Effects of Constraint-Induced Movement Therapy on Patients With Chronic Motor Deficits After Stroke

TLDR

Constraint‑induced movement therapy has been shown to markedly increase use of the more affected upper limb in chronic stroke patients. This study aimed to replicate those gains in a German laboratory where conventional physical therapy is more extensive than in the United States. Fifteen chronic stroke patients received CI therapy that restricted the intact arm in a sling for 90 % of waking hours over 12 days while the affected arm was trained for 7 hours per day across eight weekdays. Patients achieved large improvements on laboratory motor tests (effect size 0.9) and real‑world use of the affected limb (effect size 2.2), with gains maintained at six‑month follow‑up and no change during a pretreatment control interval, confirming the intervention’s general applicability.

Abstract

Background and Purpose —Constraint-induced movement therapy (CI therapy) has previously been shown to produce large improvements in actual amount of use of a more affected upper extremity in the “real-world” environment in patients with chronic stroke (ie, >1 year after the event). This work was carried out in an American laboratory. Our aim was to determine whether these results could be replicated in another laboratory located in Germany, operating within the context of a healthcare system in which administration of conventional types of physical therapy is generally more extensive than in the United States. Methods —Fifteen chronic stroke patients were given CI therapy, involving restriction of movement of the intact upper extremity by placing it in a sling for 90% of waking hours for 12 days and training (by shaping) of the more affected extremity for 7 hours on the 8 weekdays during that period. Results —Patients showed a significant and very large degree of improvement from before to after treatment on a laboratory motor test and on a test assessing amount of use of the affected extremity in activities of daily living in the life setting (effect sizes, 0.9 and 2.2, respectively), with no decrement in performance at 6-month follow-up. During a pretreatment control test-retest interval, there were no significant changes on these tests. Conclusions —Results replicate in Germany the findings with CI therapy in an American laboratory, suggesting that the intervention has general applicability.