(Stroke. 1999;30:2369-2375.)
© 1999 American Heart Association, Inc.
Original Contributions |
Forced Use of the Upper Extremity in Chronic Stroke Patients
Results From a Single-Blind Randomized Clinical Trial
From the Departments of Rehabilitation Medicine (J.H. van der L., G.J.L., T.W.V.) and Physical Therapy (R.C.W.), University Hospital Vrije Universiteit, and Institute for Research in Extramural Medicine, Vrije Universiteit (J.H. van der L., G.J.L., W.L.D., L.M.B.), Amsterdam, the Netherlands.
Correspondence to J.H. van der Lee, MD, Department of Rehabilitation Medicine, University Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, Netherlands. E-mail jh.vanderlee{at}azvu.nl
Background and Purpose—Of all stroke survivors, 30% to 66% are unable to use their affected arm in performing activities of daily living. Although forced use therapy appears to improve arm function in chronic stroke patients, there is no conclusive evidence. This study evaluates the effectiveness of forced use therapy.
Methods—In an observer-blinded randomized clinical trial, 66 chronic stroke patients were allocated to either forced use therapy (immobilization of the unaffected arm combined with intensive training) or a reference therapy of equally intensive bimanual training, based on Neuro-Developmental Treatment, for a period of 2 weeks. Outcomes were evaluated on the basis of the Rehabilitation Activities Profile (activities), the Action Research Arm (ARA) test (dexterity), the upper extremity section of the Fugl-Meyer Assessment scale, the Motor Activity Log (MAL), and a Problem Score. The minimal clinically important difference (MCID) was determined at the onset of the study.
Results—One week after the last treatment session, a significant difference in effectiveness in favor of the forced use group compared with the bimanual group (corrected for baseline differences) was found for the ARA score (3.0 points; 95% CI, 1.3 to 4.8; MCID, 5.7 points) and the MAL amount of use score (0.52 points; 95% CI, 0.11 to 0.93; MCID, 0.50). The other parameters revealed no significant differential effects. One-year follow-up effects were observed only for the ARA. The differences in treatment effect for the ARA and the MAL amount of use scores were clinically relevant for patients with sensory disorders and hemineglect, respectively.
Conclusions—The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm (ARA) and a temporary clinically relevant effect on the amount of use of the affected arm during activities of daily living (MAL amount of use). The effect of forced use therapy was clinically relevant in the subgroups of patients with sensory disorders and hemineglect, respectively.
Key Words: arm • clinical trials • disability • hemiplegia • rehabilitation
This article has been cited by other articles:
 |
|
 |
|
  R. L. Harvey, C. J. Winstein, and for the Everest Trial Group Design for the Everest Randomized Trial of Cortical Stimulation and Rehabilitation for Arm Function Following Stroke Neurorehabil Neural Repair, January 1, 2009; 23(1): 32 - 44. [Abstract] [PDF]
|
|
|
|
|
|
R. Turk, S. V. Notley, R. M. Pickering, D. M. Simpson, P. A. Wright, and J. H. Burridge Reliability and Sensitivity of a Wrist Rig to Measure Motor Control and Spasticity in Poststroke Hemiplegia Neurorehabil Neural Repair, November 1, 2008; 22(6): 684 - 696. [Abstract] [PDF]
|
|
|
|
|
|
S.-W. Park, S. L. Wolf, S. Blanton, C. Winstein, and D. S. Nichols-Larsen The EXCITE Trial: Predicting a Clinically Meaningful Motor Activity Log Outcome Neurorehabil Neural Repair, September 1, 2008; 22(5): 486 - 493. [Abstract] [PDF]
