Michelle Ploughman1, Dale Corbett. 1. Div. of Basic Medical Sciences, Faculty of Medicine, Memorial University, St. John's, NL, Canada. mploughm@mun.ca
Abstract
OBJECTIVE: To determine the efficacy, safety, and compliance with forced-use therapy (FUT) applied without additional "shaping" therapy during the rehabilitation phase of stroke. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary mixed rehabilitation center. PARTICIPANTS: Consecutive sample of 30 inpatients or outpatients with first stroke showing minimal movement of the arm and hand. Subjects who scored below 26 on the Mini-Mental State Examination were excluded. Seven subjects either did not provide consent or withdrew from the study. The remaining subjects were randomized into the control group (n=13) and the FUT group (n=10). INTERVENTION: FUT involved wearing a thick constraint mitten on the sound arm for as many as 6 hours a day. MAIN OUTCOME MEASURES: The Chedoke McMaster Impairment Inventory for arm, hand, postural control, and shoulder pain; Action Research Arm Test; grip strength; and FIM instrument. RESULTS:FUT subjects experienced 20% more recovery of the arm than did control subjects and more recovery of postural control (P=.04). Men benefited most from the program, and there was a tendency for FUT subjects to have more shoulder pain. Compliance was related to cognitive status. CONCLUSIONS:FUT, without shaping therapy, appears to augment arm recovery, but a larger sample is required to confirm these findings. The FUT mitten was safe and well tolerated; however, more research is needed to determine the relation between FUT and hemiplegic shoulder pain.
RCT Entities:
OBJECTIVE: To determine the efficacy, safety, and compliance with forced-use therapy (FUT) applied without additional "shaping" therapy during the rehabilitation phase of stroke. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary mixed rehabilitation center. PARTICIPANTS: Consecutive sample of 30 inpatients or outpatients with first stroke showing minimal movement of the arm and hand. Subjects who scored below 26 on the Mini-Mental State Examination were excluded. Seven subjects either did not provide consent or withdrew from the study. The remaining subjects were randomized into the control group (n=13) and the FUT group (n=10). INTERVENTION: FUT involved wearing a thick constraint mitten on the sound arm for as many as 6 hours a day. MAIN OUTCOME MEASURES: The Chedoke McMaster Impairment Inventory for arm, hand, postural control, and shoulder pain; Action Research Arm Test; grip strength; and FIM instrument. RESULTS:FUT subjects experienced 20% more recovery of the arm than did control subjects and more recovery of postural control (P=.04). Men benefited most from the program, and there was a tendency for FUT subjects to have more shoulder pain. Compliance was related to cognitive status. CONCLUSIONS:FUT, without shaping therapy, appears to augment arm recovery, but a larger sample is required to confirm these findings. The FUT mitten was safe and well tolerated; however, more research is needed to determine the relation between FUT and hemiplegic shoulder pain.
Authors: Edward Taub; Gitendra Uswatte; Victor W Mark; David M Morris; Joydip Barman; Mary H Bowman; Camille Bryson; Adriana Delgado; Staci Bishop-McKay Journal: Stroke Date: 2013-03-21 Impact factor: 7.914
Authors: Janne Marieke Veerbeek; Erwin van Wegen; Roland van Peppen; Philip Jan van der Wees; Erik Hendriks; Marc Rietberg; Gert Kwakkel Journal: PLoS One Date: 2014-02-04 Impact factor: 3.240