Modified constraint-induced movement therapy improved upper limb function in subacute poststroke patients: a small-scale clinical trial.

BACKGROUND: Constraint-induced movement therapy (CIMT) has been advocated as a means of facilitating motor function in poststroke patients; however, the evidence for its efficacy is controversial. OBJECTIVE: To evaluate the effect of modified CIMT on improving paretic arm function in poststroke patients during a subacute rehabilitation period. METHODS: A single-blinded randomized controlled trial was conducted at the Loewenstein Rehabilitation Hospital, Israel. Twenty-eight subacute stroke patients with arm paresis after a first ischemic stroke in the middle cerebral artery area were randomized into a modified CIMT or control group by a 1:2 ratio. The modified CIMT group received 1-hour daily physical rehabilitation sessions for 2 weeks. The unaffected arm was restrained during the sessions. Subjects were encouraged to wear a restrictive mitten up to 4 hours a day. The control group received similar intensive regular rehabilitation. Three upper limb function tests, developed for this study, were used as outcome measures. The subjects were asked to perform the following tasks, with the affected hand for 30 seconds: (1) transfer pegs from a saucer to a pegboard; (2) grasp, carry, and release a hard rubber ball; and (3) "eating," using a spoon to remove the jelly from the plate, bring it towards the mouth, and then place it on another plate. The number of repetitions in each test was recorded as an outcome. RESULTS: The modified CIMT group showed significantly higher changes in all 3 tests compared to the standard rehabilitation group. CONCLUSION: Our study provides additional support for the use of modified CIMT during a subacute rehabilitation period of poststroke patients. CIMT may facilitate functional improvement of a plegic hand.

Constraint-induced movement therapy alters cerebral blood flow in subacute post-stroke patients.

We attempted to evaluate patterns of hemispheric activation, according to cerebral blood flow changes, in post-stroke patients during motor tasks with and without arm restriction. Bilateral continuous middle cerebral artery monitoring of 6 healthy subjects (control group) and 28 post-stroke patients by transcranial Doppler sonography was executed while performing three simple motor tasks using the paretic or nondominant (in controls) hand: ball grasping, pegs insertion, and "eating" with a spoon. The nonaffected or dominant (in controls) arm was free and thereafter restricted. Mean blood flow velocity and flow velocity changes during the tests were estimated. No significant mean blood flow velocity changes were found in the healthy subjects. Significant elevation of mean blood flow velocity in damaged middle cerebral artery was recorded in post-stroke patients after restricting the undamaged hand. This may explain the positive effect of constraint-induced movement therapy on upper limb function.

Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients.

OBJECTIVE: To evaluate the association between mean flow velocity (MFV) in the middle cerebral artery (MCA) measured by using transcranial Doppler (TCD) and functional and neurologic impairment change during rehabilitation after acute stroke. DESIGN: Cross-sectional observational study. SETTING: Acute neurologic rehabilitation department. PARTICIPANTS: Consecutive patients (N=67; 53 men, 14 women; mean ± SD age, 61.54±8.92y) referred to the rehabilitation center during the first 6 months of 2006 for a first ischemic stroke in the MCA area. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All subjects were evaluated on admission and at discharge by using the National Institutes of Health Stroke Scale (NIHSS) and the FIM. TCD measurements of MFV of the ipsilateral and contralateral MCA were performed on admission (during the first 20 days after stroke) and a few days before discharge. RESULTS: Contralateral MFV at admission was associated significantly with all indexes of functional rehabilitation success (FIM score at discharge [ß=.169; P=.010], change in FIM score [ß=.554; P=.010], relative improvement in FIM score [ß=.783; P=.003]). No significant association was found between indexes of NIHSS change and ipsilateral or contralateral MFV. CONCLUSIONS: Ipsilateral or contralateral MFV measured at admission did not change during the 2-month rehabilitation period. Our data showed a significant association between blood flow velocity in the contralateral MCA and functional rehabilitation parameters of patients after first ischemic stroke in the MCA area.