|
|
|
|
|
|
L. Sawaki, A. J. Butler, Xiaoyan Leng, P. A. Wassenaar, Y. M. Mohammad, S. Blanton, K. Sathian, D. S. Nichols-Larsen, S. L. Wolf, D. C. Good, et al. Constraint-Induced Movement Therapy Results in Increased Motor Map Area in Subjects 3 to 9 Months After Stroke Neurorehabil Neural Repair, September 1, 2008; 22(5): 505 - 513. [Abstract] [PDF]
|
|
|
|
 |
|
 B. C. Huijgen, M. M. Vollenbroek-Hutten, M. Zampolini, E. Opisso, M. Bernabeu, J. Van Nieuwenhoven, S. Ilsbroukx, R. Magni, C. Giacomozzi, V. Marcellari, et al. Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis J Telemed Telecare, July 1, 2008; 14(5): 249 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Dahl, T. Askim, R. Stock, E. Langorgen, S. Lydersen, and B. Indredavik Short- and long-term outcome of constraint-induced movement therapy after stroke: a randomized controlled feasibility trial Clinical Rehabilitation, May 1, 2008; 22(5): 436 - 447. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Page and P. Levine Author Response Physical Therapy, May 1, 2008; 88(5): 684 - 688. [Full Text] [PDF]
|
|
|
|
|
|
S. J Page, P. Levine, A. Leonard, J. P Szaflarski, and B. M Kissela Modified Constraint-Induced Therapy in Chronic Stroke: Results of a Single-Blinded Randomized Controlled Trial Physical Therapy, March 1, 2008; 88(3): 333 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. W. W. Myint, G. F. C. Yuen, T. K. K. Yu, C. P. L. Kng, A. M. Y. Wong, K. K. C. Chow, H. C. K. Li, and Chun Por Wong A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong Clinical Rehabilitation, February 1, 2008; 22(2): 112 - 124. [Abstract] [PDF]
|
|
|
|
|
|
K.-C. Lin, C.-Y. Wu, T.-H. Wei, C. Gung, C.-Y. Lee, and J.-S. Liu Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study Clinical Rehabilitation, December 1, 2007; 21(12): 1075 - 1086. [Abstract] [PDF]
|
|
|
|
|
|
A. Burns, J. Burridge, and R. Pickering Does the use of a constraint mitten to encourage use of the hemiplegic upper limb improve arm function in adults with subacute stroke? Clinical Rehabilitation, October 1, 2007; 21(10): 895 - 904. [Abstract] [PDF]
|
|
|
|
|
|
R. T. Kaplon, M. G. Prettyman, C. L. Kushi, and C. J. Winstein Six hours in the laboratory: a quantification of practice time during constraint-induced therapy (CIT) Clinical Rehabilitation, October 1, 2007; 21(10): 950 - 958. [Abstract] [PDF]
|
|
|
|
|
|
M. N. McDonnell, S. L. Hillier, T. S. Miles, P. D. Thompson, and M. C. Ridding Influence of Combined Afferent Stimulation and Task-Specific Training Following Stroke: A Pilot Randomized Controlled Trial Neurorehabil Neural Repair, October 1, 2007; 21(5): 435 - 443. [Abstract] [PDF]
|
|
|
|
|
|
C.-y. Wu, K.-c. Lin, H.-c. Chen, I-h. Chen, and W.-h. Hong Effects of Modified Constraint-Induced Movement Therapy on Movement Kinematics and Daily Function in Patients With Stroke: A Kinematic Study of Motor Control Mechanisms Neurorehabil Neural Repair, October 1, 2007; 21(5): 460 - 466. [Abstract] [PDF]
|
|
|
|
|
|
S. L. Wolf, C. J. Winstein, J. P. Miller, S. Blanton, P. C. Clark, and D. Nichols-Larsen Looking in the Rear View Mirror When Conversing With Back Seat Drivers: The EXCITE Trial Revisited Neurorehabil Neural Repair, October 1, 2007; 21(5): 379 - 387. [Abstract] [PDF]
|
|
|
|
|
|
B. Hemmen and H.A.M. Seelen Effects of movement imagery and electromyography-triggered feedback on arm hand function in stroke patients in the subacute phase Clinical Rehabilitation, July 1, 2007; 21(7): 587 - 594. [Abstract] [PDF]
