Modified Constraint-Induced Therapy in Patients With Chronic Stroke Exhibiting Minimal Movement Ability in the Affected Arm

Abstract

Background and Purpose The purpose of this study was to determine the efficacy of a reimbursable, outpatient modified constraint-induced therapy (mCIT) protocol administered to subjects with chronic stroke who initially exhibited minimal movement ability in their affected wrists and fingers. Subjects The subjects were 4 individuals who had experienced a stroke more than 1 year prior to study entry (mean age [±SD]=60.25±1.98 years, mean time since stroke=37.5±23.2 months). Method A multiple-baseline, preintervention-postintervention, single-blinded case series design was used. The intervention consisted of structured, ½-hour therapy sessions emphasizing affected arm use in valued activities, occurring 3 times per week for 10 weeks. Subjects’ less affected arms also were restrained 5 days per week for 5 hours per day during the same 10-week period. The main outcome measures were the Action Research Arm Test (ARAT), the Motor Activity Log (MAL), and the Fugl-Meyer Assessment of Motor Recovery (FM). Results The subjects exhibited improvements in use of the more affected arm (+1.9, +1.8, +1.7, and +2.3 for subjects 1 through 4, respectively) and in quality of movement (+1.5, +2.1, +1.63, and +1.9 for subjects 1 through 4, respectively), as measured by the MAL. They also exhibited reduced impairment, as measured by the FM (+5.0, +6.5, +5.5, and +5.0 for subjects 1 through 4, respectively), and increased fine motor skill movement, as measured by the ARAT (+7.5, +7.0, +7.0, and +5.5 for subjects 1 through 4, respectively). Discussion and Conclusion The findings demonstrated that mCIT participation was efficacious because it led to increased use of the affected arm and of function and to increased ability to perform valued activities. The subjects reported some new ability to perform some valued activities. These outcomes are significant because few therapies are believed to effectively increase use of the affected arm and function in this population.