Upper Limb In Stroke Patients Research Articles

Comparing effects of constraint-induced movement therapy and robotic therapy: Randomized clinical trial

Stroke is the one of the main causes of adult disability and up to 80% of the stroke survivors will develop upper extremity motor dysfunction. Currently, Constraint-Induced Movement Therapy (CIMT) and Robotic Therapy (RT) have high level of evidence for upper limb dysfunction treatment. However, to the best of our knowledge, there have been no studies comparing CIMT and RT on functionality and motor recovery of upper limb in stroke patients. Therefore, this study aims to compare RT and CIMT and understand their effects of on upper limb motor recovery and functionality of chronic stroke patients. This is a parallel, single blinded, randomized (1:1) clinical trial. From May 2012 to May 2015, 51 patients, who fulfilled the eligibility criteria, were enrolled into one of treatment groups–CIMT or RT. The outcomes of upper limb function were measured by Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment–Upper Limb (FMA-UL), Arm motor Ability Test (AMAT), Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Stroke Impact Scale (SIS). Our results showed that both treatments are equally beneficial to chronic stroke patients, with no statistical difference between the groups for primary or secondary outcomes. From baseline, the mean improvement, standard deviation and P -value are described in Table 1 . Additionally, patients kept the gains along the follow up visits, 3 and 12 months after treatment. CIMT and RT could be equally effective in improve upper limb function, motor recovery, functionality and quality of life in chronic stroke patients, even when compared 12 months after the end of treatment.

Combining tDCS and computerized mirror therapy in upper limb rehabilitation in stroke patients. A feasibility study

Mirror therapy (MT) relies on a mirror and movements of the healthy limb to generate visual illusions of movement of the paralyzed limb. MT has proven to be effective for the motor rehabilitation of the upper limb of stroke patients, but suffers several limitations for patients. To overcome these difficulties, a computerized mirror therapy device was developed (IVS3™, Dessintey). MT effects could also be enhanced by applying simultaneous neuromodulation with tDCS. This small sample trial was conducted to evaluate the feasibility and tolerance of an IVS3 motor training combined with simultaneous bi-hemispheric tDCS. Four patients with right or left hemiparesis following stroke were included in this trial. They received 20 sessions of computerized MT (IVS3 ™, Dessintey; 5 sessions/week; 1 hour and 200 movements/session) combined with bi-hemispheric tDCS over the hand motor cortex (2 mA, 20 minutes). The primary endpoint was adherence to the therapeutic program. The secondary judgment criteria were the safety assessment and the evolution of the tolerance of repeated tDCS stimulation coupled with IVS3. The synergy of these two therapies is well tolerated by patients with a compliance rate of 99% ± 0.025. There have been no serious adverse reactions or unknown side effects. The upper limb motor function of the 4 patients improved, but this small sample non-controlled trial do not allow to conclude on a significant effect. In this feasibility small sample study, the 4 patients well tolerated and perfectly complied with the computerized mirror therapy associated with bi-hemispheric tDCS. This finding calls for clinical controlled study to evaluate the efficacy of this combined IVS3-tDCS program in stroke patients.

