http://nnr.sagepub.com/cgi/content/abstract/27/2/99?etoc
Abstract
Background. Constraint-induced movement therapy (CIMT) has proven effective in increasing functional use of the affected arm in patients
with chronic stroke. The mechanism of CIMT is not well understood. Objective.
To demonstrate, in a proof-of-concept study, the feasibility of using
kinematic measures in conjunction with clinical outcome
measures to better understand the mechanism of
recovery in chronic stroke patients with mild to moderate motor
impairments
who undergo CIMT. Methods. A total of 10
patients with chronic stroke were enrolled in a modified CIMT protocol
over 2 weeks. Treatment response was
assessed with the Action Research Arm Test (ARAT),
the Upper-Extremity Fugl-Meyer score (FM-UE), and kinematic analysis of
visually guided arm and wrist movements. All
assessments were performed twice before the therapeutic intervention and
once
afterward. Results. There was a clinically
meaningful improvement in ARAT from the second pre-CIMT session to the
post-CIMT session compared
with the change between the 2 pre-CIMT sessions. In
contrast, FM-UE and kinematic measures showed no meaningful
improvements.
Conclusions. Functional improvement in the
affected arm after CIMT in patients with chronic stroke appears to be
mediated through compensatory
strategies rather than a decrease in impairment or
return to more normal motor control. We suggest that future large-scale
studies of new interventions for
neurorehabilitation track performance using kinematic analyses as well
as clinical scales.
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