Constraint-induced movement therapy during early stroke rehabilitation.
BACKGROUND
Limited data are available about the effectiveness of early rehabilitation after stroke.


OBJECTIVE
This is the 1st randomized controlled trial of constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome.


METHODS
Within 2 weeks after stroke, 23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day. Motor function of the affected UE was blindly assessed before treatment, after treatment, and 3 months after stroke. Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand.


RESULTS
Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy. All outcome comparisons showed trends favoring CIMT over intensive traditional therapy, but none was statistically significant except for improvements in the Fugl-Meyer (FM) UE motor scale immediately following treatment and in reported quality of hand function at 3 months. Improvement in UE motor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where responses of the affected hand were evoked by TMS.


CONCLUSIONS
Future trials of CIMT during early stroke rehabilitation need greater statistical power, more inclusive eligibility criteria, and improved experimental control over treatment intensity. The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3 months after stroke is associated with increased motor excitability of the affected cerebral hemisphere.
Boake
Corwin
C
Department of Physical Medicine, Baylor College of Medicine/University of Texas-Houston Medical School, Houston, TX, USA. corwin.boake@uth.tmc.edu
Noser
Elizabeth A
EA
Ro
Tony
T
Baraniuk
Sarah
S
Gaber
Mary
M
Johnson
Ruth
R
Salmeron
Eva T
ET
Tran
Thao M
TM
Lai
Jenny M
JM
Taub
Edward
E
Moye
Lemuel A
LA
Grotta
James C
JC
Levin
Harvey S
HS
D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D012149:Restraint, Physical; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome