In adult patients with unilateral stroke, is distributed constraint-induced therapy or bilateral arm training more effective in improving upper extremity motor and functional outcomes compared with a routine approach?
Stroke survivors may experience deficits and impairments of upper extremity (UE) function that limit their engagement in meaningful everyday occupations. It is important for occupational therapists to identify and test the effectiveness of interventions targeted to decrease UE learned nonuse, improve functional performance, and increase participation in one’s daily occupations.
This study compared the efficacy of distributed constraint-induced therapy (dCIT) and bilateral arm training (BAT) in improving movement strategies and functional abilities of the UE in stroke survivors. Each intervention group participated in the intervention 2 hr/day, five times per week for 3 consecutive weeks. Participants in the dCIT group focused on practicing use of the affected UE during occupational therapy, plus additional functional use of the affected UE in daily activities by restricting the unaffected UE for six hours daily. Participants in the BAT group focused on concurrent movements using both UEs in functional tasks during occupational therapy only.
On the basis of the results of the study, both dCIT and BAT may help decrease UE learned nonuse in patients with stroke. Both interventions may facilitate the use of the affected UE, thereby improving the quality of motor control and movement and increasing stroke patients’ self-efficacy and safety during functional activities such as cooking, shaving, and eating. Although BAT may result in greater improvement of force generation during movement initiation, dCIT may result in increased functional ability, including longer time using the affected UE and enhanced quality of movement. Thus, occupational therapists working with patients who have had strokes may use dCIT to increase the quality of functional performance and use BAT to improve force generation in movement
With the additional 6 hours/day forced use of the affected arm in the dCIT group, this group had more intervention time than the BAT group. To achieve equality in comparison, future research may focus on providing the participants with the same amount of intervention for both the dCIT and the BAT groups to integrate use of affected UE in daily activities. Furthermore, additional research may place an emphasis on whether the effects after dCIT or BAT can be generalized to daily functional tasks and maintained beyond therapy.
Copyright © 2016 American Occupational Therapy Association. All Rights Reserved. Reproduced here with permission.
Originally published as: Beyer, C., Kim, C., Li, J., Solitis, A., & Li, K. (2016). Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabilitation and Neural Repair, 25(2). Bethesda, MD: American Occupational Therapy Association, Evidence-Based Practice Project.
Beyer, Courtney; Kim, Christine; Li, Janice; Soltis, Angelica; and Li, Kitsum, "In adult patients with unilateral stroke, is distributed constraint-induced therapy or bilateral arm training more effective in improving upper extremity motor and functional outcomes compared with a routine approach?" (2016). Occupational Therapy | Critically Appraised Papers Series. 20.