Constraint-Induced Stroke Therapy Improves Function

Stroke Therapy

The benefits of a stroke rehabilitation technique that restrains one arm to strengthen the other lasted throughout a two-year, placebo-controlled follow-up, researchers reported in today's rapid access issue of Stroke: Journal of the American Heart Association.

The study is the first placebo-controlled trial of Constraint-Induced Movement therapy (CI therapy), a technique that requires patients wear a hand splint or sling on their arm unaffected by stroke for 90 percent of waking hours during a 14-day treatment period. The rationale is that survivors are forced to use their stroke-weakened arm.

The prevailing view has been that the amount of motor recovery present at one year after stroke is the level at which patients will remain. In contrast, CI therapy has improved limb function years after stroke. However, no placebo-controlled study had been done.

Led by Edward Taub, Ph.D., of the University of Alabama at Birmingham, researchers studied stroke survivors with mild to moderate motor impairment of an upper limb, an average of 4.5 years after stroke. Twenty-one survivors (average age 55) underwent CI therapy: six hours of intensive therapy a day for 10 consecutive weekdays. Twenty survivors (average age 51) had placebo therapy - a general fitness program of strength, balance and stamina training, games to provide cognitive challenges and relaxation exercises for six hours a day for 10 consecutive weekdays.

CI therapy patients showed "large to very large" improvements in the functional use of their more affected arm in their daily lives. Scores on a motor activity log (MAL) in which survivors and caregivers noted how well and how much survivors used their more impaired arm in daily living improved an average of 1.8 points for those undergoing CI therapy. Those in the control group reported no change. In addition, CI patients were able to speed their completion of tasks in lab testing while the placebo patients were slower in the tasks.

At two year follow-up, the CI group showed a large improvement in MAL scores compared to pre-treatment scores. Those in the placebo group displayed no significant changes.

Researchers said these findings indicate that chronic stroke patients may benefit from CI therapy. The study was partly funded by the National Institutes of Health.