Christina Brogårdh1, Bengt H Sjölund. 1. Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden. christina.brogardh@rehabmed.umu.se
Abstract
OBJECTIVE: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome. DESIGN: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers. SETTING:A university hospital rehabilitation department. PARTICIPANTS: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb. INTERVENTION: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment. OUTCOME MEASURES: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log. RESULTS: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P < 0.001). However, no additional effect was seen from wearing a mitt for another three months. CONCLUSION: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.
RCT Entities:
OBJECTIVE: (1) To evaluate constraint-induced movement therapy for chronic strokepatients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome. DESIGN: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers. SETTING: A university hospital rehabilitation department. PARTICIPANTS: Sixteen strokepatients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb. INTERVENTION: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment. OUTCOME MEASURES: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log. RESULTS: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P < 0.001). However, no additional effect was seen from wearing a mitt for another three months. CONCLUSION: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.
Authors: Ryanne J M Lemmens; Annick A A Timmermans; Yvonne J M Janssen-Potten; Rob J E M Smeets; Henk A M Seelen Journal: BMC Neurol Date: 2012-04-12 Impact factor: 2.474
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