What is the long-term benefit of constraint-induced movement therapy? A four-year follow-up

Abstract

Objective: To evaluate the long-term benefits of constraint-induced movement therapy in chronic stroke.

Design: A four-year follow-up after constraint-induced group therapy assessing arm and hand function and self-reported daily hand use.

Subjects: Fourteen post-stroke individuals (six women and eight men; mean age 59.6 ± 12.7 years, range 23—75 years) with mild to moderate impairments of hand function.

Outcome measures: The Sollerman hand function test and the Motor Activity Log test.

Results: Four years after constraint-induced group therapy the participants had maintained their hand function, as measured by the Sollerman hand function test. The self-reported use and quality of movements of the more affected hand, as measured by the Motor Activity Log test, had decreased compared to post-treatment and three months follow-up (P<0.01), but was still significantly higher than pre-treatment (P<0.05).

Conclusion: There seems to be a long-term benefit of constraint-induced group therapy. Hand function was maintained over time and daily hand use had increased compared to pre-treatment. To provide guidelines about the clinical use of constraint-induced movement therapy further, larger and controlled studies are needed.

Get full access to this article

View all access options for this article.

References

Taub E. , Wolf S. Constraint induced movement techniques to facilitate upper extremity use in stroke patients. Top Stroke Rehabil 1997; 3: 38-61.

Taub E. , Uswatte G. , Elbert T. New treatments in neurorehabilitation founded on basic research. Nat Rev Neurosci 2002; 3: 228-36.

Wolf S. , Lecraw D. , Barton L. , Jann B. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp Neurol 1989; 104: 125-32.

Taub E. , Miller NE , Novack TA , Cook EW , Fleming WC , Nepomuceno CS Technique to improve chronic motor deficit after stroke. Arch Phys Med 1993; 74: 347-54.

Morris DM , Crago JE , DeLuca SC , Pidikiti RD , Taub E. Constraint-induced movement therapy for motor recovery after stroke. Neurorehabilitation 1997; 9: 29-43.

Miltner WHR , Bauder H. , Sommer M. , Dettmers C. , Taub E. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke. Stroke 1999; 30: 586-92.

Kunkel A. , Kopp B. , Muller G. , Villringer K. , Villringer A. , Taub E. Constraint-induced movement therapy for motor recovery in chronic stroke patients . Arch Phys Med Rehabil 1999; 80: 624-28.

Page SJ , Sisto SA , Levine P. , McGrath RE Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Arch Phys Med Rehabil 2004; 85: 14-18.

Taub E. , Uswatte G. , King DK , Morris D. , Crago JE , Chatterjee A. A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke 2006 ; 37: 1045-49.

10.

Brogårdh C. , Sjölund BH Constraint induced movement therapy in patients with stroke: A pilot study on effects of small group training and of extended mitt use. Clin Rehabil 2006 ; 20: 218-27.

11.

Wolf S. , Winstein C. , Miller J. et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke. The excite randomized clinical trial . JAMA 2006; 296: 2095-104.

12.

Blanton S. , Wolf SL An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Phys Ther 1999 ; 79: 847-53.

13.

Page S. , Sisto SA , Johnston MV , Levine P. Modified constraint-induced therapy after subacute stroke: A preliminary study . Neurorehabil Neural Repair 2002; 16: 290-95.

14.

Dromerick AW , Edwards DF , Hahn M.

Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?

Stroke 2000; 31: 2984-88.

15.

Ploughman M. , Corbett D. Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial. Arch Phys Med Rehabil 2004; 85: 1417-23.

16.

Page S. , Levine P. , Leonard AC Modified constraint-induced therapy in acute stroke: A randomized controlled pilot study. Neurorehabil Neural Repair 2005 ; 19: 27-32.

17.

Page S. , Sisto SA , Levine P. , Johnston MV , Hughes M. Modified constraint induced therapy: a randomized feasibility and efficacy study. J Rehabil Res Dev 2001; 38: 583-90.

18.

Taub E. , Lum PS , Hardin P. , Mark VW , Uswatte G. Automated delivery of CI therapy with reduced effort by therapists . Stroke 2005; 36: 1301-304.

19.

Bonifer NM , Anderson KM , Arciniegas DB Constraint-induced therapy for moderate chronic upper extremity impairment after stroke. Brain Inj 2005; 19: 323-30.

20.

van der Lee JH , Wagenaar RC , Lankhorst GJ , Vogelaar TW , Deville WL , Bouter LM Forced use of the upper extremity in chronic stroke patients. Stroke 1999; 30: 2369-75.

21.

Sollerman C. , Ejeskär A. Sollerman hand function test. A standardised method and its use in tetraplegic patients. Scand J Plast Reconstr Surg Hand Surg 1995; 29: 167-76.

22.

Brogårdh C. , Persson A. , Sjölund B. Intra-and interrater reliability of the Sollerman hand function test in patients with chronic stroke . Disabil Rehabil 2007; 29: 145-54.

23.

van der Lee JH , Beckerman H. , Knol DL , de Vet HCW , Bouter LM Clinimetric properties of the Motor Activity Log for the assessment of arm use in hemiparetic patients . Stroke 2004; 35: 1410-14.

24.

Uswatte G. , Taub E. , Morris D. , Vignolo M. , McCulloch K. Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke 2005 ; 36: 2496-99.

25.

Uswatte G. , Taub E. , Morris D. , Light K. , Thompson P. The Motor Activity Log-28: Assessing daily use of the hemiparetic arm after stroke. Neurology 2006; 67: 1189-94.