|
|
|
|
|
|
S. J Page and P. Levine Modified Constraint-Induced Therapy in Patients With Chronic Stroke Exhibiting Minimal Movement Ability in the Affected Arm Physical Therapy, July 1, 2007; 87(7): 872 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. L Scheets, S. A Sahrmann, and B. J Norton Use of Movement System Diagnoses in the Management of Patients With Neuromuscular Conditions: A Multiple-Patient Case Report Physical Therapy, June 1, 2007; 87(6): 654 - 669. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L Fritz, S. Z George, S. L Wolf, and K. E Light Participant Perception of Recovery as Criterion to Establish Importance of Improvement for Constraint-Induced Movement Therapy Outcome Measures: A Preliminary Study Physical Therapy, February 1, 2007; 87(2): 170 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Boake, E. A. Noser, T. Ro, S. Baraniuk, M. Gaber, R. Johnson, E. T. Salmeron, T. M. Tran, J. M. Lai, E. Taub, et al. Constraint-Induced Movement Therapy During Early Stroke Rehabilitation Neurorehabil Neural Repair, January 1, 2007; 21(1): 14 - 24. [Abstract] [PDF]
|
|
|
|
|
|
E. M Frick and J. L Alberts Combined Use of Repetitive Task Practice and an Assistive Robotic Device in a Patient With Subacute Stroke Physical Therapy, October 1, 2006; 86(10): 1378 - 1386. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-F. Sun, C.-W. Hsu, C.-W. Hwang, P.-T. Hsu, J.-L. Wang, and C.-L. Yang Application of Combined Botulinum Toxin Type A and Modified Constraint-Induced Movement Therapy for an Individual With Chronic Upper-Extremity Spasticity After Stroke Physical Therapy, October 1, 2006; 86(10): 1387 - 1397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D Ries and R. Leonard Is there evidence to support the use of constraint-induced therapy to improve the quality or quantity of upper extremity function of a 2 1/2-year-old girl with congenital hemiparesis? If so, what are the optimal parameters of this intervention? Physical Therapy, May 1, 2006; 86(5): 746 - 752. [Full Text] [PDF]
|
|
|
|
|
|
J. Higgins, N. M Salbach, S. Wood-Dauphinee, C. L Richards, R. Cote, and N. E Mayo The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial Clinical Rehabilitation, April 1, 2006; 20(4): 296 - 310. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Taub, G. Uswatte, D. K. King, D. Morris, J. E. Crago, and A. Chatterjee A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke Stroke, April 1, 2006; 37(4): 1045 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Brogardh and B. H Sjolund Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use Clinical Rehabilitation, March 1, 2006; 20(3): 218 - 227. [Abstract] [PDF]
|
|
|
|
|
|
S. M. Michaelsen, R. Dannenbaum, and M. F. Levin Task-Specific Training With Trunk Restraint on Arm Recovery in Stroke: Randomized Control Trial Stroke, January 1, 2006; 37(1): 186 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Rijntjes, V. Hobbeling, F. Hamzei, S. Dohse, G. Ketels, J. Liepert, and C. Weiller Individual Factors in Constraint-Induced Movement Therapy after Stroke Neurorehabil Neural Repair, September 1, 2005; 19(3): 238 - 249. [Abstract] [PDF]
|
|
|
|
|
|
P. W. Duncan, R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline Stroke, September 1, 2005; 36(9): e100 - e143. [Full Text] [PDF]
|
|
|
|
|
|
U. Gabr, P. Levine, and S. J Page Home-based electromyography-triggered stimulation in chronic stroke Clinical Rehabilitation, July 1, 2005; 19(7): 737 - 745. [Abstract] [PDF]
|
|
|
|
|
|
J. Desrosiers, D. Bourbonnais, H. Corriveau, S. Gosselin, and G. Bravo Effectiveness of unilateral and symmetrical bilateral task training for arm during the subacute phase after stroke: a randomized controlled trial Clinical Rehabilitation, June 1, 2005; 19(6): 581 - 593. [Abstract] [PDF]
|
|
|
|
|
|
K. Kawahira, M. Shimodozono, S. Etoh, and N. Tanaka New facilitation exercise using the vestibulo-ocular reflex for ophthalmoplegia: preliminary report Clinical Rehabilitation, June 1, 2005; 19(6): 627 - 634. [Abstract] [PDF]
|
|
|
|
|
|
E. Taub, P. S. Lum, P. Hardin, V. W. Mark, and G. Uswatte AutoCITE: Automated Delivery of CI Therapy With Reduced Effort by Therapists Stroke, June 1, 2005; 36(6): 1301 - 1304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Waller and J. Whitall Hand dominance and side of stroke affect rehabilitation in chronic stroke Clinical Rehabilitation, May 1, 2005; 19(5): 544 - 551. [Abstract] [PDF]
|
|
|
|
|
|
S. L Fritz, Y.-P. Chiu, M. P Malcolm, T. S Patterson, and K. E Light Feasibility of Electromyography-Triggered Neuromuscular Stimulation as an Adjunct to Constraint-Induced Movement Therapy Physical Therapy, May 1, 2005; 85(5): 428 - 442. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P M van Vliet, N B Lincoln, and A Foxall Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial J. Neurol. Neurosurg. Psychiatry, April 1, 2005; 76(4): 503 - 508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. M. Pomeroy, C. A. Clark, J. S. G. Miller, J.-C. Baron, H. S. Markus, and R. C. Tallis The Potential for Utilizing the "Mirror Neurone System" to Enhance Recovery of the Severely Affected Upper Limb Early after Stroke: A Review and Hypothesis Neurorehabil Neural Repair, March 1, 2005; 19(1): 4 - 13. [Abstract] [PDF]
|
|
|
|
|
|
S. J. Page, P. Levine, and A. C. Leonard Modified Constraint-Induced Therapy in Acute Stroke: A Randomized Controlled Pilot Study Neurorehabil Neural Repair, March 1, 2005; 19(1): 27 - 32. [Abstract] [PDF]
|
|
|
|
|
|
J. L. Alberts, A. J. Butler, and S. L. Wolf The Effects of Constraint-Induced Therapy on Precision Grip: A Preliminary Study Neurorehabil Neural Repair, December 1, 2004; 18(4): 250 - 258. [Abstract] [PDF]
|
|
|
|
|
|
J. E Sullivan and L. D Hedman A Home Program of Sensory and Neuromuscular Electrical Stimulation With Upper-Limb Task Practice in a Patient 5 Years After a Stroke Physical Therapy, November 1, 2004; 84(11): 1045 - 1054. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R P. Van Peppen, G Kwakkel, S Wood-Dauphinee, H J. Hendriks, P. J Van der Wees, and J Dekker The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clinical Rehabilitation, August 1, 2004; 18(8): 833 - 862. [Abstract] [PDF]
|
|
|
|
|
|
C. Luke, K. J Dodd, and K. Brock Outcomes of the Bobath concept on upper limb recovery following stroke Clinical Rehabilitation, August 1, 2004; 18(8): 888 - 898. [Abstract] [PDF]
|
|
|
|
 |
|
 J.-K. Lee, J.-E. Kim, M. Sivula, and S. M. Strittmatter Nogo Receptor Antagonism Promotes Stroke Recovery by Enhancing Axonal Plasticity J. Neurosci., July 7, 2004; 24(27): 6209 - 6217. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J Turton and S. R Butler A multiple case design experiment to investigate the performance and neural effects of a programme for training hand function after stroke Clinical Rehabilitation, July 1, 2004; 18(7): 754 - 763. [Abstract] [PDF]
|
|
|
|
|
|
