title: Characterizing the protocol for early modified constraint-induced movement therapy in the EXPLICIT-stroke trial.
abstract: Constraint-induced movement therapy (CIMT) is a commonly used rehabilitation intervention to improve upper limb function after stroke. CIMT was originally developed for patients with a chronic upper limb paresis. Although there are indications that exercise interventions should start as early as possible after stroke, only a few randomized controlled trials have been published on either CIMT or modified forms of CIMT (mCIMT) during the acute phase after stroke. The implementation of (m)CIMT in published studies is very heterogeneous in terms of content, timing and intensity of therapy. Moreover, mCIMT studies often fail to provide a detailed description of the protocol applied. The purpose of the present paper is therefore to describe the essential elements of the mCIMT protocol as developed for the EXplaining PLastICITy after stroke (EXPLICIT-stroke) study. The EXPLICIT-stroke mCIMT protocol emphasizes restoring body functions, while preventing the development of compensatory movement strategies. More specifically, the intervention aims to improve active wrist -and finger extension, which is assumed to be a key factor for upper limb function. The intervention starts within 2 weeks after stroke onset. The protocol retains two of the three key elements of the original CIMT protocol, that is, repetitive training and the constraining element. Repetitive task training is applied for 1 hour per working day, and the patients wear a mitt for at least 3 hours per day for three consecutive weeks.
authors.affiliation: Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Rinske
authors.initials: R
authors.lastname: Nijland
authors.forename: Erwin
authors.initials: E
authors.lastname: van Wegen
authors.forename: Hanneke
authors.initials: H
authors.lastname: van der Krogt
authors.forename: Chantal
authors.initials: C
authors.lastname: Bakker
authors.forename: Floor
authors.initials: F
authors.lastname: Buma
authors.forename: Asbjørn
authors.initials: A
authors.lastname: Klomp
authors.forename: Joost
authors.initials: J
authors.lastname: van Kordelaar
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D002985:Clinical Protocols; D005385:Fingers / Q000502:physiology; D006801:Humans; D009426:Netherlands; D010291:Paresis / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology; D012149:Restraint, Physical / Q000379:methods*; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D014953:Wrist / Q000502:physiology