title: The EXCITE Trial: reacquiring upper-extremity task performance with early versus late delivery of constraint therapy.
abstract: OBJECTIVE
  This study examines performance of Wolf Motor Function Test (WMFT) tasks in terms of the ability of EXCITE trial participants (who had suffered a stroke 3-9 months before recruitment) to complete the task within the timed interval.
  
  
  METHODS
  Data were collected from participants who received constraint-induced movement therapy (CIMT) 3 to 9 months poststroke (CIMT-I, n = 106) or 15 to 21 months poststroke (CIMT-D, n = 116). Performance on the 15 timed WMFT tasks was converted into binary values, and changes in completion of the tasks were analyzed with generalized estimating equation methods, under the assumption of a binomial or Poisson process for completion.
  
  
  RESULTS
  During CIMT, the CIMT-I group showed significant within-group improvements in 3 fine-movement tasks and in total noncompleted tasks (noncompletes), whereas the CIMT-D group did not (P ≤ .0036). CIMT-I improvement was significantly greater than CIMT-D improvement for the lifting pencil task and total noncompletes. During the year following CIMT, neither group showed significant changes in completion of WMFT tasks. Over all time intervals, only the CIMT-I group displayed significant improvement in several tasks and total noncompletes. Between groups, there were significant and almost-significant differences between the improvements of the 2 groups in 3 tasks requiring fine distal movement.
  
  
  CONCLUSIONS
  Receiving CIMT earlier appears to improve reacquisition and retention of WMFT tasks, especially those requiring fine motor skills. Combined with earlier findings, these results indicate that improvements in existing motor abilities are possible with both immediate and delayed CIMT, but early CIMT is necessary for significant reacquisition of tasks.
authors.affiliation: Emory University, Graduate Division of Biological and Biomedical Sciences, Atlanta, GA 30322, USA. klang@emory.edu
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Lang
authors.forename: Paul A
authors.initials: PA
authors.lastname: Thompson
authors.forename: Steven L
authors.initials: SL
authors.lastname: Wolf
mesh_terms: D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D009043:Motor Activity / Q000502:physiology*; D012149:Restraint, Physical / Q000379:methods*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D034941:Upper Extremity / Q000502:physiology*
keywords: cerebrovascular accident; outcome; stroke; upper extremity