Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke.
OBJECTIVE
This study compared the efficacy of distributed constraint-induced therapy (dCIT), bilateral arm training (BAT), and control treatment (CT) on motor control and functional performance of the upper limb in stroke patients.


METHODS
A total of 66 patients with mean stroke onset of 16.20 months and mild to moderate motor impairment were randomized to dCIT, BAT, or CT groups. Each group received treatment for 2 h/d and 5 d/wk for 3 weeks. Pretreatment and posttreatment measures included reaching kinematic variables in unilateral and bilateral tasks, the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL).


RESULTS
The dCIT and BAT groups had smoother reaching trajectories in the unilateral and bilateral tasks than the CT group. The BAT group, but not the dCIT group, generated greater force at movement initiation than the CT group during the unilateral and bilateral tasks. The dCIT patients had decreased WMFT time and higher functional ability scores than the CT patients. MAL results pointed to better performance in the amount and quality of use of the affected arm than BAT and CT patients.


CONCLUSIONS
BAT and dCIT exhibited similar beneficial effects on movement smoothness but differential effects on force at movement initiation and functional performance. Therefore, BAT is a better option if improvement of force generation is the treatment goal, and dCIT is more appropriate for improving functional ability and use of the affected arm in daily life. These findings may assist in the planning of individually tailored rehabilitation therapies.
Wu
Ching-yi
CY
Chang Gung University, Taoyuan, Taiwan.
Chuang
Li-ling
LL
Lin
Keh-chung
KC
Chen
Hsieh-ching
HC
Tsay
Pei-kwei
PK
D001132:Arm / Q000294:innervation / Q000503:physiopathology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009473:Neuronal Plasticity / Q000502:physiology*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010291:Paresis / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation