title: Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements.
abstract: BACKGROUND
  Previous studies show that chronic hemiparetic patients after stroke, presents inabilities to perform movements in paretic hemibody. This inability is induced by positive reinforcement of unsuccessful attempts, a concept called learned non-use. Forced use therapy (FUT) and constraint induced movement therapy (CIMT) were developed with the goal of reversing the learned non-use. These approaches have been proposed for the rehabilitation of the paretic upper limb (PUL). It is unknown what would be the possible effects of these approaches in the rehabilitation of gait and balance.
  
  
  OBJECTIVE
  To evaluate the effect of Modified FUT (mFUT) and Modified CIMT (mCIMT) on the gait and balance during four weeks of treatment and 3 months follow-up.
  
  
  METHODS
  This study included thirty-seven hemiparetic post-stroke subjects that were randomly allocated into two groups based on the treatment protocol. The non-paretic UL was immobilized for a period of 23 hours per day, five days a week. Participants were evaluated at Baseline, 1st, 2nd, 3rd and 4th weeks, and three months after randomization. For the evaluation we used: The Stroke Impact Scale (SIS), Berg Balance Scale (BBS) and Fugl-Meyer Motor Assessment (FM). Gait was analyzed by the 10-meter walk test (T10) and Timed Up & Go test (TUG).
  
  
  RESULTS
  Both groups revealed a better health status (SIS), better balance, better use of lower limb (BBS and FM) and greater speed in gait (T10 and TUG), during the weeks of treatment and months of follow-up, compared to the baseline.
  
  
  CONCLUSIONS
  The results show mFUT and mCIMT are effective in the rehabilitation of balance and gait.
authors.affiliation: Laboratory of Neuropsychobiology and Motor Behavior, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Fuzaro
authors.forename: Carlos T
authors.initials: CT
authors.lastname: Guerreiro
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Galetti
authors.forename: Renata B V M
authors.initials: RB
authors.lastname: Jucá
authors.forename: João E de
authors.initials: JE
authors.lastname: Araujo
mesh_terms: D005260:Female; D005684:Gait; D006801:Humans; D007103:Immobilization; D008297:Male; D026741:Physical Therapy Modalities; D004856:Postural Balance; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation