Application of Constraint-induced Movement Therapy for People with Severe Chronic Plegic Hand

Abstract

Objective: To determine the efficacy of intense constraint-induced movement therapy (CIMT) for patients who cannot achieve finger extension due to a severe plegic hand after stroke. Design: Pre-post, pre-1 month follow-up, single-blinded, multi-baseline case. Participants: Fifteen participants who were all >12 months post-stroke. Interventions: Two weeks of CIMT including restraint of the nonparetic upper extremity and 6 hours of training each day. Outcome: There was a statistically significant effect of CIMT on upper extremity motor impairment assessed by the Fugl-Meyer Motor Assessment (FMA), the Motor Activity Log for low functioning patients (Grade 5 MAL) and Active Range of Motion (AROM). Post hoc analysis showed significant differences between pre- and post-treatment motor impairment scores, and the improvements in these scores were maintained at 1 month after completion of treatment. Improvements were mostly in the use of the involved upper extremity for bimanual activities. Conclusions: Intense CIMT conferred significant changes in objective measures in subjects with chronic severe plegic hand after stroke. Additional studies of the long-term benefits of this treatment on post-stroke motor impairments and related functional disabilities are warranted.