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New Technique Helps Stroke Patients Regain Arm Movement

Constraint-induced movement -- or forced-used -- therapy allows stroke patients to improve upper extremity motor functions even if the treatment does not begin until two weeks after a stroke, a study has found.

This study looked at whether a constraint-induced movement (CIM) program could be implemented within 14 days after stroke and whether it is more effective than traditional upper-extremity (UE) therapies during this period.

Twenty-three people were enrolled in the randomized, controlled pilot study comparing the new technique with traditional therapies.

Inclusion criteria were ischemic stroke within 14 days, persistent hemiparesis, evidence of preserved cognitive function and presence of a protective motor response.

A blinded observer rated the primary end point, the Action Research Arm Test (ARA); differences between the two groups were compared using the Student's t test, ANCOVA and Mann-Whitney U tests.

Of the 23 subjects, 20 completed the 14-day treatment. In the traditional therapies group, there were two adverse outcomes -- a recurrent stroke and a death.

One CIM subject met rehabilitation goals and was discharged before completing 14 in-patient days.

Overall, the CIM group had significantly higher scores on total ARA and pinch subscale scores, although differences in the mean ARA grip, grasp and gross movement subscale scores were not significant between the groups.

None of the subjects withdrew because of pain or frustration.

Study authors concluded that CIM is associated with less arm impairment at the end of treatment and suggest a clinical trial of the therapy during acute rehabilitation is feasible.

They also note long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies.
Stroke. 2000;31:2984.

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