Constraint-induced movement therapy after stroke: efficacy for patients with minimal upper-extremity motor ability.
OBJECTIVE
To examine the effects of constraint-induced movement therapy (CIMT) on chronic moderate-to-severe upper-extremity motor impairment after stroke.


METHODS
Within-subjects design; pre- and posttesting as well as 1-month follow-up.


METHODS
Outpatient clinic within a rehabilitation hospital.


METHODS
Twenty participants, each greater than 12 months poststroke.


METHODS
Three weeks of CIMT including restraint of the nonparetic upper extremity and 6 hours of training a day.


METHODS
Fugl-Meyer Assessment (FMA), Graded Wolf Motor Function Test (GWMFT), and Motor Activity Log (MAL).


RESULTS
There was a statistically significant effect of treatment on upper-extremity motor impairment as assessed by the FMA, the MAL, and the functional ability scale of the GWMFT. There was a trend toward an effect of CIMT on mean speed of performance on the GWMFT. Post hoc analysis showed significant differences between motor impairment scores between pretreatment and posttreatment assessments, and improvements in motor impairment scores remained stable 1 month after completion of formal treatment. Improvements appeared to be mostly in the use of the involved upper extremity for bimanual activities.


CONCLUSIONS
CIMT conferred significant changes in objective measures in subjects with chronic moderate-to-severe impairments after stroke. Additional studies of long-term benefits of this treatment on poststroke motor impairments and related functional disabilities are warranted.
Bonifer
Nancy M
NM
HealthONE Spalding Rehabilitation Hospital, Aurora, CO, USA. nbonifer@aol.com
Anderson
Kristin M
KM
Arciniegas
David B
DB
D000368:Aged; D000553:Ambulatory Care; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D026741:Physical Therapy Modalities; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000502:physiology*