Constraint-induced movement therapy during early stroke rehabilitation.

BACKGROUND: Limited data are available about the effectiveness of early rehabilitation after stroke. OBJECTIVE: This is the 1st randomized controlled trial of constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome. METHODS: Within 2 weeks after stroke, 23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day. Motor function of the affected UE was blindly assessed before treatment, after treatment, and 3 months after stroke. Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand. RESULTS: Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy. All outcome comparisons showed trends favoring CIMT over intensive traditional therapy, but none was statistically significant except for improvements in the Fugl-Meyer (FM) UE motor scale immediately following treatment and in reported quality of hand function at 3 months. Improvement in UE motor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where responses of the affected hand were evoked by TMS. CONCLUSIONS: Future trials of CIMT during early stroke rehabilitation need greater statistical power, more inclusive eligibility criteria, and improved experimental control over treatment intensity. The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3 months after stroke is associated with increased motor excitability of the affected cerebral hemisphere.

Twenty-four-Hour blood pressure variability after acute ischemic stroke.

In people who are healthy, circadian rhythm in blood pressure is well established, with a 10% to 20% decrease in systolic and diastolic blood pressure during nighttime. Deviations correlate with target organ disease such as left ventricular hypertrophy, retinopathy, renal disease, and stroke. Little is known about blood pressure and circadian patterns in stroke patients. This study examined 13 patients hospitalized after ischemic stroke and monitored 24-hour blood pressure with ambulatory blood pressure monitors programmed tocollect readings every 30 minutes. All subjects had an abnormal pattern in blood pressure that did not dip during nighttime. Blood pressure load, a reported indicator of risk for target organ damage, was exceeded in all subjects during daytime and nighttime. Thus stroke patients are at high risk for target organ disease including recurrent stroke. Hypertensive management of stroke patients requires further investigation.