Stroke
Patients Benefit from "Constraint" Therapy
Stroke patients who receive constraint-induced movement
therapy, a rehabilitative technique that restrains the less-impaired arm, show
significant improvement in arm and hand function, according to a report in
the Journal of the American Medical Association (JAMA).
 Each year more than 700,000 Americans suffer from stroke,
an interruption of blood flow to the brain. About 85 percent of stroke survivors experience partial
paralysis on one side of the body.
The annual health care costs for stroke care is approximately
$35 billion.
The new study involved restraining the less-impaired hand
and arm with an immobilizing mitt during working hours in an effort to encourage
use of the affected extremity.
Patients then engaged in daily repetitive task and behavioral
shaping sessions, which included training in tasks such as opening a lock,
turning a doorknob, or pouring a drink.
Participants were assigned to receive either the new technique
or usual and customary care.
"The basic principal behind constraint-induced therapy is
re-teaching a patient to regain use of his or her impaired limb by limiting
their use of the good one," says Dr. Steven L. Wolf at Emory University School
of Medicine in Atlanta.
"Often, stroke rehabilitation has primarily focused on teaching
patients how to better rely on their stronger limbs, even if they retain some
use in the impaired limbs - creating a learned disuse," notes Dr. Wolf.
Known as the EXCITE trial, for Extremity Constraint-Induced
Therapy Evaluation, the study enrolled 222 patients who had suffered from predominantly
ischemic stroke (the most common form, in which a blood vessel becomes clogged)
within the previous three to nine months.
Patients were evaluated using the Wolf Motor Function Test,
a measure of laboratory time and strength-based ability and quality of movement
(functional ability).
Additionally, the Motor Activity Log measured how well and
how often 30 common daily activities were performed.
Investigators found that over the course of a year from
the beginning of therapy, the new technique group showed greater improvements
than the control group in regaining function.
This included a 52 versus 26 percent reduction in time to
complete a task and a 24 versus 13 percent increase in the proportion of tasks
performed more than 50 percent of the time with the partially paralyzed arm,
compared to pre-stroke levels.
According to Dr. Wolf, until now, research into constraint-induced
therapy for stroke rehabilitation has centered primarily on chronic stroke
patients, defined as those who experienced stroke more than a year previously.
The EXCITE trial represents the first national study with
participants placed into various groups to compare testing of the effects of
therapy on patients. They looked at who had the ability to initiate movement
at the wrist and fingers, and who had experienced a first stroke within three
to nine months prior to enrollment.
“This study provides the strongest evidence to date
that constraint induced movement therapy can help stroke patients regain lost
arm function,” says National Institutes of Health
(NIH) director Elias A. Zerhouni. “This is welcome news
for stroke patients and those who care about them.”
Always consult your physician for more information.
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