Effects of modified constraint-induced movement therapy on movement kinematics and daily function in patients with stroke: a kinematic study of motor control mechanisms.
OBJECTIVE
Motor control of the upper extremity during unilateral and bimanual functional tasks and functional change during daily activities were evaluated in patients with stroke treated with modified constraint-induced movement therapy (mCIMT).


METHODS
In a pre-post randomized, controlled trial, 30 stroke patients received 2 hours of mCIMT or traditional rehabilitation (TR) for 3 weeks. Motor control of the upper extremity was evaluated using kinematic analysis in unilateral and bilateral tasks. Kinematic variables included spatial and temporal movement efficiency and type of movement control (preplanned control, representing well-learned movement, or feedback-guided control). Functional outcomes were evaluated using the Motor Activity Log (MAL) and the Functional Independence Measure (FIM).


RESULTS
Patients receiving mCIMT showed more temporally (P = .013) and spatially (P = .011) efficient movement and more preplanned movement control (P = .009) during the bimanual task, and greater gains in FIM (P = .004) and MAL scores (amount of use: P < .0001, and quality of movement: P = .012) than patients in the TR group. Patients receiving mCIMT produced more ballistic/preplanned reaching movement than did patients receiving TR (P = .023) during the unilateral task; but there were no group differences in temporal or spatial efficiency in unilateral task performance.


CONCLUSIONS
Relative to TR, mCIMT produced a greater improvement in functional performance and motor control. Improvement of motor control after mCIMT was based on improved spatial and temporal efficiency, apparently more salient during bimanual rather than unilateral task performance. This suggests that bilateral task performance should potentially be emphasized in kinematic study of changes in motor control after mCIMT.
Wu
Ching-yi
CY
Department of Occupational Therapy and Graduate Institute of Clinical Behavioral Science, Chang Gung University, Taoyuan, Taiwan. cywu@mail.cgu.edu.tw
Lin
Keh-chung
KC
Chen
Hsieh-ching
HC
Chen
I-hsuen
IH
Hong
Wei-hsien
WH
D000203:Activities of Daily Living; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D012046:Rehabilitation / Q000379:methods; D012149:Restraint, Physical; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome