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Rehabilitation therapy that restrains the less damaged arm or hand appears to improve functional use of the paralyzed area in stroke patients, according to a study in the November 1 issue of JAMA.
More than 730,000 Americans yearly experience a new or recurrent stroke. That translates into $35 billion in health care costs. Almost 90 percent of stroke survivors have hemiparesis (partial paralysis on one side of the body), resulting in upper extremity impairment immediately after stroke. More than half of those patients continue to have functional limitations 3 to 6 months later.
A rehabilitation technique involveing placing the less impaired area in a sling (arm) or mitt(hand) for most of the day encourages use of the paralyzed side. Constraint-induced movement therapy (CIMT) also involves repetitive task practice. Single-site studies have shown a 2-week CIMT program improves functionality of the affected side.
Steven L. Wolf, Ph.D., P.T., of the Emory University School of Medicine and colleagues compared a 2-week multisite program of CIMT vs. currently accepted care on upper-extremity function in first time stroke patients (having a first time stroke in the previous 3 to 9 months). The Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial, a randomized, multisite clinical trial, included 222 individuals with predominantly ischemic stroke.
Patients were evaluated using the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL). The researchers found CIMT patients showed greater improvement than the control group in both the WMFT Performance Time (a measure of functional ability) and in the MAL measurements (assesses the effectiveness and frequency of 30 common daily activities). The CIMT group also had a 65 percent increase in the amount of tasks performed with the partially-paralyzed arm as well as a greater perceived increased in arm functionality by the patients.
Researchers concluded that CIMT patients can have significant improvements in paretic arm motor ability compared with participants receiving usual and customary care. The results suggest that further research should identify the central nervous system changes associated with observed motor gains as well as alternate models of CIMT delivery.
Effect of Constraint-Induced Movement Therapy on Upper Extremity Function 3 to 9 Months After Stroke JAMA. 2006;296:2095-2104.
About the Author
Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator.
The author has no financial relationship to any of the companies listed in the article.