(Stroke. 2000;31:2984.)
© 2000 American Heart Association, Inc.
Original Contributions |
Does the Application of Constraint-Induced Movement Therapy During Acute Rehabilitation Reduce Arm Impairment After Ischemic Stroke?
From the Department of Neurology and Program in Occupational Therapy, Washington University School of Medicine, St Louis, Mo.
Correspondence and reprint requests to Alexander Dromerick, MD, Campus Box 8111, 660 South Euclid Ave, St Louis, MO 63110. E-mail dromericka{at}neuro.wustl.edu
Background and Purpose—Motor dysfunction after unilateral deafferentation in primates can be overcome by restraining the unaffected limb. We asked whether a constraint-induced movement (CIM) program could be implemented within 2 weeks after stroke and whether CIM is more effective than traditional upper-extremity (UE) therapies during this period.
Methods—Twenty-three persons were enrolled in a pilot randomized, controlled trial that compared CIM with traditional therapies. A blinded observer rated the primary end point, the Action Research Arm Test (ARA). Inclusion criteria were the following: ischemic stroke within 14 days, persistent hemiparesis, evidence of preserved cognitive function, and presence of a protective motor response. Differences between the groups were compared by using Student’s t tests, ANCOVA, and Mann-Whitney U tests.
Results—Twenty subjects completed the 14-day treatment. Two adverse outcomes, a recurrent stroke and a death, occurred in the traditional group; 1 CIM subject met rehabilitation goals and was discharged before completing 14 inpatient days. The CIM treatment group had significantly higher scores on total ARA and pinch subscale scores (P<0.05). Differences in the mean ARA grip, grasp, and gross movement subscale scores did not reach statistical significance. UE activities of daily living performance was not significantly different between groups, and no subject withdrew because of pain or frustration.
Conclusions—A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatment. Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies.
Key Words: cerebrovascular disorders • controlled clinical trials • motor activity • neuronal plasticity • rehabilitation
This article has been cited by other articles:
 |
|
 |
|
  S. L. Wolf On "Effects of forced use on arm function in the subacute phase..." Hammer AM, Lindmark B. Phys Ther. 2009;89:526-539. Physical Therapy, September 1, 2009; 89(9): 993 - 995. [Full Text] [PDF]
|
|
|
|
 |
|
 A. W. Dromerick, C. E. Lang, R. L. Birkenmeier, J. M. Wagner, J. P. Miller, T. O. Videen, W. J. Powers, S. L. Wolf, and D. F. Edwards Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT Neurology, July 21, 2009; 73(3): 195 - 201. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Harris, J. J. Eng, W. C. Miller, and A. S. Dawson A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation: A Multi-Site Randomized Controlled Trial Stroke, June 1, 2009; 40(6): 2123 - 2128. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K.-c. Lin, Y.-h. Huang, Y.-w. Hsieh, and C.-y. Wu Potential Predictors of Motor and Functional Outcomes After Distributed Constraint-Induced Therapy for Patients With Stroke Neurorehabil Neural Repair, May 1, 2009; 23(4): 336 - 342. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Brogardh, U.-B. Flansbjer, and J. Lexell What is the long-term benefit of constraint-induced movement therapy? A four-year follow-up Clinical Rehabilitation, May 1, 2009; 23(5): 418 - 423. [Abstract] [PDF]
|
|
|
|
|
|
K.-c. Lin, C.-y. Wu, J.-s. Liu, Y.-t. Chen, and C.-j. Hsu Constraint-Induced Therapy Versus Dose-Matched Control Intervention to Improve Motor Ability, Basic/Extended Daily Functions, and Quality of Life in Stroke Neurorehabil Neural Repair, February 1, 2009; 23(2): 160 - 165. [Abstract] [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
N. Yozbatiran, L. Der-Yeghiaian, and S. C. Cramer A Standardized Approach to Performing the Action Research Arm Test Neurorehabil Neural Repair, February 1, 2008; 22(1): 78 - 90. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
S. L Wolf Revisiting Constraint-Induced Movement Therapy: Are We Too Smitten With the Mitten? Is All Nonuse "Learned"? and Other Quandaries Physical Therapy, September 1, 2007; 87(9): 1212 - 1223. [Abstract] [Full Text] [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
B. H. Dobkin Confounders in Rehabilitation Trials of Task-Oriented Training: Lessons From the Designs of the EXCITE and SCILT Multicenter Trials Neurorehabil Neural Repair, January 1, 2007; 21(1): 3 - 13. [Abstract] [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]
|
|
|
|
|
|
J. M. Wagner, C. E. Lang, S. A. Sahrmann, Q. Hu, A. J. Bastian, D. F. Edwards, and A. W. Dromerick Relationships between Sensorimotor Impairments and Reaching Deficits in Acute Hemiparesis Neurorehabil Neural Repair, September 1, 2006; 20(3): 406 - 416. [Abstract] [PDF]
|
|
|
|
|
|
J. Underwood, P. C Clark, S. Blanton, D. M Aycock, and S. L Wolf Pain, Fatigue, and Intensity of Practice in People With Stroke Who Are Receiving Constraint-Induced Movement Therapy Physical Therapy, September 1, 2006; 86(9): 1241 - 1250. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sharma, V. M. Pomeroy, and J.-C. Baron Motor Imagery: A Backdoor to the Motor System After Stroke? Stroke, July 1, 2006; 37(7): 1941 - 1952. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L Fritz, K. E Light, S. N Clifford, T. S Patterson, A. L Behrman, and S. B Davis Descriptive Characteristics as Potential Predictors of Outcomes Following Constraint-Induced Movement Therapy for People After Stroke Physical Therapy, June 1, 2006; 86(6): 825 - 832. [Abstract] [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
B. Bates, J. Y. Choi, P. W. Duncan, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, D. Reker, and R. Zorowitz Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: Executive Summary Stroke, September 1, 2005; 36(9): 2049 - 2056. [Abstract] [Full Text] [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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 B. H. Dobkin Rehabilitation after Stroke N. Engl. J. Med., April 21, 2005; 352(16): 1677 - 1684. [Full Text] [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. C. Grotta, E. A. Noser, T. Ro, C. Boake, H. Levin, J. Aronowski, and T. Schallert Constraint-Induced Movement Therapy Stroke, November 1, 2004; 35(11_suppl_1): 2699 - 2701. [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]
|
|
|
|
|
|
S. E. Fasoli, H. I. Krebs, M. Ferraro, N. Hogan, and B. T. Volpe Does Shorter Rehabilitation Limit Potential Recovery Poststroke? Neurorehabil Neural Repair, June 1, 2004; 18(2): 88 - 94. [Abstract] [PDF]
|
|
|
|
|
|
C. G Canning, L. Ada, R. Adams, and N. J O'Dwyer Loss of strength contributes more to physical disability after stroke than loss of dexterity Clinical Rehabilitation, March 1, 2004; 18(3): 300 - 308. [Abstract] [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]
|
|
|
|
|
|
M. Ferraro, J. J. Palazzolo, J. Krol, H. I. Krebs, N. Hogan, and B. T. Volpe Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke Neurology, December 9, 2003; 61(11): 1604 - 1607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Pierce, K. G. Gallagher, S. W. Schaumburg, A. M. Gershkoff, J. P. Gaughan, and L. Shutter Home Forced Use in an Outpatient Rehabilitation Program for Adults with Hemiplegia: A Pilot Study Neurorehabil Neural Repair, December 1, 2003; 17(4): 214 - 219. [Abstract] [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
M. Ferraro, J. H. Demaio, J. Krol, C. Trudell, K. Rannekleiv, L. Edelstein, P. Christos, M. Aisen, J. England, S. Fasoli, et al. Assessing the Motor Status Score: A Scale for the Evaluation of Upper Limb Motor Outcomes in Patients after Stroke Neurorehabil Neural Repair, September 1, 2002; 16(3): 283 - 289. [Abstract] [PDF]
|
|
|
|
|
|
S. J. Page, S. Sisto, M. V. Johnston, and P. Levine Modified Constraint-Induced Therapy after Subacute Stroke: A Preliminary Study Neurorehabil Neural Repair, September 1, 2002; 16(3): 290 - 295. [Abstract] [PDF]
|
|
|
|
 |
|
 W. M. Landau and S. A. Sahrmann Preservation of Directly Stimulated Muscle Strength in Hemiplegia Due to Stroke Arch Neurol, September 1, 2002; 59(9): 1453 - 1457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D Herbert, C. G Maher, A. M Moseley, and C. Sherrington Regular review: Effective physiotherapy BMJ, October 6, 2001; 323(7316): 788 - 790. [Full Text] [PDF]
|
|