Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use.
OBJECTIVE
(1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome.


METHODS
A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers.


METHODS
A university hospital rehabilitation department.


METHODS
Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb.


METHODS
Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment.


METHODS
Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log.


RESULTS
The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P < 0.001). However, no additional effect was seen from wearing a mitt for another three months.


CONCLUSIONS
Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.
Brogårdh
Christina
C
Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden. christina.brogardh@rehabmed.umu.se
Sjölund
Bengt H
BH
D000704:Analysis of Variance; D016022:Case-Control Studies; D002908:Chronic Disease; D026241:Exercise Movement Techniques; D005260:Female; D006126:Group Processes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D012149:Restraint, Physical; D000071939:Stroke Rehabilitation