Never once do they mention that those like me that have dead brain that used to control arm and hand function will not be helped. I would have torn the mitt off by any means possible. I wouldn't have been able to eat, piss, shit, or get dressed. What is the solution for dead brain rehab like mine?
The EXCITE Stroke Trial Comparing Early and Delayed Constraint-Induced Movement Therapy
Steven L. Wolf, Ph.D., F.A.P.T.A., F.A.H.A.
,
Paul A. Thompson, Ph.D.
,
Carolee J. Winstein,Ph.D., F.A.P.T.A.
,
J. Phillip Miller, A.B.
,
Sarah R. Blanton, D.P.T., N.C.S.
,
Deborah S. Nichols-Larsen, Ph.D., P.T.
,
David M. Morris, Ph.D., P.T.
,
Gitendra Uswatte, Ph.D.
,
Edward Taub,Ph.D.
,
Kathye E. Light, Ph.D., P.T.
, and
Lumy Sawaki, Ph.D., M.D.
Department of Rehabilitation Medicine (S.L.W., S.R.B.), Departments of Medicine and Cell Biology(S.L.W.), Emory University School of Medicine, Atlanta; Methodology and Data Analysis Center, Sanford Research/University of South Dakota (P.A.T.); Division of Biostatistics (J.P.M.),Washington University School of Medicine, St. Louis; Division of Biokinesiology and Physical Therapy at the School of Dentistry (C.J.W.), University of Southern California, Los Angeles; School of Allied Medical Professions (D.S.L.), The Ohio State University, Columbus; Department of Physical Therapy (D.M.M.), Department of Psychology (G.U., E.T.), University of Alabama at Birmingham, Birmingham; Department of Physical Therapy (K.L.), University of Florida, Gainesville; Department of Physical Medicine and Rehabilitation (L.S.), University of Kentucky, Lexington
,
Paul A. Thompson, Ph.D.
,
Carolee J. Winstein,Ph.D., F.A.P.T.A.
,
J. Phillip Miller, A.B.
,
Sarah R. Blanton, D.P.T., N.C.S.
,
Deborah S. Nichols-Larsen, Ph.D., P.T.
,
David M. Morris, Ph.D., P.T.
,
Gitendra Uswatte, Ph.D.
,
Edward Taub,Ph.D.
,
Kathye E. Light, Ph.D., P.T.
, and
Lumy Sawaki, Ph.D., M.D.
Department of Rehabilitation Medicine (S.L.W., S.R.B.), Departments of Medicine and Cell Biology(S.L.W.), Emory University School of Medicine, Atlanta; Methodology and Data Analysis Center, Sanford Research/University of South Dakota (P.A.T.); Division of Biostatistics (J.P.M.),Washington University School of Medicine, St. Louis; Division of Biokinesiology and Physical Therapy at the School of Dentistry (C.J.W.), University of Southern California, Los Angeles; School of Allied Medical Professions (D.S.L.), The Ohio State University, Columbus; Department of Physical Therapy (D.M.M.), Department of Psychology (G.U., E.T.), University of Alabama at Birmingham, Birmingham; Department of Physical Therapy (K.L.), University of Florida, Gainesville; Department of Physical Medicine and Rehabilitation (L.S.), University of Kentucky, Lexington
Abstract
Background and Purpose—
Although constraint-induced movement therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages post-stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to compare functional improvements between stroke participants randomized to receive this intervention within3–9 months (early group)to participants randomized upon recruitment to receive the identical intervention 15–21 months post-stroke(delayed group).
Methods—
Two weeks of CIMT was delivered to participants immediately after randomization(early group) or one year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test [WMFT], Motor Activity Log [MAL]) and secondary (Stroke Impact Scale [SIS]) outcome measures among the 106 early participants and 86 delayed participants prior to delivery of CIMT, two weeks thereafter and 4, 8 and 12 months later.
Results—
While both groups showed significant improvements from pretreatment to 12 months post-treatment, the earlier CIMT group showed greater improvement than the delayed CIMT group in WMFT Performance Time and the MAL (P’s < .0001) as well as in Stroke Impact Scale Hand and Activities domains (P <. 0009 and .0214, respectively). Early and delayed group comparison of scores on these measures 24 months after enrollment, showed no statistically significant differences between groups.
Conclusions—
CIMT can be delivered to eligible patients 3 to 9 months or 15 to 21 months following stroke. Both patient groups achieved approximately the same level of significant arm motor function 24 months after enrollment.
Methods—
Two weeks of CIMT was delivered to participants immediately after randomization(early group) or one year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test [WMFT], Motor Activity Log [MAL]) and secondary (Stroke Impact Scale [SIS]) outcome measures among the 106 early participants and 86 delayed participants prior to delivery of CIMT, two weeks thereafter and 4, 8 and 12 months later.
Results—
While both groups showed significant improvements from pretreatment to 12 months post-treatment, the earlier CIMT group showed greater improvement than the delayed CIMT group in WMFT Performance Time and the MAL (P’s < .0001) as well as in Stroke Impact Scale Hand and Activities domains (P <. 0009 and .0214, respectively). Early and delayed group comparison of scores on these measures 24 months after enrollment, showed no statistically significant differences between groups.
Conclusions—
CIMT can be delivered to eligible patients 3 to 9 months or 15 to 21 months following stroke. Both patient groups achieved approximately the same level of significant arm motor function 24 months after enrollment.
Americans continue to experience more than 780,000 strokes each year with total costs for care and management estimated at $65.5 billion in 2008 and two thirds demonstrating impaired function in upper extremity usage.
1
Rehabilitation regimens emphasize functional retraining for these stroke survivors
2
. Constraint-induced movement therapy (CIMT) requires restraint of the less impaired upper extremity (UE) through the use of a padded mitt that restricts hand usage and is coupled with behavioral training (repetitive and adaptive task practice) for up to 6 hours per day.
3
The EXtremity Constraint Induced Therapy Evaluation (EXCITE) Trial was the first multisite randomized controlled study of a non-surgical or pharmacological procedure applied to patients3–9 months post stroke.
4
We found that, in comparison to a group receiving customary care only, those undergoing two weeks of CIMT showed significantly greater improvement
5
that persisted through another follow up year.
6
The control group subsequently was crossed over to receive CIMT one year after enrollment. In this paper we report the extent to which improvements in functional recovery following CIMT among this more chronic group(15–21months post-stroke)would compare to those already reported for participants receiving CIMT within 3–9 months post-stroke.
Corresponding Author: Steven L. Wolf, PH.D., PT, FAPTA, FAHA, Center for Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Atlanta, GA 30322, FAX: 404-712-5895, TEL: 404-712-4801, swolf@emory.edu.DisclosuresNone
NIH Public Access
1
Rehabilitation regimens emphasize functional retraining for these stroke survivors
2
. Constraint-induced movement therapy (CIMT) requires restraint of the less impaired upper extremity (UE) through the use of a padded mitt that restricts hand usage and is coupled with behavioral training (repetitive and adaptive task practice) for up to 6 hours per day.
3
The EXtremity Constraint Induced Therapy Evaluation (EXCITE) Trial was the first multisite randomized controlled study of a non-surgical or pharmacological procedure applied to patients3–9 months post stroke.
4
We found that, in comparison to a group receiving customary care only, those undergoing two weeks of CIMT showed significantly greater improvement
5
that persisted through another follow up year.
6
The control group subsequently was crossed over to receive CIMT one year after enrollment. In this paper we report the extent to which improvements in functional recovery following CIMT among this more chronic group(15–21months post-stroke)would compare to those already reported for participants receiving CIMT within 3–9 months post-stroke.
Corresponding Author: Steven L. Wolf, PH.D., PT, FAPTA, FAHA, Center for Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Atlanta, GA 30322, FAX: 404-712-5895, TEL: 404-712-4801, swolf@emory.edu.DisclosuresNone
NIH Public Access
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