importance of parental inclusion in joint therapy with the child and provide an additional validation of the field of movement therapy in general.

Dance movement therapy group intervention in stress treatment: A randomized controlled trial (RCT)

This randomized controlled trial compares the effect of a dance movement therapy (DMT) group intervention on stress management improvement and stress reduction with a wait-listed control group (WG). 162 self-selected clients suffering from stress were randomly assigned to a WG or a DMT intervention that received 10 group therapy sessions. Stress management [Stressverarbeitungsfragebogen/SVF 120], psychopathology and overall distress (Brief Symptom Inventory/BSI) were evaluated at baseline (t1: pre-test), immediately after completion of the ten sessions DMT group intervention (t2: post-test), and 6 months after the DMT treatment (t3: follow-up test). Analysis of variance was calculated to evaluate the between-group (time×condition) and within-group (time) effect of the DMT intervention. Negative stress management strategies decreased significantly in the short-term at t2 (p<.005) and long-term at t3 (p<.05), Positive Strategy Distraction improved significantly in the short-term (p<.10), as well as Relaxation (p<.10). Significant short-term improvements were observed in the BSI psychological distress scales Obsessive-Compulsive (p<.05), Interpersonal Sensitivity (p<.10), Depression (p<.05), Anxiety (p<.005), Phobic Anxiety (p<.01), Psychoticism (p<.05), and in Positive Symptom Distress (p<.02). Significant long-term improvement in psychological distress through DMT existed in Interpersonal Sensitivity (p<.05), Depression (p<.000), Phobic Anxiety (p<.05), Paranoid Thinking (p<.005), Psychoticism (p<.05), and Global Severity Index (p<.01). Results indicate that DMT group treatment is more effective to improve stress management and reduce psychological distress than non-treatment. DMT effects last over time.

Unimanual and Bimanual Intensive Training in Children With Hemiplegic Cerebral Palsy and Persistence in Time of Hand Function Improvement

This study aims to compare in hemiplegic children the effectiveness of intensive training (unimanual and bimanual) versus standard treatment in improving hand function, assessing the persistence after 6 months. A multicenter, prospective, cluster-randomized controlled clinical trial was designed comparing 2 groups of children with hemiplegic cerebral palsy, treated for 10 weeks (3 h/d 7 d/wk; first with unimanual constraint-induced movement therapy, second with intensive bimanual training) with a standard treatment group. Children were assessed before and after treatment and at 3 and 6 months postintervention using Quality of Upper Extremity Skills Test (QUEST) and Besta Scales. One hundred five children were recruited (39 constraint-induced movement therapy, 33 intensive bimanual training, 33 standard treatment). Constraint-induced movement therapy and intensive bimanual training groups had significantly improved hand function, showing constant increase in time. Grasp improved immediately and significantly with constraint-induced movement therapy, and with bimanual training grasp improved gradually, reaching the same result. In both, spontaneous hand use increased in long-term assessment.

Is modified constraint-induced movement therapy more effective than bimanual training in improving arm motor function in the subacute phase post stroke? A randomized controlled trial

Objective: To compare the effect of modified constraint-induced movement therapy (mCIMT) to bimanual task-related training for patients in the subacute phase post stroke. Design: A single-blinded randomized controlled trial. Settings: Inpatient and outpatient rehabilitation clinics and the patient’s home. Subjects: Thirty patients in the subacute phase post stroke (2–16 weeks) were randomized to modified constraint-induced movement therapy with an emphasis on unimanual tasks, or bimanual task-related training, emphasizing bimanual tasks. All trained with a therapist 4 hours a week for four weeks, followed by a 2–3 hours daily self-training program. Patients in the modified constraint-induced movement therapy group were supposed to wear a restraining mitt on the unaffected hand for 4 hours a day for four weeks. Main measures: Blinded assessments at pre and post treatment and after three months with Action Research Arm Test as a primary outcome measure, Nine-Hole Peg Test and Motor Activity Log. Results: Power calculations suggested an inclusion of 60 patients, but due to recruitment difficulties the trial was stopped after an interim analysis at 30 patients. There was no difference in change (P > 0.05) between the groups on any of the measures, neither at post treatment nor at follow-up assessments. From pre-intervention to follow-up assessment the modified constraint-induced movement therapy group obtained a mean change score of 17.77 (14.66) on Action Research Arm Test, the bimanual group 15.47 (13.59). Conclusion: Bimanual training was as effective as modified constraint-induced movement therapy in improving arm motor function. Wearing a mitt seems unnecessary for most patients in the subacute phase post stroke when focused affected arm training is provided.

The efficacy of dance movement therapy group on improvement of quality of life: A randomized controlled trial

This study examines the treatment outcome of a ten weeks dance movement therapy intervention on quality of life (QOL). The multicentred study used a subject-design with pre-test, post-test, and six months follow-up test. 162 participants who suffered from stress were randomly assigned to the dance movement therapy treatment group (TG) (n=97) and the wait-listed control group (WG) (65). The World Health Organization Quality of Life Questionnaire 100 (WHOQOL-100) and Munich Life Dimension List were used in both groups at all three measurement points. Repeated measures ANOVA revealed that dance movement therapy participants in all QOL dimensions always more than the WG. In the short term, they significantly improved in the Psychological domain (p>.001, WHOQOL; p>.01, Munich Life Dimension List), Social relations/life (p>.10, WHOQOL; p>.10, Munich Life Dimension List), Global value (p>.05, WHOQOL), Physical health (p>.05, Munich Life Dimension List), and General life (p>.10, Munich Life Dimension List). In the long term, dance movement therapy significantly enhanced the psychological domain (p>.05, WHOQOL; p>.05, Munich Life Dimension List), Spirituality (p>.10, WHOQOL), and General life (p>.05, Munich Life Dimension List). Dance movement therapy is effective in the short- and long-term to improve QOL.

Bobath Concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients: a randomized controlled trial

Objective: To compare the effects of the Bobath Concept and constraint-induced movement therapy on arm functional recovery among stroke patients with a high level of function on the affected side. Design: A single-blinded, randomized controlled trial. Setting: Outpatient physiotherapy department of a stroke unit. Subjects: A total of 24 patients were randomized to constraint-induced movement therapy or Bobath Concept group. Intervention: The Bobath Concept group was treated for 1 hour whereas the constraint-induced movement therapy group received training for 3 hours per day during 10 consecutive weekdays. Main measures: Main measures were the Motor Activity Log-28, the Wolf Motor Function Test, the Motor Evaluation Scale for Arm in Stroke Patients and the Functional Independence Measure. Results: The two groups were found to be homogeneous based on demographic variables and baseline measurements. Significant improvements were seen after treatment only in the ‘Amount of use’ and ‘Quality of movement’ subscales of the Motor Activity Log-28 in the constraint-induced movement therapy group over the the Bobath Concept group (P = 0.003; P = 0.01 respectively). There were no significant differences in Wolf Motor Function Test ‘Functional ability’ (P = 0.137) and ‘Performance time’ (P = 0.922), Motor Evaluation Scale for Arm in Stroke Patients (P = 0.947) and Functional Independence Measure scores (P = 0.259) between the two intervention groups. Conclusions: Constraint-induced movement therapy and the Bobath Concept have similar efficiencies in improving functional ability, speed and quality of movement in the paretic arm among stroke patients with a high level of function. Constraint-induced movement therapy seems to be slightly more efficient than the Bobath Concept in improving the amount and quality of affected arm use.

무용/동작치료가 입원중인 정신분열증 환자의 정신건강 변화에 미치는 영향

The purpose of this study was examine the effects of dance / movement therapy on anger and anger expression, depression and anxiety, and positive as well as negative symptoms in in-patient with schizophrenia. Among inpatients with schizophrenia in J Dajeon psychiatric hospital, 38 patients were allocated to either dance and movement therapy (DMT) group (n

Comparison of conventional therapy, intensive therapy and modified constraint-induced movement therapy to improve upper extremity function after stroke

To compare the effects of 4 weeks of intervention using conventional rehabilitation, intensive conventional rehabilitation and modified constraint-induced movement therapy on the hemiplegic upper extremity in stroke patients. Thirty stroke patients (mean age: 63.3, standard deviation 9.63 years; mean time since stroke: 11.33, standard deviation 8.29 weeks) were randomly divided into 3 groups: conventional rehabilitation, intensive conventional rehabilitation, and modified constraint-induced movement therapy (10 individuals in each). Motor function was assessed using the Wolf Motor Function Test before treatment, and 2 weeks and 4 weeks after treatment. The constraint-induced movement therapy and intensive conventional rehabilitation groups improved their function ability scores in the Wolf Motor Function Test significantly more than the conventional rehabilitation group after 2 weeks of treatment (p < 0.05), but all groups reached comparable levels at the end of 4 weeks of intervention. However, only the constraint-induced movement therapy intervention proved to have robust and systematic effects on the function ability scores, as revealed by the large, positive and significant correlation between the initial scores and the scores 2 and 4 weeks after the intervention. The median performance time of the Wolf Motor Function Test decreased significantly in all groups after 4 weeks of treatment (p < 0.05), but only the modified constraint-induced movement therapy group showed significant improvements both 2 and 4 weeks after the initiation of treatment. Compared with classical intervention, modified constraint-induced movement therapy showed an apparent advantage over both conventional intervention and intensive conventional rehabilitation for patients after stroke.

Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper

BackgroundUse of Botulinum toxin-A (BoNT-A) for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A.Methods/DesignA randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental) or bimanual occupational therapy group (control). Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale.DiscussionThe aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy) versus bimanual occupational therapy (a bimanual therapy) on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following upper limb injection of BoNT-A. The paper outlines the background to the study, the study hypotheses, outcome measures and trial methodology. It also provides a comprehensive description of the interventions provided.Trial RegistrationACTRN12605000002684

A randomized trial of novel upper limb rehabilitation in children with congenital hemiplegia

A randomized trial of novel upper limb rehabilitation in children with congenital hemiplegia

Experimental study of the effects of Uyghur sand therapy on the ultrastructure of knee articular cartilage in osteoarthritis

Objective To study the effects of sand therapy on the ultrastructure of knee articular cartilage in rabbits with osteoarthritis ( OA ) and provide evidence of the effectiveness of sand therapy for OA in Uyghur medicine. Methods Models of knee OA were established by fixing with gypsum the right hind limbs of 28 rabbits. Of these, twenty-six rabbits were divided randomly into a free movement group and a free movement plus sand therapy group, and their left hind limbs were used as normal controls. Another two rabbits were used as specimens. The thirteen rabbits in the free movement group after the gypsum fixings were removed were allowed free movement every day for 20 days; the thirteen rabbits in the free movement plus sand therapy group had free movement plus sand therapy every day. The ultrastructure of each rabbit' s knee articular cartilage was observed using an electron microscope. Results Models of knee OA were established successfully. The changes in the ultrastructure of the knee articular cartilage revealed cell swelling, cell debris in part of the cartilage lacunae, and cartilage cells proliferating. The matrix of cartilage cells was thin, hetero chromatin concentrated on the margin and presented in a crescent form. Cell organellae decreased obviously, which was a sign of apoptosis. After the gypsum fixings were removed, the proliferation of cartilage cells gradually increased and rough endoplasmic reticula increased remarkably in the articular cartilages of the right hind knees of the free movement group. Cell pycnosis, disintegration and necrosis could be found in a few cells. The movement of the affected knees of the group treated with sand therapy plus free movement improved more significantly , and the changes in cartilage ultrastructure revealed more cell active proliferation, more rough endoplasmic reticu-lum, more cell surface processes and more matrix fibers. The morphology of cartilage cells in the control knees remained normal. Conclusion It is confirmed that Uyghur sand therapy combined with movement can improve the ultrastructure of knee articular cartilage in a rabbit model of OA. Key words: Uyghur medicine; Sand therapy; Osteoarthritis; Cartilage; Ultrastructure

A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong

Objective: To investigate the beneficial effect of constraint-induced movement therapy in improving the function of hemiplegic upper extremity in the early subacute stroke patients. Design: A prospective, single-blinded, randomized controlled study comparing the effectiveness of constraint-induced movement therapy or control treatment at post intervention and 12 weeks follow-up. Subjects: The inclusion criteria were 2—16 weeks after stroke, hemiparesis of the affected limb, minimal function of ≥20 degrees wrist extension and ≥10 degrees extension of all digits and Mini-Mental State Examination score ≥17. Interventions: The intervention group underwent a programme of 10 days upper extremity training (4 hours per day) with the unaffected limb being restrained in a shoulder sling and the control group received an equivalent duration of conventional rehabilitation therapy. Main measures: Functional level for hemiparetic upper extremity, Motor Activity Log, Action Research Arm Test and modified Barthel Index. Results: There were 23 and 20 subjects respectively in the constraint-induced movement therapy and control groups. Significant improvements were seen at post intervention and 12 weeks after constraint-induced movement therapy in functional level for hemiparetic upper extremity (P= 0.001), and in the `amount of use' (P= 0.001) and `how well' (P= 0.021) subscales of the Motor Activity Log. The total Action Research Arm Test score, grasp (P= 0.004), grip (P= 0.004), pinch (P= 0.032) and gross (P= 0.006) components showed significant improvement over the control group at post intervention. The grip component (P=0.019) and the total Action Research Arm Test score (P= 0.009) were superior to the control group at 12 weeks. Conclusion: Significant improvement in hand function could be achieved with constraint-induced movement therapy in subacute stroke patients, which was maintained up to 12 week follow-up.

Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study

Objective: To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. Design: Two-group randomized controlled trial with pretreatment and posttreatment measures. Setting: Rehabilitation clinics. Subjects: Thirty-two chronic stroke patients (21 men, 11 women; mean age=57.9 years, range=43—81 years) 13—26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. Intervention: Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. Main measures: Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. Results: There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (P=0.018) more efficiently and depended more on the feedforward control of reaching (P=0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (P<0.0001) and the Functional Independence Measure (P=0.016). Conclusions: In addition to improving functional use of the affected arm and daily functioning, modified constraint-induced movement therapy improved motor control strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.

Becoming a client, becoming a practitioner: student narratives of a dance movement therapy group

This paper documents one of several themes arising from a larger research study which invited trainees’ views on their experience in a weekly, 2 year, dance movement therapy (DMT) personal development group. This group formed part of their post-graduate training. The study used a phenomenological, grounded theory and collaborative methodology followed by an interpretive framework. The research sought to discover participants’ views on the experience of this personal development group in relation to their clinical practice with DMT groups during and following their training (the latter is not the subject of this paper). The study identifies a gap in the literature on trainee experience, particularly in relation to group process. Following a brief introduction and overview of methodology employed, the theme entitled ‘becoming a client, becoming a practitioner’ is presented, as it manifested for the students in the DMT group over time. The personal development component of therapists’ training is directly relevant to most counselling/psychotherapy and arts therapies practitioners; consequently, the study has broader implications.