Traditional Rehabilitation Group Research Articles

Effects of Modified Constraint-Induced Movement Therapy on Movement Kinematics and Daily Function in Patients With Stroke: A Kinematic Study of Motor Control Mechanisms

Background and Objective. Motor control of the upper extremity during unilateral and bimanual functional tasks and functional change during daily activities were evaluated in patients with stroke treated with modified constraint-induced movement therapy (mCIMT). Methods. In a pre-post randomized, controlled trial, 30 stroke patients received 2 hours of mCIMT or traditional rehabilitation (TR) for 3 weeks. Motor control of the upper extremity was evaluated using kinematic analysis in unilateral and bilateral tasks. Kinematic variables included spatial and temporal movement efficiency and type of movement control (preplanned control, representing well-learned movement, or feedback-guided control). Functional outcomes were evaluated using the Motor Activity Log (MAL) and the Functional Independence Measure (FIM). Results. Patients receiving mCIMT showed more temporally (P = .013) and spatially (P = .011) efficient movement and more preplanned movement control (P = .009) during the bimanual task, and greater gains in FIM (P = .004) and MAL scores (amount of use: P < .0001, and quality of movement: P = .012) than patients in the TR group. Patients receiving mCIMT produced more ballistic/preplanned reaching movement than did patients receiving TR (P = .023) during the unilateral task; but there were no group differences in temporal or spatial efficiency in unilateral task performance. Conclusions. Relative to TR, mCIMT produced a greater improvement in functional performance and motor control. Improvement of motor control after mCIMT was based on improved spatial and temporal efficiency, apparently more salient during bimanual rather than unilateral task performance. This suggests that bilateral task performance should potentially be emphasized in kinematic study of changes in motor control after mCIMT.

A Randomized Controlled Trial of Modified Constraint-Induced Movement Therapy for Elderly Stroke Survivors: Changes in Motor Impairment, Daily Functioning, and Quality of Life

Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Objective To examine the benefits of modified constraint-induced movement therapy (mCIMT) on motor function, daily function, and health-related quality of life (HRQOL) in elderly stroke survivors. Design Two-group randomized controlled trial, with pretreatment and posttreatment measures. Setting Rehabilitation clinics. Participants Twenty-six elderly stroke patients (mean age, 72y) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident. Interventions Twenty-six patients received either mCIMT (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for a period of 3 weeks. Main Outcome Measures Outcome measures included the Fugl-Meyer Assessment (FMA), FIM instrument, Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The FMA evaluated the severity of motor impairment; the FIM instrument and MAL reported daily function; and the SIS detected HRQOL. Results The mCIMT group exhibited significantly greater improvements in motor function, daily function, and the physical domain of HRQOL than the traditional rehabilitation group. Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group. Conclusions These findings suggest mCIMT is a promising intervention for improving motor function, daily function, and physical aspects of HRQOL in elderly patients with stroke. The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program.

Erratum

Poster Session Abstracts. Am J Health Promot. 2003; 17:410–418. The following Research Abstract was inadvertently omitted from the Poster Session Abstracts. RESEARCH ABSTRACT A Randomized Controlled Trial on the Effectiveness of a Wellness Program on the Lives of People With Multiple Sclerosis Jennie Q. Lou, MD, MSc; C. Pierce, PhD; S. Classen, PhD; P. Hardigan, PhD; J. Alvarez, BS, RN; Lee Chinshue-Coello, BS Statement of the Problem. Multiple sclerosis (MS), the most common demyelinating disease, significantly affects people's quality of life. Traditionally, wellness programs are not implemented to populations with potentially disabling chronic disorders such as MS. The objective of this research study was to investigate the long-term effectiveness of an innovative wellness program on the general health and well-being, and quality of life in MS populations. Methods. This randomized controlled trial compared the impact of a wellness program to a traditional rehabilitation and a social activity program. Outcome variables were measured by the Short Form-36 version 2 (SF-36v2) and the Quality of Life Inventory (QOLI), and by the Occupational Self-Assessment (OSA). A multivariate analysis of variance (MANOVA) was conducted. Results. The wellness group demonstrated a statistically significant increase in the mental composite score (MCS) of the SF-36v2 (p = .093). The wellness group also demonstrated a statistically significant positive difference in the environmental impact scale of the OSA over the traditional rehabilitation group (p = .115) and the social activity group (p = .065). Conclusions. This pilot study supports the effectiveness of a wellness approach in improving coping skills and qualitative of life for populations with chronic disorders such as multiple sclerosis over the long term.