Constraint Induced Movement Therapy

Smania N, Gandolfi M, Paolucci S, Iosa M, Ianes P, Recchia S, Giovanzana C, Molteni SFF, Avesani R, Di Paolo P, Zaccala M, Agostini M, Tassorelli C, Fiaschi A, Primon D, Ceravolo MR, Farina S.  (2012) Reduced-Intensity Modified Constraint-Induced Movement Therapy Versus Conventional Therapy for Upper Extremity Rehabilitation After Stroke : A Multicenter Trial. Neurorehabilitation and Neural Repair, 26(9), 1035-1045

Background. Constraint-induced movement therapy (CIMT) is a rehabilitation approach for arm paresis consisting of an
intensive schedule of treatment (6 h/d). The high demand of resources for CIMT is a critical issue for its implementation in the Italian health system.

Objective. To compare the effects of a reduced-intensity modified CIMT (mCIMT) program that included splinting the unaffected arm for 12 hours daily with the effects of a conventional rehabilitation program for arm paresis in patients with stroke.

Methods. Sixty-six participants with hemiparesis (3-24 months poststroke) who could extend the wrist and several fingers at least 10° were randomly assigned to mCIMT or conventional rehabilitation. Each group underwent 10 (2 h/d) treatment sessions (5 d/wk for 2 weeks). Patients were assessed with the Wolf Motor Function Test (WMFT-FA and WMFT-T), the Motor Activity Log (MAL-AOU and MAL-QOM), and the Ashworth Scale before and after treatment and 3 months later.

Results. Between-groups analysis showed that the mCIMT group overall had greater improvement than the control group in terms of the WMFT-FA (P = .010), MAL-AOU (P < .001), and MAL-QOM (P < .001). Differences between groups were significant both after treatment (P < .01) and at the 3-month follow-up (P < .01), although 40% of participants did not complete the 3-month assessment. Furthermore, the mCIMT group showed a greater decrease of Ashworth Scale score than the control group at 3 months (P = .021).

Conclusion. Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke.