Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 3 , Pages 273-278 , March 2007

A Randomized Controlled Trial of Modified Constraint-Induced Movement Therapy for Elderly Stroke Survivors: Changes in Motor Impairment, Daily Functioning, and Quality of Life

  • Ching-yi Wu, ScD, OTR

      Affiliations

    • Graduate Institute of Clinical Behavioral Science and Department of Occupational Therapy, Chang Gung University, Tao-yuan, Taiwan
    • ,
  • Chia-ling Chen, MD, PhD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Tao-yuan, Taiwan
    • ,
  • Wen-chung Tsai, MD, PhD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Tao-yuan, Taiwan
    • ,
  • Keh-chung Lin, ScD, OTR

      Affiliations

    • School of Occupational Therapy, College of Medicine, National Taiwan University, and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
    • Corresponding Author InformationCorrespondence to Keh-chung Lin, ScD, OTR, Sch of Occupational Therapy, College of Medicine, National Taiwan University and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 17, F4, Xu Zhou Rd, Taipei, Taiwan 100
    • ,
  • Shih-han Chou, BS

      Affiliations

    • Graduate Institute of Clinical Behavioral Science and Department of Occupational Therapy, Chang Gung University, Tao-yuan, Taiwan

References 

  1. Ricauda NA, Bo M, Molaschi M, et al. Home hospitalization service for acute uncomplicated first ischemic stroke in elderly patients: a randomized trial. J Am Geriatr Soc. 2004;52:278–283
  2. Stephens S, Kenny RA, Rowan E, et al. Association between mild vascular cognitive impairment and impaired activities of daily living in older stroke survivors without dementia. J Am Geriatr Soc. 2005;53:103–107
  3. American Heart Association. Heart disease and stroke statistics—2006 update. Dallas: AHA; 2006;
  4. Grotta JC, Noser EA, Ro T, et al. Constraint-induced movement therapy. Stroke. 2004;35(11 Suppl 1):2699–2701
  5. Taub E, Uswatte G, Elbert T. New treatments in neurorehabilitation founded on basic research. Nature Rev Neurosci. 2002;3:228–236
  6. Sunderland A, Tuke A. Neuroplasticity, learning and recovery after stroke: a critical evaluation of constraint-induced therapy. Neuropsychol Rehabil. 2005;15:81–96
  7. Taub E, Uswatte G, Pidikiti R. Constraint-induced movement therapy: a new family. J Rehabil Res Dev. 1999;36:237–251
  8. Page SJ, Levine P, Sisto S, Bond Q, Johnston MV. Stroke patients’ and therapists’ opinions of constraint-induced movement therapy. Clin Rehabil. 2002;16:55–60
  9. Page SJ, Sisto SA, Johnston MV, Levine P, Hughes M. Modified constraint induced therapy: a randomized, feasibility and efficacy study. J Rehabil Res Dev. 2001;38:583–590
  10. Dromerick AW, Edwards DF, Hahn M. Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?. Stroke. 2000;31:2984–2988
  11. Miltner W, Bauder H, Sommer M, Dettmers C, Taub E. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. Stroke. 1999;30:586–592
  12. Page SJ, Sisto S, Johnston MV, Levine P. Modified constraint-induced therapy after subacute stroke: a preliminary study. Neurorehabil Neural Repair. 2002;16:290–295
  13. Page SJ, Sisto S, Levine P. Modified constraint-induced therapy in chronic stroke. Am J Phys Med Rehabil. 2002;81:870–875
  14. Page SJ, Sisto S, Levine P, McGrath R. Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. 2004;85:1377–1381
  15. World Health Organization. ICIDH-2: international classification of functioning and disability (Beta-2 draft, short version). Geneva: WHO; 1999;
  16. van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. 1999;30:2369–2375
  17. Samsa GP, Matchar DB. How strong is the relationship between functional status and quality of life among persons with stroke?. J Rehabil Res Dev. 2004;41:279–282
  18. Dettmers C, Teske U, Hamzei F, Uswatte G, Taub E, Weiller C. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil. 2005;86:204–209
  19. Murphy MA, Roberts-Warrior D. A review of motor performance measures and treatment interventions for patients with stroke. Top Geriatr Rehabil. 2003;19:3–42
  20. Brunnstrom S. Movement therapy in hemiplegia. New York: Harper & Row; 1970;
  21. Teng EL, Chui HC. The modified Mini-Mental State Exam. J Clin Psychiatry. 1987;48:314–318
  22. Uswatte G, Taub E. Constraint-induced movement therapy: new approaches to outcome measurement in rehabilitation. In:  Struss DT,  Winocur G,  Robertson IH editor. Cognitive neurorehabilitation: a comprehensive approach. Cambridge: Cambridge Univ Pr; 1999;p. 215–229
  23. Bohannon R, Smith M. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206–207
  24. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient (1. A method for evaluation of physical performance). Scand J Rehabil Med. 1975;7:13–31
  25. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63:1606–1610
  26. DiFabio RP, Badke RB. Relationship of sensory organization to balance function in patients with hemiplegia. Phys Ther. 1990;70:542–548
  27. Hamilton BB, Granger CV, Sherwin FS, Zielezny M, Tashman JS. A uniform national data system for medical rehabilitation. In:  Fuhrer MJ editors. Rehabilitation outcomes: analysis and measurements. Baltimore: Brookes; 1987;p. 137–147
  28. Chau N, Daler S, Andre JM, Patris A. Inter-rater agreement of two functional independence scales: the Functional Independence Measure (FIM) and a subjective uniform continuous scale. Disabil Rehabil. 1994;16:63–71
  29. Hamilton B, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level Functional Independence Measure (FIM). Scand J Rehabil Med. 1994;26:115–119
  30. Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the Functional Independence Measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil. 1993;74:531–536
  31. Kidd D, Stewart G, Baldry J, et al. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil. 1995;17:10–14
  32. Gosman-Hedstrom G, Svensson E. Parallel reliability of the Functional Independence Measure and the Barthel ADL index. Disabil Rehabil. 2000;22:702–715
  33. Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0: evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30:2131–2140
  34. Duncan PW, Bode RK, Lai SM, Perera S. Rasch analysis of a new stroke-specific outcome scale: the stroke impact scale. Arch Phys Med Rehabil. 2003;84:950–963
  35. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134:663–694
  36. Stevens JP. Applied multivariate statistics for the social sciences. 4th ed.. Mahwah: Lawrence Erlbaum Associates; 2002;
  37. Rosenthal R, Rosnow RL. Essentials of behavioral research: methods and data analysis. 2nd ed.. New York: McGraw-Hill; 1991;
  38. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed.. Hillsdale: Lawrence Erlbaum Associates; 1988;
  39. Kwakkel G, Kollen BJ, Wagenaar RC. Long term effects of intensity of upper and lower limb training after stroke: a randomized trial. J Neurol Neurosurg Psychiatry. 2002;72:473–479
  40. Carmeli E, Patish H, Coleman R. The aging hand. J Gerontol A Biol Sci Med Sci. 2003;58:146–152
  41. Guan J, Wade MG. The effect of aging on adaptive eye-hand coordination. J Gerontol B Psychol Sci Soc Sci. 2000;55:151–162
  42. Ranganathan VK, Siemionow V, Sahgal V, Liu JZ, Yue GH. Skilled finger movement exercise improves hand function?. J Gerontol A Biol Sci Med Sci. 2001;56:518–522
  43. Brogardh C, Sjolund BH. Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use. Clin Rehabil. 2006;20:218–227
  44. McAuley E, Blissmer B, Marquez DX, Jerome GJ, Kramer AF, Katula J. Social relations, physical activity, and well-being in older adults. Prev Med. 2000;31:608–617
  45. Studenski S, Duncan PW, Perera S, Reker D, Lai SM, Richards L. Daily functioning and quality of life in a randomized controlled trial of therapeutic exercise for subacute stroke survivors. Stroke. 2005;36:1764–1770
  46. Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 2nd ed.. Upper Saddle River: Prentice-Hall; 2000;

 Supported by the National Health Research Institutes (grant no. NHRI-EX95-9103EC) and the National Science Council (grant no. NSC 93-2314-B-002-116).No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(06)01529-2

doi: 10.1016/j.apmr.2006.11.021

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 3 , Pages 273-278 , March 2007

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