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.

Good Hand and Arm Immobilized

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.

Therapy Begins Early, Makes a Difference

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.