Hemiplegia affects the biomechanics of reaching with the unaffected upper limb

Objective To analyze the bio-mechanics when hemiplegics reach with the unaffected upper limb. Methods Thirty post-stroke hemiplegics were selected into the patient group, while 23 healthy counterparts were chosen for the control group. Both groups completed a reaching test of their upper limbs which divided reaching into a moving stage and a holding stage. Surface electromyography (sEMG) data were recorded during the tests along with the degree of torso twist, the range of motion of the shoulder, movement velocity, smoothness of movement and angle divergence collected using a wearable micro-sensor motion capture system. Results For the stroke patients whose dominant upper limb was unaffected, the average root mean square (RMS) signal from the upper trapezius (34.3 μV) and the average torso twist (-1.4°) in the moving phase were significantly larger than among the control subjects (19.7 μV and -2.3°), but their average movement velocity was significantly slower. In the holding phase the average RMS signal from the upper trapezius (55.4 μV) was still significantly higher than in the control group, but their average pectoralis major signal and the integrated EMG ratio of the anterior segments of the deltoid and upper trapezius muscle pairs were significantly lower. For the stroke patients whose dominant upper limbs were affected, in the moving phase their average signal from the middle segments of the deltoid were significantly greater than those of the controls, but their movement velocity was significantly slower. For the control subjects, in the moving phase the average signal from the upper trapezius on their non-dominant side was significantly higher than that from the dominant upper limb. The integrated EMG ratio from the anterior segments of the deltoid and upper trapezius muscle pairs on that side was smaller throughout the whole reaching movement. Conclusion The bio-mechanical characteristics in reaching of the unaffected upper limbs of stroke patients are not the same as those of the corresponding upper limbs of healthy subjects. It is more reasonable to select the corresponding upper limbs of healthy subjects as controls when a bio-mechanical study of the affected upper limbs is conducted. Key words: Stroke; Reaching; Kinematics; Electromyography

Robotic approaches for the rehabilitation of upper limb recovery after stroke: a systematic review and meta-analysis.

This systematic review with a meta-analysis of studies was carried out to evaluate the effectiveness of robotic training (RT) and conventional training (CT) in improving the motor recovery of paretic upper limbs in stroke patients. Numerous electronic databases were searched from January 2000 to May 2016. Finally, 13 randomized-controlled trials fulfilled the inclusion criteria and were included in the three meta-analyses. The first meta-analysis carried out for those studies using RT for stroke patients indicated a significant improvement in the RT groups. The second meta-analysis suggested that the upper limb function (measured by Fugl-Meyer test) was significantly improved when RT was used with CT compared with CT alone. The third meta-analysis noted a significant difference in motor recovery between the CT-only and RT groups (RT only or RT combined with CT) in the chronic stages of stroke, but not in the acute or subacute stages. However, the RT group also showed a higher Fugl-Meyer score in patients at both the acute and the subacute stage. RT appeared to have positive outcomes to enhance motor recovery of the paralyzed upper limb. Robotic devices were believed to provide more assistance to patients to help support the weight of the upper limb; thus, active movement training can begin in the early rehabilitation stage. These novel devices may also help those chronic patients to achieve better rehabilitation goals. As a summary, RT could be used in addition to CT to help both therapists and patients in the management of the paralyzed upper limb.

Motor cortex activation during motor imagery of the upper limbs in stroke patients

ABSTRACT Objective: The objective of this study was to analyze the functional brain activation in acute stroke patients during motor execution (ME) and motor imagery (MI) and to discuss the association between damaged brain structure and impaired brain function in stroke patients. Methods: The functional magnetic resonance imaging technique was used to observe activation of the brain during ME/MI of the upper limbs in 12 acute stroke patients (with the left brain damage) and 12 healthy controls. Results: During ME, the stroke patients appeared to be activated more strongly than the healthy controls in the ipsilateral primary motor areas. The MI of the affected hand in the stroke patients was not significantly different from that of the healthy hand. The nonmotor areas, the angular gyrus, and the fusiform gyrus were also activated during ME/MI. Conclusion: Structural damage in the brain is associated with the activation of brain function in acute stroke patients. Ipsilateral inhibition is reduced in stroke patients during ME and the damaged brain needs to recruit more brain areas to complete the desired action due to motion difficulties resulting from brain damage. The participation of nonmotor brain areas in ME/MI indicates that cortical reorganization may contribute to the restoration of motor function following stroke. MI can be used to improve injured brain areas, helping with the rehabilitation of stroke patients.

