title: Effective targets for constraint-induced movement therapy for patients with upper-extremity impairment after stroke.
abstract: OBJECTIVE
  Examination of effectiveness of different sites of constraint-induced movement therapy (CI therapy) for upper-extremity impairment of patients after stroke.
  
  
  METHODS
  Patients exhibiting moderate to slight upper-extremity impairment after stroke.
  
  
  METHODS
  The patients received a modified version of CI therapy for a cumulative total of 5 h daily for 10 days. Using Fugl-Meyer scores, shoulder/elbow/forearm, wrist and hand functions were separately assessed before and after treatment. To assess the site-specific effects of CI therapy, before and after scores were statistically compared at each site using Wilcoxon signed-rank tests. Relative effects were evaluated by paired comparison of the results at each site with, in turn, the results at every other site. Instances of single-score increments were, using standard chi-square tests, statistically isolated and compared.
  
  
  RESULTS
  Nineteen patients, 12-169 (median 31) months after stroke, were enrolled in this study and completed the protocol. Age range was 40-81 (median 65) years old and pretreatment Fugl-Meyer total scores spanned 31-64 (median 48). Analyses detected statistically significant improvements for wrist, hand and coordination but not for shoulder/elbow/forearm subcomponents. For the hand, at least single-point increments were observed in 74% of the population, while only 47% showed similar increments for the shoulder/elbow/forearm, and 53% for the wrist. Statistical analysis revealed that a higher proportion had increments in hand scores.
  
  
  CONCLUSIONS
  Statistical analysis shows that CI therapy is most beneficial for treating hand function, suggesting an efficient application of this treatment.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. ytkoyama@bd6.so-net.ne.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Koyama
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sano
authors.forename: Shotaro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Teruaki
authors.initials: T
authors.lastname: Hatanaka
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Domen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D012149:Restraint, Physical; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*