Clinical Study Of Constraint-induced Movement Therapy

Background:stroke is a disease with high rate of incidence and deformation,majority of patients have dysfunction in hemi upper extremity.Therefore training affected upper extremity of survivors can improve social participation and quality of life of patients.Conventional rehabilitation emphasizes on repeated and bilateral training,while our study introduce a new training method-- constraint- induced movement therapy (CIMT),which is first put forword by Taub. In 1963,Taub severed nerve innervating forelimb,so when monkey uses affected limb, it is easy to fall down and fail to coordinate and feed itself,so it had to use intact side to feed itself after failing many times,and action is more skillful,through repeated, positive training,monkey learns to use intact side to accomplish all the activityies instead of affected side,the phenomenon is called"learned nonuse theory".To overcome Learned nonuse phenomenon,Taub thought of a treatment mothed.During treatment,reseachers restricted movement of intact forelimb through the restricting device that left affect limb free and forced monkey to use it,after one or two weeks,they removed the restriction,then it was found monkey could use affected limb to do functional activities which would last for a long time.Through above experiment,Taub thought that"learned nonuse theory"can extend to human,especially patients suffered from central nerve diseases,because they use intact upper extremity to do all instead of affected one in the early period of stroke ,so came the constraint-induced movement therapy.He tried to generalize the therapy to chronic stroke patients,expecting to improve upper extremity function of stroke .Objective:To investigate the beneficial effect of constraint-induced movement therapy in improving the function of hemiplegic upper extremity in the subacute stroke patients in contrast with conventional rehabilitation therapy and whether extending wearing constraint mitten can promote the recovery of affected arm.Design:A prospective,single-blind,randomized controlled study comparing the effectiveness of constaint-induced movement therapy or conventional rehabilitation therapy at post intervention and whether extending constraint time can promote recovery of affected arm.Methods:Eighteen stroke patients accordant with inclusion criteria were randomly divided into 3 groups:conventional constaint-induced movement therapy(CIMT1)group(6 cases),extending mitten wearing (CIMT2)group(6 cases),and control treatment(CTL)group(6 cases).Affected upper extremity of patients in CIMT1 group received shaping exercises of 6 hours everyday,with restriction of movement of the unaffected upper extremity in the sling and mitten for 90% waking time,10days in all(resting on weekend).During the period,therapists can choose 6～7shaping plans,which include movements usually used in everyday life,such as using chopsticks or scoops,opening or closing door,elaborate-movement hand training and so on.They choose different shaping tasks and make individual training scheme according to one's disorder then receiving conventional rehabilitation therapy after the two-week time;CIMT2 group is the same as CIMT1 group in the first two weeks,then their unaffected upper extremities were restricted in the sling and mitten for 90% waking time in the following 4 weeks,while their affected upper extremities received conventional rehabilitation therapy;CTL group received conventional rehabilitation therapy everyday such as physical therapy(PT),occupational therapy(OT), Chinese traditional therapy and so on in the six-week time.Main measures:Functional levels for affected upper extremity of all patients were measured by Action Research Arm Test(ARAT), Fugl-Meyer Assessment(FMA),Motor Activity Log(MAL)at baseline before treatment,two week and six week after treatment respectively.Results:In each group,scores of ARAT,FMA and the'amount of use'and'how well'subscales of MAL were seen significant improvements after two-week CIMT(P<0.05).Comparing every two groups,CIMT1 and CIMT2 groups showed significant improvements over control group at two-week time(P<0.05).At six-week time, CIMT2 groups showed significant improvements over CIMT1 group(P<0.05) and CIMT1 group showed significant improvements over control group(P<0.05).Conclusion:Significant improvement in affected hand function could be achieved with constraint-induced movement therapy in subacute stroke patients,better than conventional rehabilitation therapy . Wearing restriction mitten constrains patients to use affected limb,which can help patients cultivate affected side-using habit.Extending constraint mitten wearing-time can promote recovery of affected arm.. Constraint and intensive training both play decisive role in CIMT,therapy lack of either one cannot replace constraint-induced movement therapy.