Document Type

Article

Publication Date

2017

Abstract

This study explored the effect of modified constraint-induced movement therapy (CIMT) on the spasticity and functional use of the affected arm and hand among persons of working age who presented with spastic hemiplegia resulting from a stroke that occurred more than 6 months ago. The researchers developed a modified CIMT program for use in an outpatient rehabilitation clinic with intensive and varied exercise training aimed at targeting the negative symptoms of spastic hemiplegia. Previous research on CIMT has taken place in laboratory settings and has not specifically focused on CIMT’s effects on spasticity.

The researchers used a battery of assessments to evaluate the effects of the modified CIMT program on spasticity, active range of motion (AROM), grip strength, daily hand use, functional change in dexterity, and gross manual dexterity of the affected limb. Participants took part in a 2-week modified CIMT intervention in which they were instructed to wear a restraint on their unaffected arm for 90% of each day and were encouraged to actively use the affected arm in daily activities at home. From Monday through Friday, participants completed an individualized training program for 6 hr/day at the outpatient clinic. On the weekends, participants were instructed to continue wearing the restraint; they were asked not to perform any exercise but continue with their daily activities.

The training program was implemented at an outpatient rehabilitation clinic by an occupational therapist and a physiotherapist. Participants were initially assessed for baseline data. They were then retested for changes in spasticity and functional use of the affected limb after the 2-week modified CIMT training period and again at the 6-month follow-up.

At the end of the 2-week training period and the 6-month postintervention follow-up, results showed that application of the modified CIMT program was successful in reducing spasticity in the affected elbow and wrist flexors, increasing AROM in the affected elbow and wrist, increasing grip strength of the affected hand, and increasing functional use in the affected arm and hand.

This study suggests that a 2-week modified CIMT program, using intensive and varied exercise training aimed at the negative symptoms of spastic hemiplegia, can be used in outpatient rehabilitation clinics to reduce spasticity and increase functional use among persons with poststroke upper extremity spastic hemiplegia. This study further suggests that these changes may persist 6 months after completion of the program.

This study lacks generalizability to populations outside the intervention group, because of its small sample size and noninclusion of patients older than 67 years. This study also lacks a control group, which diminishes its validity. In summary, a modified CIMT intervention shows promising results for reducing spasticity among persons ages 22–67 years with poststroke upper extremity spastic hemiplegia; however, research on this topic would benefit from further validation through studies that include a larger sample size, a control group, and a greater age range of participants.

Comments

Originally published as: Bloom, J., Lu E., Tong, M., & Li, K. (2017). Critically Appraised Paper for “The Effect of Modified Constraint-Induced Movement Therapy on Spasticity and Motor Function of the Affected Arm in Patients with Chronic Stroke.” Physiotherapy Canada, 62(4), 388-396. Bethesda, MD: American Occupational Therapy Association, Evidence-Based Practice Project.

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