Constraint-Induced Movement Therapy for the Lower Extremities in Multiple Sclerosis: Case Series With 4-Year Follow-Up

Abstract Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1–3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.

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Original article Clinical and neuroimaging correlation of movement disorders in multiple sclerosis: case series and review of the literature

Folia Neuropathologica ◽

10.5114/fn.2014.41747 ◽

2014 ◽

Vol 1 ◽

pp. 92-100 ◽

Cited By ~ 2

Author(s):

Anna Potulska-Chromik ◽

Monika Rudzinska ◽

Monika Nojszewska ◽

Aleksandra Podlecka-Piętowska ◽

Andrzej Szczudlik ◽

...

Keyword(s):

Multiple Sclerosis ◽

Movement Disorders ◽

Case Series ◽

Review Of The Literature ◽

Multiple Sclerosis Case

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Early versus late-applied constraint-induced movement therapy: A multisite, randomized controlled trial with a 12-month follow-up

Physiotherapy Research International ◽

10.1002/pri.1689 ◽

2017 ◽

Vol 23 (1) ◽

pp. e1689 ◽

Cited By ~ 3

Author(s):

Roland Stock ◽

Gyrd Thrane ◽

Audny Anke ◽

Ragna Gjone ◽

Torunn Askim

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Movement Therapy ◽

Randomized Controlled ◽

Constraint Induced Movement Therapy

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Participant Perception of Recovery as Criterion to Establish Importance of Improvement for Constraint-Induced Movement Therapy Outcome Measures: A Preliminary Study

Physical Therapy ◽

10.2522/ptj.20060101 ◽

2007 ◽

Vol 87 (2) ◽

pp. 170-178 ◽

Cited By ~ 26

Author(s):

Stacy L Fritz ◽

Steven Z George ◽

Steven L Wolf ◽

Kathye E Light

Keyword(s):

Outcome Measures ◽

Regression Models ◽

Negative Likelihood Ratio ◽

Movement Therapy ◽

Self Report ◽

Change Scores ◽

Constraint Induced Movement Therapy ◽

Starting Point ◽

Cutoff Scores

Background and PurposeChanges in function following constraint-induced movement therapy (CIMT) are characterized primarily by improvements in performance; however, the importance of these outcome measures to the participant may be unclear. The primary purpose of this study was to determine whether either change scores or raw follow-up scores for the Motor Activity Log amount scale (MALa) and the Wolf Motor Function Test (WMFT) predicted participants’ self-reports of recovery of upper-extremity function at 4 to 6 months after starting CIMT.Subjects and MethodsThis study was a secondary analysis of a cohort of subjects (N=46) who participated in CIMT trials. Subjects completed measures at baseline and 4 to 6 months later. Hierarchical regression models determined whether change scores or raw follow-up scores of CIMT outcome measures were predictive of perceived recovery. Receiver operating characteristic (ROC) curves determined cutoff scores for measures that significantly contributed to participants’ reports of perceived recovery.ResultsThe regression models indicated that raw follow-up MALa scores (β=0.80, P=.024) and WMFT scores (β=−0.37, P=.03) contributed to perceived recovery. Proposed cutoff scores for the MALa scores were less than 1.15 (negative likelihood ratio [LR]=0.17) for predicting less than 50% recovery and greater than 2.50 (positive LR=2.75) for predicting 50% or greater recovery. Proposed cutoff scores for follow-up WMFT scores were greater than 34.0 seconds (negative LR=0.24) for predicting less than 50% recovery and less than 11.0 seconds (positive LR=5.96) for predicting 50% or greater recovery.Discussion and ConclusionRaw follow-up scores for the MALa and WMFT were better predictors of self-report of recovery in comparison with change scores. These data also serve as a starting point for developing cutoff scores that accurately predict self-report of recovery.

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Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 2: Effect on White Matter Integrity

Neurorehabilitation and Neural Repair ◽

10.1177/1545968317753073 ◽

2018 ◽

Vol 32 (3) ◽

pp. 233-241 ◽

Cited By ~ 6

Author(s):

Ameen Barghi ◽

Jane B. Allendorfer ◽

Edward Taub ◽

Brent Womble ◽

Jarrod M. Hicks ◽

...

Keyword(s):

Multiple Sclerosis ◽

Randomized Controlled Trial ◽

White Matter ◽

Phase Ii ◽

Controlled Trial ◽

Movement Therapy ◽

White Matter Integrity ◽

Randomized Controlled ◽

Constraint Induced Movement Therapy

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An Application of Upper-Extremity Constraint-Induced Movement Therapy in a Patient With Subacute Stroke

Physical Therapy ◽

10.1093/ptj/79.9.847 ◽

1999 ◽

Vol 79 (9) ◽

pp. 847-853 ◽

Cited By ~ 119

Author(s):

Sarah Blanton ◽

Steven L Wolf

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Internal Capsule ◽

Movement Therapy ◽

Self Report ◽

Full Potential ◽

Posterior Limb ◽

Constraint Induced Movement Therapy ◽

Subacute Stroke

Abstract Background and Purpose. The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a “learned nonuse phenomenon.” Case Description. The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). Outcomes. For the Wolf Motor FunctionTest, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both “how well” and “how much” the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. Discussion. Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.

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