CI therapy is beneficial to patients which chronic low-functioning hemiparesis after stroke

I remember a PT friend who worked at the hospital I was at telling me about constraint induced therapy. Considering I had very limited arm movement and zero use of the hand I replied they would never do that to me.  I'm not sure how you get any use at all without hand movement.
But I'm willing to be convinced otherwise.
http://journal.frontiersin.org/Journal/10.3389/fneur.2014.00204/abstract

Annette Sterr^1*, darragh o'neill², Philip Dean¹ and Katherine Herron³

• ¹Psychology, University of Surrey, United Kingdom
• ²School of Life and Medical Sciences, University of Surrey, United Kingdom
• ³Pain Management Center, National Hospital For Neurology and Neurosurgery, United Kingdom

CI therapy is effective in patients with relatively good levels of residual arm function but its applicability to patients with low functioning hemiparesis is not entirely clear. In the present study we examined the feasibility and efficacy of the CI therapy concept in patients with very limited upper arm function prior to treatment, and further tested how the length of daily shaping training and constraining the good arm affects treatment outcome. In a baseline-controlled design, 65 chronic patients were treated with 2 weeks of modified CI therapy. Patients were randomly allocated to four treatment groups receiving 90 or 180 minutes of daily shaping training applied with or without constraint respectively. Outcome was measured through the Reliable Change Index, which was calculated for parameters of motor function, health and psychological wellbeing. Follow-up data were collected at 6 and 12 months. Two analyses were conducted, a whole-group analysis across all 65 participants and a subgroup analysis contrasting the four treatment variants. The whole-group analysis showed a significant treatment effect, which was largely sustained after one year. The subgroup analysis revealed a mixed picture: while improvements against the baseline period were observed in all four subgroups, 180 minutes of daily shaping training coupled with the constraint yielded better outcome on the MAL but not the WMFT, while for 90 minutes of training the level of improvement was similar for those who wore the constraint and those who did not. Together these results suggest that, at least in those patients available for follow up measures, modified CI therapy induces sustained improvements in motor function in patients with chronic low-functioning hemiparesis. The absence of clear differences between the four treatment variants points to a complex relationship between the length of daily shaping training and the constraint in this patient group which is likely to be mediated by fatigue and

Keywords: motor rehabilitation, Arm, constraint, motor practice, motor activity log, Wolf motor function test, Frenchay arm test, modified CI therapy
Citation: Sterr A, o'neill d, Dean P and Herron K (2014). CI therapy is beneficial to patients which chronic low-functioning hemiparesis after stroke. Front. Neurol. 5:204. doi: 10.3389/fneur.2014.00204
Received: 25 Jun 2014; Accepted: 27 Sep 2014.

Edited by:
Ashfaq Shuaib, University of Alberta, Canada

Reviewed by:
Ru-Lan Hsieh, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
Roshini Prakash, University of California, Los Angeles, USA  

Copyright: © 2014 Sterr, o'neill, Dean and Herron. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Prof. Annette Sterr, University of Surrey, Psychology, Guildford, United Kingdom, a.sterr@surrey.ac.uk

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