title: Constraint-induced movement therapy combined with conventional neurorehabilitation techniques in chronic stroke patients with plegic hands: a case series.
abstract: OBJECTIVE
  To determine whether the combination of Constraint-Induced Movement Therapy (CIMT) and conventional rehabilitation techniques can produce meaningful motor improvement in chronic stroke patients with initially fisted hands.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University hospital outpatient laboratory.
  
  
  METHODS
  Consecutive sample (N=6) >1 year poststroke with plegic hands.
  
  
  METHODS
  Treatment consisted of an initial period of 3 weeks (phase A) when adaptive equipment in the home, orthotics, and splints were employed to improve ability to engage in activities of daily living. This was continued in phase B, when CIMT and selected neurodevelopmental treatment techniques were added.
  
  
  METHODS
  Motor Activity Log (MAL), accelerometry, Fugl-Meyer Motor Assessment (F-M).
  
  
  RESULTS
  Patients exhibited a large improvement in spontaneous real-world use of the more-affected arm (mean lower-functioning MAL change=1.3±0.4 points; P<.001; d'=3.0) and a similar pattern of increase in an objective measure of real-world more-affected arm movement (mean change in ratio of more- to less-affected arm accelerometer recordings=0.12±0.1 points; P=.016; d'=1.2). A large improvement in motor status was also recorded (mean F-M change=5.3±3.3 points; P=.005; d'=1.6).
  
  
  CONCLUSIONS
  The findings of this pilot study suggest that stroke patients with plegic hands can benefit from CIMT combined with some conventional rehabilitation techniques, even long after brain injury. More research is warranted.
authors.affiliation: Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA. etaub@uab.edu
authors.forename: Edward
authors.initials: E
authors.lastname: Taub
authors.forename: Gitendra
authors.initials: G
authors.lastname: Uswatte
authors.forename: Mary H
authors.initials: MH
authors.lastname: Bowman
authors.forename: Victor W
authors.initials: VW
authors.lastname: Mark
authors.forename: Adriana
authors.initials: A
authors.lastname: Delgado
authors.forename: Camille
authors.initials: C
authors.lastname: Bryson
authors.forename: David
authors.initials: D
authors.lastname: Morris
authors.forename: Staci
authors.initials: S
authors.lastname: Bishop-McKay
mesh_terms: D002908:Chronic Disease; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006429:Hemiplegia / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology; D012149:Restraint, Physical; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation