Kinematic and Clinical Analyses of Upper-Extremity Movements After Constraint-Induced Movement Therapy in Patients With Stroke: A Randomized Controlled Trial
Abstract
Wu CY, Chen CL, Tang SF, Lin KC, Huang YY. Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial.
Objective
To study the effects of constraint-induced movement therapy (CIMT) relative to traditional intervention on motor-control strategies for upper-arm reaching and motor performance at the impairment and functional levels in stroke patients.
Design
Two-group randomized controlled trial (RCT); pretreatment and posttreatment measures.
Setting
Rehabilitation clinics.
Participants
Forty-seven stroke patients (mean age, 55y) 3 weeks to 37 months postonset of a first-ever cerebrovascular accident.
Interventions
Forty-seven patients received either CIMT (restraint of the less affected hand combined with intensive training of the more affected upper extremity) or traditional intervention (control treatment) during the study. The treatment intensity was matched between the 2 groups (2h/d, 5d/wk for 3wk).
Main Outcome Measures
Outcomes were evaluated using (1) kinematic variables of reaching movement used to describe the control strategies for reaching, (2) the Fugl-Meyer Assessment (FMA) of motor-impairment severity, and (3) the Motor Activity Log (MAL) evaluating the functional ability of the upper extremity.
Results
After treatment, the CIMT group showed better strategies of reaching control than the control group (P<.03). The CIMT group also showed less motor impairment on the FMA (P=.019) and higher functional ability on the MAL (P<.001).
Conclusions
This study is the first RCT to show differences in motor-control strategies as measured by kinematic variables after CIMT versus traditional intervention. In addition to improving motor performance at the impairment and functional levels, CIMT conferred therapeutic benefits on control strategies determined by kinematic analysis.
aGraduate Institute of Clinical Behavioral Science and Department of Occupational Therapy, Chang Gung University, Tao-yuan, Taiwan
bDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Tao-yuan, Taiwan
cSchool of Occupational Therapy, College of Medicine, and Neurobiology and Cognitive Science Center, National Taiwan University, and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
dDepartment of Occupational Therapy, Jianan Mental Hospital, Tainan, Taiwan.
Reprint requests to Keh-chung Lin, ScD, OTR, Sch of Occupational Therapy, College of Medicine, National Taiwan University and Dept of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 17, F4, Xu Zhou Rd, Taipei, Taiwan 100
Supported by the National Health Research Institutes (grant nos. NHRI-EX94-9103EC, NHRI-EX95-9103EC), Medical Research Center at Chang Gung Memorial Hospital (grant no. CMRPD32022), and the National Science Council, Taiwan (grant no. NSC 92-2314-B-002-139).
No commercial party having a direct financial interest in the results of 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.
ABSTRACT