With zero ability to move my fingers or hand due to the dead neurons that used to control that I would have never consented to such a trial. There would have been no ability to eat, relieve, or dress myself. WHAT PROTOCOL DO YOU HAVE TO GET MY HAND/FINGERS RECOVERED?
Constraint-Induced Movement Therapy During Early Stroke Rehabilitation
2007, Neurorehabilitation and Neural Repair
Corwin Boake,PhD,
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.
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) UE motor scale immediately following treatment and in reported quality of hand function at 3 months.Improvement in UE motor 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.
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.
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) UE motor scale immediately following treatment and in reported quality of hand function at 3 months.Improvement in UE motor 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.
Key Words:
Stroke—Cerebrovascular disorders—Hemiplegia— Randomized controlled trial—Rehabilitation—Transcranial magnetic stimulation.
Constraint induced movement therapy (CIMT) is a rehabilitation technique for hemiparesis developed in the laboratory of one of the authors (ET)that consists of restraining the unaffected upper extremity (UE) while intensively training the affected arm and hand to improve performance on functional motor tasks.1,2Although the effectiveness of CIMT in chronic stroke is well established,3-6support for CIMT early after stroke is limited to a single clinical trial involving hospitalized patients7in which outcome was measured immediately after completion of therapy without including a follow-up assessment.Apart from preliminary reports from the current study,8,9no data are available about the long term maintenance of therapeutic gains or about the neurophysiologic mechanisms that mediate the effects of early therapy.This article reports a clinical trial of CIMT during early stroke rehabilitation that is the 1st controlled study to evaluate whether improved motor function is maintained after treatment and to investigate how neurophysiologic changes resulting from therapy are related to therapeutic gains.The major aim of this single-blind randomized clinical trial was to evaluate whether providing 2 weeks of CIMT initiated within 2 weeks of unilateral stroke was feasible and induced lasting beneficial changes in motor function of the affected upper limb.The study used a parallel groups design comparing a group of patients who received CIMT with a control group receiving therapy consisting of traditional techniques.Frequency and duration of therapy were equated between the treatment groups to avoid confounding type of therapy with the intensity of intervention.Motor function was measured by behavioral motor performance tests and by self-report.A follow-up assessment at 3 to 4 monthsafter stroke evaluated whether therapeutic gains had been maintained.A secondary aim was to investigate neurophysiologic mechanisms that mediated effects of therapy,using transcranial magnetic stimulation (TMS)to map the cortical hand area of the stroke hemisphere.TMS was coadministered on the same occasions as behavioral testing in order to explore correlations between motor recovery and neurophysiologic changes.
From the Departments of Physical Medicine and Rehabilitation,Baylor College of Medicine/University of Texas-Houston Medical School,Houston,TX (CB,ETS,TMT,JML,HSL);the Department of Neurology Stroke Program,University of Texas-Houston Medical School,Houston,TX (EAN,JCG);the Department of Psychology,Rice University,Houston,TX (TR,RJ);University of Texas Houston School of Public Health,Houston,TX (SB,LAM);Department of Physical Medicine and Rehabilitation,Memorial Hermann Hospital,Houston,TX (MG);Department ofPsychology,University ofAlabamaat Birmingham,Birmingham,AL (ET).Address correspondence to Corwin Boake,PhD,TIRR,1333 Moursund,Houston,TX 77030-3405.E-mail:corwin.boake@uth.tmc.edu.Boake C,Noser EA,Ro T,Baraniuk S,Gaber M,Johnson R,SalmeronET,Tran TM,Lai JM,Taub E,Moye LA,Grotta JC,Levin HS.Constraint-induced movement therapy during early stroke rehabilita-tion.
Neurorehabil Neural Repair
2007;21:14–24.DOI:10.1177/1545968306291858
by guest on March 8, 2016nnr.sagepub.comDownloaded from
Stroke—Cerebrovascular disorders—Hemiplegia— Randomized controlled trial—Rehabilitation—Transcranial magnetic stimulation.
Constraint induced movement therapy (CIMT) is a rehabilitation technique for hemiparesis developed in the laboratory of one of the authors (ET)that consists of restraining the unaffected upper extremity (UE) while intensively training the affected arm and hand to improve performance on functional motor tasks.1,2Although the effectiveness of CIMT in chronic stroke is well established,3-6support for CIMT early after stroke is limited to a single clinical trial involving hospitalized patients7in which outcome was measured immediately after completion of therapy without including a follow-up assessment.Apart from preliminary reports from the current study,8,9no data are available about the long term maintenance of therapeutic gains or about the neurophysiologic mechanisms that mediate the effects of early therapy.This article reports a clinical trial of CIMT during early stroke rehabilitation that is the 1st controlled study to evaluate whether improved motor function is maintained after treatment and to investigate how neurophysiologic changes resulting from therapy are related to therapeutic gains.The major aim of this single-blind randomized clinical trial was to evaluate whether providing 2 weeks of CIMT initiated within 2 weeks of unilateral stroke was feasible and induced lasting beneficial changes in motor function of the affected upper limb.The study used a parallel groups design comparing a group of patients who received CIMT with a control group receiving therapy consisting of traditional techniques.Frequency and duration of therapy were equated between the treatment groups to avoid confounding type of therapy with the intensity of intervention.Motor function was measured by behavioral motor performance tests and by self-report.A follow-up assessment at 3 to 4 monthsafter stroke evaluated whether therapeutic gains had been maintained.A secondary aim was to investigate neurophysiologic mechanisms that mediated effects of therapy,using transcranial magnetic stimulation (TMS)to map the cortical hand area of the stroke hemisphere.TMS was coadministered on the same occasions as behavioral testing in order to explore correlations between motor recovery and neurophysiologic changes.
From the Departments of Physical Medicine and Rehabilitation,Baylor College of Medicine/University of Texas-Houston Medical School,Houston,TX (CB,ETS,TMT,JML,HSL);the Department of Neurology Stroke Program,University of Texas-Houston Medical School,Houston,TX (EAN,JCG);the Department of Psychology,Rice University,Houston,TX (TR,RJ);University of Texas Houston School of Public Health,Houston,TX (SB,LAM);Department of Physical Medicine and Rehabilitation,Memorial Hermann Hospital,Houston,TX (MG);Department ofPsychology,University ofAlabamaat Birmingham,Birmingham,AL (ET).Address correspondence to Corwin Boake,PhD,TIRR,1333 Moursund,Houston,TX 77030-3405.E-mail:corwin.boake@uth.tmc.edu.Boake C,Noser EA,Ro T,Baraniuk S,Gaber M,Johnson R,SalmeronET,Tran TM,Lai JM,Taub E,Moye LA,Grotta JC,Levin HS.Constraint-induced movement therapy during early stroke rehabilita-tion.
Neurorehabil Neural Repair
2007;21:14–24.DOI:10.1177/1545968306291858
by guest on March 8, 2016nnr.sagepub.comDownloaded from
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