뇌졸중 환자의 상지 강제유도운동치료에 관한 체계적 고찰

본 연구의 목적은 뇌졸중 환자를 대상으로 임상에서 보다 구체화된 강제유도운동치료 계획을 수립하는데 유용한 자료를 제공하고자 함이며, 추후 강제유도운동치료에 대한 연구 방안에 대해 제시하고자 함이다. 연구방법은 정해진 주제에 대해 과학적인 근거를 제공할 수 있는 체계적 고찰을 사용하였으며, 도출된 자료는 PICO(Patient, Intervention, Comparison, Outcome)원리에 따라 정리하였다. 분석대상 연구는 데이터베이스 Embase와 Medline에 'Constraint Induced Movement Therapy', 'Stroke'을 검색한 후 본 연구의 목적에 부합하는 총 42개 연구로 선정하였다. 연구결과 강제유도운동치료 연구의 질적 근거 수준은 체계적 고찰 메타분석 무작위 대조군 연구가 전체의 50%로 높은 질적 근거 수준이었다. 연구 진행시기는 2010년 이전에 진행된 연구가 2010년 이후에 진행된 연구 보다 42.8% 더 많았다. 강제유도운동치료 중재를 받는 뇌졸중 환자의 발병단계는 급성, 아급성, 만성 구분 없이 진행한 연구가 40.5%로 가장 많았다. 중재는 수정된 강제유도운동치료보다 기존의 강제유도운동치료로 진행한 연구가 40.2% 더 많았다. 강제유도운동치료 중재 방법에 따른 효과는 중재 방법에 상관없이 75% 이상의 연구에서 효과가 있다는 것을 확인하였다. 결론적으로 강제유도운동치료는 뇌졸중 환자의 손상된 상지에 효과가 있으며, 연구결과는 임상에서 강제유도 운동치료 계획을 수립할 때 유용한 자료로 사용할 수 있을 것이다. 추후 연구에서는 근거자료가 부족한 수정된 강제유도운동치료의 효과성 검증에 대한 연구가 이루어져야 할 것이며, 효과성 검증에 따른 고찰 연구가 필요할 것으로 사료된다. The purpose of this study is provided to useful data to establish the Constraint Induced Movement Therapy(CIMT) in clinical plan to more specific for stroke patients. Also It is provided way for further study about CIMT. Methods used a systematic review. Systematic review is a research method that can be presented to the scientific evidence. Data were organized by PICO(Patient, Intervention, Comparison, Outcome). Research using the database Embase and Medline, It was searched for CIMT and Stroke. We selected for a total of 42 studies that meet the purpose of the present study. We was selected for a total of 42 studies that meet the purpose of the present study. Results was that the quality of the study is a systematic review, meta-analyzes, randomized controlled. CIMT studies was based on a high quality level of 50% of the total. The difference between the study period was 42.8%, more research was conducted prior to 2010. CIMT has been used more than mCIMT by to differ 40.5%. It is effective in over 75% of study, regardless of the CIMT intervention. In conclusion, CIMT has an effect on the upper limbs of stroke patients damaged, results will be used as a useful material to develop a CIMT in the clinical treatment plan. In future studies will need to validate studies on the effectiveness of the mCIMT, It will require a review of the effectiveness of validation studies.

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 self-managed training of the paretic upper limb in stroke patients in the convalescent phase: application of the Transfer Package, an element of CI therapy

Effect of self-managed training of the paretic upper limb in stroke patients in the convalescent phase: application of the Transfer Package, an element of CI therapy

Prediction of Motor Recovery Using Quantitative Parameters of Motor Evoked Potential in Patients With Stroke