S.-W. Park, A. J. Butler, V. Cavalheiro, J. L. Alberts, and S. L. Wolf Changes in Serial Optical Topography and TMS during Task Performance after Constraint-Induced Movement Therapy in Stroke: A Case Study Neurorehabil Neural Repair, June 1, 2004; 18(2): 95 - 105. [Abstract] [PDF]
|
|
|
|
|
|
J.H. van der Lee, H. Beckerman, D.L. Knol, H.C.W. de Vet, and L.M. Bouter Clinimetric Properties of the Motor Activity Log for the Assessment of Arm Use in Hemiparetic Patients Stroke, June 1, 2004; 35(6): 1410 - 1414. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N M Salbach, N E Mayo, S Wood-Dauphinee, J A Hanley, C L Richards, and R Cote A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial Clinical Rehabilitation, May 1, 2004; 18(5): 509 - 519. [Abstract] [PDF]
|
|
|
|
|
|
J. Whitall Stroke Rehabilitation Research: Time to Answer more Specific Questions? Neurorehabil Neural Repair, March 1, 2004; 18(1): 3 - 8. [PDF]
|
|
|
|
|
|
R. J Siegert, S. Lord, and K. Porter Constraint-induced movement therapy: time for a little restraint? Clinical Rehabilitation, January 1, 2004; 18(1): 110 - 114. [Abstract] [PDF]
|
|
|
|
|
|
J. V Bastille and K. M Gill-Body A Yoga-Based Exercise Program for People With Chronic Poststroke Hemiparesis Physical Therapy, January 1, 2004; 84(1): 33 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Barreca, S. L. Wolf, S. Fasoli, and R. Bohannon Treatment Interventions for the Paretic Upper Limb of Stroke Survivors: A Critical Review Neurorehabil Neural Repair, December 1, 2003; 17(4): 220 - 226. [Abstract] [PDF]
|
|
|
|
 |
|
 F. M. Mottaghy TMS: Using brain plasticity to treat chronic poststroke symptoms Neurology, October 14, 2003; 61(7): 881 - 882. [Full Text] [PDF]
|
|
|
|
|
|
M. E. Selzer and R. D. Zorowitz Designing Prospective, Randomized, Multicenter Clinical Trials of Physical Rehabilitation Treatment Modalities Neurorehabil Neural Repair, September 1, 2003; 17(3): 135 - 136. [PDF]
|
|
|
|
|
|
C. J. Winstein, J. P. Miller, S. Blanton, E. Taub, G. Uswatte, D. Morris, D. Nichols, and S. Wolf Methods for a Multisite Randomized Trial to Investigate the Effect of Constraint-Induced Movement Therapy in Improving Upper Extremity Function among Adults Recovering from a Cerebrovascular Stroke Neurorehabil Neural Repair, September 1, 2003; 17(3): 137 - 152. [Abstract] [PDF]
|
|
|
|
|
|
H. Rodgers, J. Mackintosh, C. Price, R. Wood, P. McNamee, T. Fearon, A. Marritt, and R. Curless Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome? Clinical Rehabilitation, June 1, 2003; 17(6): 579 - 589. [Abstract] [PDF]
|
|
|
|
|
|
N. Bonifer and K. M Anderson Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia Physical Therapy, April 1, 2003; 83(4): 384 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. DeBow, M. L.A. Davies, H. L. Clarke, and F. Colbourne Constraint-Induced Movement Therapy and Rehabilitation Exercises Lessen Motor Deficits and Volume of Brain Injury After Striatal Hemorrhagic Stroke in Rats Stroke, April 1, 2003; 34(4): 1021 - 1026. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Wittenberg, R. Chen, K. Ishii, K. O. Bushara, E. Taub, L. H. Gerber, M. Hallett, and L. G. Cohen Constraint-Induced Therapy in Stroke: Magnetic-Stimulation Motor Maps and Cerebral Activation Neurorehabil Neural Repair, March 1, 2003; 17(1): 48 - 57. [Abstract] [PDF]
|
|
|
|
|
|
I-P. Hsueh and C.-L. Hsieh Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation Clinical Rehabilitation, June 1, 2002; 16(6): 617 - 624. [Abstract] [PDF]
|
|
|
|
|
|