Contralesional plasticity following constraint-induced movement therapy benefits outcome: contributions of the intact hemisphere to functional recovery

Stroke is a leading cause of death and disability worldwide. A common, chronic deficit after stroke is upper limb impairment, which can be exacerbated by compensatory use of the nonparetic limb. Resulting in learned nonuse of the paretic limb, compensatory reliance on the nonparetic limb can be discouraged with constraint-induced movement therapy (CIMT). CIMT is a rehabilitative strategy that may promote functional recovery of the paretic limb in both acute and chronic stroke patients through intensive practice of the paretic limb combined with binding, or otherwise preventing activation of, the nonparetic limb during daily living exercises. The neural mechanisms that support CIMT have been described in the lesioned hemisphere, but there is a less thorough understanding of the contralesional changes that support improved functional outcome following CIMT. Using both human and non-human animal studies, the current review explores the role of the contralesional hemisphere in functional recovery of stroke as it relates to CIMT. Current findings point to a need for a better understanding of the functional significance of contralesional changes, which may be determined by lesion size, location, and severity as well stroke chronicity.

Comparison of Constraint-Induced Movement Therapy Vs Traditional Rehabilitation Therapy to Improve Upper Limb Function in Hemiplegic Acute and Subacute Stroke Patients

Background: Stroke is a generic term in use to describe the sudden interruption of blood flow to the part of brain, resulting loss of brain function. A stroke may be also known as cerebrovascular accident. Cerebrovascular accident which defines as pathology in which brain disease occurs secondary to disorders of blood supply of brain. It is essential to know about the magnitude of impact of stroke globally. Aim: To determine effectiveness of constraint induced movement therapy and comparing its efficacy to traditional rehabilitation in acute and sub-acute stroke survivors exhibiting upper limb hemiplegia Methodology: This was a randomized clinical trial study, conducted in Lahore in which eighteen stroke patients had participated. Current study includes MAL and WMFT questionnaire in it and sample size was 18. Patients were treated 4 times a week and unaffected limb was constrained for two hours in therapy session and onwards to 10 hours to motivate the use of effected limb. Readings were taken weekly and patients were reassessed by using MAL and WMFT. CIMT treatment protocol consists of 3 or 4 month of daily intensive training of the affected extremity for 2 hours in association with restriction of the non-affected extremity for 10 hours a day. Group B: Traditional rehabilitation therapy used Sling (shoulder immobilizer) made of poly urethane material. Hair brush, cup, marbles, cards, blocks, tissue paper, cones, Swiss ball, dexterity board. Results: Statistical analysis was set at p ≤ 0.05. huge and direct to vast impacts existed on WMFT (P=0.010) noteworthy and direct to extensive impacts existed When p-value is not as much as the foreordained importance level which is frequently 0.05 or 0.01, showing that the watched results would be profoundly impossible under the alternate theory. In this way, the alternate hypothesis was supported. Subsequently null hypothesis is rejected and alternate hypothesis is accepted. Conclusion: This study concluded that the patients who were treated with CIMT showed remarkable change in upper extremity functions. While patients who were treated with traditional rehabilitation therapy they exhibited less change in their functional activities than Constraint-Induced Movement Therapy. Keywords: Comparison, traditional rehabilitation therapy, Constraint-Induced Movement Therapy (CIMT) Approaches