ObjectiveTo investigate the clinical significance of quantitative parameters in transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP) which can be adopted to predict functional recovery of the upper limb in stroke patients in the early subacute phase.MethodsOne hundred thirteen patients (61 men, 52 women; mean age 57.8±12.2 years) who suffered faiarst-ever stroke were included in this study. All participants underwent TMS-induced MEP session to assess the corticospinal excitability of both hand motor cortices within 3 weeks after stroke onset. After the resting motor threshold (rMT) was assessed, five sweeps of MEP were performed, and the mean amplitude of the MEP was measured. Latency of MEP, volume of the MEP output curve, recruitment ratios, and intracortical inhibition and facilitation were also measured. Motor function was assessed using the Fugl-Meyer Assessment scale (FMA) within 3 weeks and at 3 months after stroke onset. Correlation analysis was performed between TMS-induced MEP derived measures and FMA scores.ResultsIn the MEP response group, rMT and rMT ratio measures within 3 weeks after stroke onset showed a significant negative correlation with the total and upper limb FMA scores at 3 months after stroke (p<0.001). Multiple regression analysis revealed that FMA score and rMT ratio, but not rMT within 3 weeks were independent prognostic factors for FMA scores at 3 months after stroke.ConclusionThese results indicated that the quantitative parameter of TMS-induced MEP, especially rMT ratio in the early subacute phase, could be used as a parameter to predict motor function in patients with stroke.

Predicting Functional Recovery in Chronic Stroke Rehabilitation Using Event-Related Desynchronization-Synchronization during Robot-Assisted Movement.

Although rehabilitation robotics seems to be a promising therapy in the rehabilitation of the upper limb in stroke patients, consensus is still lacking on its additive effects. Therefore, there is a need for determining the possible success of robotic interventions on selected patients, which in turn determine the necessity for new investigating instruments supporting the treatment decision-making process and customization. The objective of the work presented in this preliminary study was to verify that fully robot assistance would not affect the physiological oscillatory cortical activity related to a functional movement in healthy subjects. Further, the clinical results following the robotic treatment of a chronic stroke patient, who positively reacted to the robotic intervention, were analyzed and discussed. First results show that there is no difference in EEG activation pattern between assisted and no-assisted movement in healthy subjects. Even more importantly, the patient's pretreatment EEG activation pattern in no-assisted movement was completely altered, while it recovered to a quasi-physiological one in robot-assisted movement. The functional improvement following treatment was large. Using pretreatment EEG recording during robot-assisted movement might be a valid approach to assess the potential ability of the patient for recovering.

Proprioceptive illusion induced by tendon vibration on the upper limb in stroke patients

Muscle vibration leads to agonist muscle contraction and antagonist muscle relaxation, this is the Tonic Vibration Reflex (TVR) [1] . Central nervous system interprets tendon vibration as a lengthening of this one inducing a virtual movement sensation [2] . The objective of this study is to observe this effect after stroke. Thirty-eight subjects have been evaluated: 19 stroke patients (10 men, 60.7 ± 9.8 years old) and 19 healthy subjects (5 men, 56 ± 11 years old). Vibrators (VibraSens VB200, TechnoConcept) were placed on the biceps brachii and wrist flexors tendons. Each subject received a vibration (80 Hz, 40 s) for each upper limb. An accelerometer was placed on the forearm in order to quantify the TVR with the elbow flexion angle. Movement perception of the subject was highlighted through a perception score created for the study. Subjects were seated on a chair, blindfolded, dangling arm. Flexion angle of the elbow (TVR) was identical on the left (32.2 ± 22.9°) and right (35.2 ± 32.2°) healthy subjects upper limb. For stroke patients it was identical on the healthy upper limb (33.1 ± 21.2°) compared to the upper limb of healthy subjects but greatly decreased on the deficient upper limb (9.6 ± 13.7°) of stroke patients compared to their healthy upper limb ( P = 0.0003). Perception score was less important on the hemiplegic side than the healthy side ( P < 0.0001) and was correlated to motor impairment (Fugl-Meyer) ( P < 0.0001, r = 0.687) and spasticity ( P < 0.00001). Anaesthesia was not correlated to a low score of perception, but only 3 subjects were concerned. TVR and usual movement illusion under tendon vibration are affected on the hemiplegic side after stroke. Any relationship or not on the observed deficiencies require confirmation with a larger sample.

