The Effects of Constraint-Induced Therapy on Kinematic Outcomes and Compensatory Movement Patterns: An Exploratory Study

Schema of experimental setup. Seated subjects reached with the stroke-affected arm between a proximal target and a distal target placed at maximum reach of the stroke-affected arm in a sagittal plane. Participants were instructed to tap back and forth as fast as they could, alternating between proximal and distal targets.

Graphical representation of group means (unaffected, n=4; stroke-affected, n=10) of the relative amount of movement accounted by trunk movement, shoulder flexion, and elbow extension (left) and schematic reaching of a representative subject's (subject 10) strategy of the affected limb pre-CIT and of the unaffected limb (right). Trunk and arm configurations are shown at proximal contact (gray) and at distal contact (dashed lines). (A) Reach with the unaffected side occurred with shoulder flexion and elbow extension with little movement at the trunk. Schematic (subject 10) is shown as a mirror-image. (B) Pre-CIT reach with the stroke-affected arm. The bird's-eye view of a representative reaching strategy (subject 10) illustrates that the trunk and arm moved together as fixed unit with large trunk displacement and little shoulder flexion.

Schematic illustration of shoulder abduction regression post-CIT (gray=unaffected; solid=pre-CIT; dashed=post-CIT). Participants used significantly more shoulder abduction post-CIT during the early stages of reach (P<.05). Compared with the unaffected side, clearly illustrated is the increased use of shoulder abduction as a compensatory strategy that increased post-CIT.

(A) Scatter plot of a representative subject's trajectory variability (subject 8). (B) Clearly illustrated is closer clustering of coordinates post-CIT. Post-CIT coefficient of variation for the group mean (n=10) was 47.91%±10.5%, which was a significant post-CIT decrease (P<.017). (C) The coefficient of variation for unaffected reach group mean (n=4) was 24.57%±9.9%.

Segmental contribution in distance. Mean distance (cm) and SE are represented at pre-CIT (black) and post-CIT (pre). After CIT, shoulder flexion accounted for significantly more movement (*P<.05); the decreases in elbow and trunk movement were not significant.