Recovery of Upper Extremity Motor Function Post Stroke with Regard to Eligibility for Constraint-Induced Movement Therapy

2011 ◽  
Vol 18 (3) ◽  
pp. 248-257 ◽  
Author(s):  
Iris Charlotte Brunner ◽  
Jan Sture Skouen ◽  
Liv Inger Strand
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Movement Therapy ◽  
Post Stroke ◽  
Constraint Induced Movement Therapy

scholarly journals Efficacy of Constraint-Induced Movement Therapy for Post-Stroke Upper Extremity Hemiparesis Patients Attending a Day-Care Center

2009 ◽  
Vol 24 (6) ◽  
pp. 929-933
Author(s):  
Taichi KURAYAMA ◽  
Anna WATANABE ◽  
Minami TAKAMOTO ◽  
Nami SHIGETA ◽  
Yuki HASEGAWA ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Day Care ◽  
Care Center ◽  
Movement Therapy ◽  
Day Care Center ◽  
Post Stroke ◽  
Constraint Induced Movement Therapy

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

1999 ◽  
Vol 79 (9) ◽  
pp. 847-853 ◽  
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.

Tele-rehabilitation of upper-extremity hemiparesis after stroke: Proof-of-concept randomized controlled trial of in-home constraint-induced movement therapy

2021 ◽  
pp. 1-16
Author(s):  
Gitendra Uswatte ◽  
Edward Taub ◽  
Peter Lum ◽  
David Brennan ◽  
Joydip Barman ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Controlled Trial ◽  
Movement Therapy ◽  
Proof Of Concept ◽  
Upper Arm ◽  
Long Term Outcome ◽  
Post Stroke ◽  
Constraint Induced Movement Therapy ◽  
Health Group ◽  
One Year

Background: Although Constraint-Induced Movement therapy (CIMT) has been deemed efficacious for adults with persistent, mild-to-moderate, post-stroke upper-extremity hemiparesis, CIMT is not available on a widespread clinical basis. Impediments include its cost and travel to multiple therapy appointments. To overcome these barriers, we developed an automated, tele-health form of CIMT. Objective: Determine whether in-home, tele-health CIMT has outcomes as good as in-clinic, face-to-face CIMT in adults ≥1-year post-stroke with mild-to-moderate upper-extremity hemiparesis. Methods: Twenty-four stroke patients with chronic upper-arm extremity hemiparesis were randomly assigned to tele-health CIMT (Tele-AutoCITE) or in-lab CIMT. All received 35 hours of treatment. In the tele-health group, an automated, upper-extremity workstation with built-in sensors and video cameras was set-up in participants’ homes. Internet-based audio-visual and data links permitted supervision of treatment by a trainer in the lab. Results: Ten patients in each group completed treatment. All twenty, on average, showed very large improvements immediately afterwards in everyday use of the more-affected arm (mean change on Motor Activity Log Arm Use scale = 2.5 points, p <  0.001, d’ = 3.1). After one-year, a large improvement from baseline was still present (mean change = 1.8, p <  0.001, d’ = 2). Post-treatment outcomes in the tele-health group were not inferior to those in the in-lab group. Neither were participants’ perceptions of satisfaction with and difficulty of the interventions. Although everyday arm use was similar in the two groups after one-year (mean difference = –0.1, 95%CI = –1.3–1.0), reductions in the precision of the estimates of this parameter due to drop-out over follow-up did not permit ruling out that the tele-health group had an inferior long-term outcome. Conclusions: This proof-of-concept study suggests that Tele-AutoCITE produces immediate benefits that are equivalent to those after in-lab CIMT in stroke survivors with chronic upper-arm extremity hemiparesis. Cost savings possible with this tele-health approach remain to be evaluated.

Modified Constraint-Induced Movement Therapy for Upper Extremity Recovery Post Stroke: What Is the Evidence?

2014 ◽  
Vol 21 (4) ◽  
pp. 319-331 ◽  
Author(s):  
Alana Fleet ◽  
Stephen J. Page ◽  
Marilyn MacKay-Lyons ◽  
Shaun G. Boe
Keyword(s):  
Upper Extremity ◽  
Movement Therapy ◽  
Post Stroke ◽  
Constraint Induced Movement Therapy

scholarly journals Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia

2003 ◽  
Vol 83 (4) ◽  
pp. 384-398 ◽  
Author(s):  
Nancy (McNamara) Bonifer ◽  
Kristin M Anderson
Keyword(s):  
Case Report ◽  
Motor Activity ◽  
Upper Extremity ◽  
Motor Function ◽  
Movement Therapy ◽  
Motor Deficits ◽  
Intensive Training ◽  
Constraint Induced Movement Therapy ◽  
Task Practice

Abstract Background and Purpose. Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. Case Description. The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. Methods. The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. Outcomes. Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. Discussion. This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.

scholarly journals Can the Wolf Motor Function Test be Streamlined?

2009 ◽  
Vol 23 (5) ◽  
pp. 422-428 ◽  
Author(s):  
Kimberly Bogard ◽  
Steven Wolf ◽  
Qin Zhang ◽  
Paul Thompson ◽  
David Morris ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Movement Therapy ◽  
Change Score ◽  
Functional Level ◽  
Regression Methods ◽  
Constraint Induced Movement Therapy ◽  
Gender Concordance ◽  
Function Test ◽  
Wolf Motor Function Test

Background. To assess upper extremity (UE) capabilities following stroke, the Wolf Motor Function Test (WMFT) measures time to complete 15 UE tasks and 2 strength tasks, but takes 30 to 45 minutes for the clinician to complete. Objective. In an effort to streamline the WMFT, this study evaluated the association between the magnitude of improvement on any timed task of the WMFT and the change score on all other tasks among participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial. Methods. This association was evaluated using regression methods according to chronicity and controlling for key covariates (functional level, gender, concordance) for log mean WMFT scores. Results. After controlling for covariates, 6 tasks (hand to table [front], hand to box [front], reach and retrieve, lift can, lift pencil, and fold towel) influenced the overall WMFT score for survivors meeting EXCITE criteria and treated within 3 to 9 months poststroke. Six different tasks (extend elbow weight, hand to box [front], lift can, lift pencil, turn key in lock, and fold towel) influenced the overall WMFT score for those receiving constraint-induced movement therapy (CIMT) 1 year later. The importance of certain tasks relative to others may best represent overall UE function, but this streamlining enables the clinician to prioritize these tasks in the evaluation. Conclusions. The delineation of those tasks depends on the time poststroke from enrollment to CIMT. This study demonstrates that the WMFT can be streamlined from 17 to 6 tasks.

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