Shock wave therapy for spastic plantar flexor muscles in hemiplegic cerebral palsy children

BackgroundThe spastic motor type is the most common form of cerebral palsy (CP). Spastic equines foot is the most frequent deformity in ambulated children with CP. Shock wave therapy on spastic muscles of the upper limb in stroke patients provided a significant reduction in muscle tone. AimThe present study aimed to investigate the efficiency of shock wave therapy on spastic planter flexor muscles and its relation to the gait in spastic hemiplegic cerebral palsy children. MethodsThirty spastic hemiplegic cerebral palsy children from both sexes participated in this study. They were divided randomly into two groups of equal number: Group I (control) included 15 children (6 boys and 9 girls), with mean 5.83±0.34years, received the therapeutic exercises program only. Group II (study) included 15 children (6 boys and 9 girls), with mean age 5.75±0.51years, received the same therapeutic exercises program which was given to the control group, in addition to shock wave therapy for 1week (3 session/week). ResultsComparing the pre and post treatment mean values of the Hoffman reflex/Motor response (H/M) ratio and gait variables, revealed statistically significant differences in these variables in the study group. ConclusionThe shock wave therapy is effective in the treatment of hypertonic muscles which help those children to become more independent and participate in everyday activities.

Effectiveness of the Motor Relearning Approach in Promoting Physical Function of the Upper Limb after a Stroke

Background: More than decades Stroke is one of the most frequently occurring disabling disease in the world. Reduced upper extremity function affects the ability to perform activities of daily living, which is likely to reduce independence, function of upper extremity is more difficult than the lower extremity. It can seriously impact the progress of rehabilitation. Methods: 60 outpatients are identified irrespective of hemorrhagic or thrombotic stroke, among those 30 patients received 40 1-h sessions in eight weeks (5 days/week) of conventional physiotherapy programme taken as group-A and another 30 patients were received 40 1-h sessions in eight weeks (5 days/week) of Motor relearning programme taken as group-B. Results: After the treatment sessions Patients who received motor relearning programme showed significantly better functional ability when assessing their functional status by task oriented performance than the conventional physiotherapy programme in both outcome scoring values, mean age of the subject who participated in study is 51 years. FMA (n = 30 post-test mean = 32.27 GROUP-A post-test mean = 43.80 GROUP-B T test value t = 5.3743, p- value= < 0.0001) WMFT (n = 30 post-test mean = 39.80 GROUP-A, post-test mean = 71.45 GROUP-B T test value t = 10.3401, p- value= < 0.0001) Conclusion: Motor relearning programme is found to be effective than the conventional physical therapy programme for enhancing functional recovery of the upper limb in stroke patients.

JSU-Diagram: A Guideline for Treatment of the Upper Limb in Stroke Patients

Recovery of efficient, functional use of the upper limb post stroke can contribute to an increased quality of life. Early implementation of well-structured upper limb treatment after stroke may affect recovery of upper limb function and dexterity. The JSU (Jessa Sint-Ursula) diagram should be considered a guideline to work on the objectives needed to shape the rehabilitation of the upper limb at various stages of recovery. The diagram starts with upper limb rehabilitation from day one, even in the absence of sufficient trunk control and aims at offering a logical theoretical strategy for improving the recovery of function of the upper limb.

Prevalence and determinants of pain in the ipsilateral upper limb of stroke patients.

This study investigated the prevalence of pain in the ipsilateral upper-limb in stroke patients. 229 stroke patients (133 men, 96 women; M age = 59.0 yr., SD = 12.4) were assessed with the Pain Behaviors Scales and their motor weakness was measured with the Motricity Index. Results indicated that over 27% of patients experienced pain in at least one joint of the ipsilateral upper limb. Shoulder pain was the most common. Further analysis indicated that the occurrence of pain in the ipsilateral upper limb was higher among women, among patients who used a cane, and among patients with a greater weakness of the affected lower limb.

