Deans' stroke musings: Constraint-Induced Movement Therapy During Early Stroke Rehabilitation

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, December 27, 2019

Constraint-Induced Movement Therapy During Early Stroke Rehabilitation

So you didn't set up your research correctly and are asking for followup because of that failure. And doing it in the first two weeks means you haven't been able to split off recovery from spontaneous recovery vs. CIMT

Constraint-Induced Movement Therapy During Early Stroke Rehabilitation

Corwin Boake,PhD,Elizabeth A.Noser,MD,Tony Ro,PhD,Sarah Baraniuk,PhD,Mary Gaber,OTR,Ruth Johnson,MA,Eva T.Salmeron,MD,Thao M.Tran,MD,Jenny M.Lai,MD,Edward Taub,PhD,Lemuel A.Moye,PhD,James C.Grotta,MD,and Harvey S.Levin,PhD
Background
.Limited data are available about the effectiveness of early rehabilitation after stroke.
Objective
.This is the 1st randomized controlled trial of constraint induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome.
Methods
.Within 2 weeks after stroke,23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day.Motor function of the affected UE was blindly assessed before treatment,after treatment,and 3 months after stroke.Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand.(So measuring potential rather than actual. Why?)
Results
.Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy.All outcome comparisons showed trends favoring CIMT over intensive traditional therapy,but none was statistically significant except for improvements in the Fugl-Meyer (FM) UEmotor scale immediately following treatment and in reported quality of hand function at 3 months.Improvement in UEmotor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where responses of the affected hand were evoked by TMS.
Conclusions
.Future trials of CIMT during early stroke rehabilitation need greater statistical power,more inclusive eligibility criteria,and improved experimental control over treatment intensity.The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3months after stroke is associated with increased motor excitability of the affected cerebral hemisphere.