Effect of Constraint-Induced Movement Therapy and Mirror Therapy for Patients With Subacute Stroke

Objective: To compare and to examine the effectiveness of mirror therapy and modified constraint induced movement therapy (mCIMT) on upper extremity in subacute stroke patients. Background: Stroke or cerebral vascular accident is sudden dead of the brain cells due to inadequate blood flow. The WHO defines stroke as rapidly developing clinical signs of focal disturbance of cerebral function, with symptoms lasting for 24hrs or longer or leading to death, with no apparent cause other than of vascular origin. The most common consequence of stroke is loss of upper limb function. The protocol planned for improving the function of upper limb are mirror therapy and modified constraint induced movement therapy (mCIMT). Mirror therapy is a simple and inexpensive treatment which uses the visual information activating the premotor and motor cortex of the brain. This is explained by activation of so called mirrorneuron system. Whereas mCIMT utilises the redundant pathway in brain through neuro plasticity. Methodology: A total of 30 participants with subacute stroke were selected. The inclusion criteria are both gender of age 55-70 years and duration of 2-12 months of post stroke. Participants with mini mental state examination score<24, uncontrolled systemic hypertension, severe shoulder subluxation, previous stroke and severe cardiac failure were excluded. The outcome measures were measured using Upper Extremity Functional Index (UEFI) and Fugl Meyer Upper Extremity Scale. Procedure: All 30 participants with sub-acute stroke were divided into two groups. Both the group individuals were assessed for pre test using Fugl Meyer Upper Extremity Scale and Upper Extremity Functional Index Scale. Group A (15) was assigned to mirror therapy for 5 days a week, for 4 weeks and rest intervals was given. Similarly group B (15) was assigned to modified constraint induced movement therapy for 5 days a week, for 4 weeks. Both the groups were given conventional therapy for 20 mins. At the end of study subjects were assessed for post test using UEFI and Fugl Meyer upper extremity scale. Results: The Modified Constraint Induced Movement (mCIMT) is more effective than Mirror Therapy in improving the hemiparetic upper extremity in subacute stroke patients. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.323-329

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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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