Kinematic Analysis of the Upper Limb Motor Strategies in Stroke Patients as a Tool towards Advanced Neurorehabilitation Strategies: A Preliminary Study

Advanced rehabilitation strategies of the upper limb in stroke patients focus on the recovery of the most important daily activities. In this study we analyzed quantitatively and qualitatively the motor strategies employed by stroke patients when reaching and drinking from a glass. We enrolled 6 hemiparetic poststroke patients and 6 healthy subjects. Motion analysis of the task proposed (reaching for the glass, bringing it to the mouth, and putting it back on the table) with the affected limb was performed. Clinical assessment using the Fugl-Meyer Assessment for Upper Extremity was also included. During the reaching for the glass the patients showed a reduced arm elongation and trunk axial rotation due to motor deficit. For this reason, as observed, they carried out compensatory strategies which included trunk forward displacement and head movements. These preliminary data should be considered to address rehabilitation treatment. Moreover, the kinematic analysis protocol developed might represent an outcome measure of upper limb rehabilitation processes.

Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke.

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains unclear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The Fugl-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sensorimotor cortex.

Deficits of Movement Accuracy and Proprioceptive Sense in the Ipsi-lesional Upper Limb of Patients with Hemiparetic Stroke.

[Purpose] Previous studies have reported on motor deficits in the ipsilateral upper limbs (UL) of a damaged brain hemisphere in motor tasks. However, little is known about sensory deficits on the ipsilateral side. Therefore, we investigated whether both motor and sensory function of the ipsilateral UL are affected in patients with stroke. [Subjects and Methods] Fifty patients with unilateral stroke and 40 age- and sex- matched normal subjects participated in this study. Subjects were evaluated on performance of a tracking task for motor function, and by the joint reposition test for integrity of proprioceptive sense in the ipsilateral UL. [Result] The comparison of the stroke group and the control group showed significant differences in performance of the tracking task and the joint reposition test. The accuracy index for the tracking task showed significant correlation with the error score for the joint reposition test in the stroke group. [Conclusion] These results suggest that the ipsilateral UL of stroke patients has impairment in sensory function which is related to proprioceptive sense, along with motor deficits. Therefore, we think that the difficulty stroke patients experience with motor tasks for the ipsilateral UL is induced by diminished integrity of sensorimotor function due to both sensory and motor deficits.

Motor impairment evaluation for upper limb in stroke patients on the basis of a microsensor

There has been an urgent need for an effective and efficient upper limb rehabilitation method for poststroke patients. We present a Micro-Sensor-based Upper Limb rehabilitation System for poststroke patients. The wearable motion capture units are attached to upper limb segments embedded in the fabric of garments. The body segment orientation relative to the reference frame is computed by fusion of the sensory data, and the upper limb trajectory and movement parameters are obtained. Using the micro-Sensor-based Upper Limb rehabilitation System, the clinical Active Range of Motion scale can be measured automatically; a set of novel quantitative measures, referred to as motor feature indices, are obtained to evaluate the quality of the movement. Experimental results show that the proposed motor feature indices reflect the real motor impairment status very well, providing objective measurements of a patient's functional recovery status in the rehabilitation process.

Functional magnetic resonance imaging evaluation of brain function reorganization in cerebral stroke patients after constraint-induced movement therapy.

In this study, stroke patients received constraint-induced movement therapy for 3 weeks. Before and after constraint-induced movement therapy, the flexibility of their upper limbs on the affected side was assessed using the Wolf motor function test, and daily use of their affected limbs was assessed using the movement activities log, and cerebral functional reorganization was assessed by functional magnetic resonance imaging. The Wolf motor function test score and the movement activities log quantity and quality scores were significantly increased, while action performance time in the Wolf motor function test was significantly decreased after constraint-induced movement therapy. By functional magnetic resonance imaging examination, only scattered activation points were visible on the affected side before therapy. In contrast, the volume of the activated area was increased after therapy. The activation volume in the sensorimotor area was significantly different before and after therapy, and the activation area increased and appeared adjusted. In addition to the activated area around the lesions being decreased, there were also some new activated areas, including the supplementary movement area, premotor area and the ipsilateral sensorimotor area. Our findings indicate that constraint-induced movement therapy significantly improves the movement ability and daily use of the affected upper limbs in stroke patients and promotes cerebral functional reorganization.