title: Effects of sling and voluntary constraint during constraint-induced movement therapy for the arm after stroke: a randomized, prospective, single-centre, blinded observer rated study.
abstract: OBJECTIVE
  To determine whether a combination of constraint-induced movement therapy and physiotherapy in stroke patients using different constraint regimens (sling versus voluntary constraint) changes or reduces motor deficits, the amount of functional use of the arm and whether the effects of treatment continue after 12 months.
  
  
  METHODS
  Forty-seven stroke patients were stratified and randomly divided into intensive physiotherapy programmes focused on regaining arm functions.
  
  
  METHODS
  Neurorehabilitation Unit of IInd Department of Neurology at Institute of Psychiatry and Neurology in Warsaw.
  
  
  METHODS
  Patients were randomly allocated to: the sling-constraint group (n = 24) or to the voluntary-constraint group (n = 23).
  
  
  METHODS
  Massed practice with the paretic arm (5 hours/day for 15 consecutive working days). Sling-constraint group had their arm immobilized in a hemi-sling during therapy. In addition, individual, 1-hour physiotherapy sessions were conducted in both groups.
  
  
  METHODS
  Rivermead Motor Assessment (RMA) Arm scale, (0-15), Motor Activity Log - Quality of Movement (MAL-QOM) (0-5 for 30 daily tasks).
  
  
  RESULTS
  There was no significant difference between groups after therapy (MAL-QOM mean change for sling group 0.78, SD = 0.46 and for voluntary-constraint group 0.84, SD = 0.48; P = 0.687). All treated patients retained mean gains in real-world arm use (MAL-QOM) mean scores after 12 months follow-up compared with posttreatment values but there was no significant difference between groups (comparison of estimated mean change of MAL-QOM stated 0.23. 95% confidence interval = -0.04-0.50).
  
  
  CONCLUSIONS
  Voluntary activity constraint in the intact arm is equivalent to sling, standard constraint during massed practice of paretic arm.
authors.affiliation: 1IInd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Krawczyk
authors.forename: Marta
authors.initials: M
authors.lastname: Sidaway
authors.forename: Anna
authors.initials: A
authors.lastname: Radwanska
authors.forename: Joanna
authors.initials: J
authors.lastname: Zaborska
authors.forename: Renata
authors.initials: R
authors.lastname: Ujma
authors.forename: Anna
authors.initials: A
authors.lastname: Czlonkowska
mesh_terms: D000328:Adult; D001132:Arm / Q000502:physiology / Q000503:physiopathology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D011044:Poland; D011446:Prospective Studies; D012149:Restraint, Physical; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation