In the eleven years since this came out, DID YOUR HOSPITAL DO ONE DAMN THING WITH IT? I'd suggest firings starting with the top; the board of directors.
Do you prefer your hospital incompetence NOT KNOWING? OR NOT DOING?
Effects of constraint-induced therapy versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors
2009, Neurorehabilitation and neural repair
441
Neurorehabilitation and Neural Repair
Volume 23 Number 5June 2009 441-448© 2009 The Author(s)10.1177/1545968308328719http://nnr.sagepub.com
Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors
Keh-chung Lin, ScD, OTR, Ya-fen Chang, MS, Ching-yi Wu, ScD, OTR, and Yi-an Chen, MS
Background and Objective.
This study investigated the relative effects of distributed constraint-induced therapy (CIT) and bilateral arm training (BAT) on motor performance, daily function, functional use of the affected arm, and quality of life in patients with hemiparetic stroke.
Methods.
A total of 60 patients were randomized to distributed CIT, BAT, or a control intervention of less specific but active therapy. Each group received intensive training for 2 hours/day, 5 days/week, for 3 weeks. Pretreatment and post treatment measures included the Fugl–Meyer Assessment (FMA), Functional Independence Measure (FIM), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The proximal and distal scores of FMA were used to examine separate upper limb (UL) elements of movement.
Results
441
Neurorehabilitation and Neural Repair
Volume 23 Number 5June 2009 441-448© 2009 The Author(s)10.1177/1545968308328719http://nnr.sagepub.com
Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors
Keh-chung Lin, ScD, OTR, Ya-fen Chang, MS, Ching-yi Wu, ScD, OTR, and Yi-an Chen, MS
Background and Objective.
This study investigated the relative effects of distributed constraint-induced therapy (CIT) and bilateral arm training (BAT) on motor performance, daily function, functional use of the affected arm, and quality of life in patients with hemiparetic stroke.
Methods.
A total of 60 patients were randomized to distributed CIT, BAT, or a control intervention of less specific but active therapy. Each group received intensive training for 2 hours/day, 5 days/week, for 3 weeks. Pretreatment and post treatment measures included the Fugl–Meyer Assessment (FMA), Functional Independence Measure (FIM), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The proximal and distal scores of FMA were used to examine separate upper limb (UL) elements of movement.
Results
The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group. The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups. Enhanced performance was found for the distributed CIT group in the MAL, the subtest of locomotion in the FIM, and certain domains of the SIS (eg, ADL/IADL).
Conclusion.
BAT may uniquely improve proximal UL motor impairment. In contrast, distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis.
Keywords:
Controlled clinical trial; Stroke rehabilitation; Constraint-induced therapy; Bilateral arm training; Upper extremity; Quality of life
Upper limb (UL) hemiparesis is a major factor restricting functional recovery in more than 85% of stroke patients.1,2 Unsuccessful use of the affected UL in stroke patients may cause “learned nonuse phenomenon,” in which patients habitually rely on their unaffected UL to accomplish daily activities.3 Constraint-induced therapy (CIT)4,5 has been found to be effective for over-coming learned nonuse.2 CIT involves restraint of the unaffected UL over an extended period of time (90% of waking hours) in combination with repetition of task-specific intensive training of the affected UL (6 hours/session, 5 sessions/week, for 2 weeks).3,5 However, such an intensive training schedule might not be acceptable for many patients.6 Distributed or modified forms of CIT were developed.7-9 These forms decreased the training hours for each session (0.5 to 3 hours/session) and restraint hours per day (5 to 9 hours/day), and distributed these sessions to a long duration (3 to 10 weeks). Several studies have demonstrated the benefits of CIT or its derivatives (distributed or modified CIT), relative to traditional rehabilitation or control intervention, in improving motor capacity, functional performance, and quality of life.3-5,8-12An alternative treatment program that is gaining increasing atten-tion is bilateral arm training (BAT), which employs the repetitive practice of symmetrical bilateral movement (0.3 to 2.25 hours/day, 3 to 5 days/week, for 2 to 8 weeks) to improve motor performance of the affected UL.13,14 There are a variety of forms of BAT.15 Some involve robot-assisted and repetitive movement training,13,16-18 whereas others employ repetitive practice of functional tasks.19-22 Some studies have revealed that BAT reduces UL impairment (evaluated by Fugl–Meyer Assessment [FMA]) when compared with traditional rehabilitation,13,17,21-23 whereas others claim that BAT did not confer benefits on performance of impaired UL18,21,22 and had limited effects on functional independence19,23 and spontaneous use of the affected hand.18 Small sample sizes, differential degrees of initial impairment, and insufficient intensity of treatment may each have contributed to the lack of significant effects.Distributed CIT and BAT share similar key therapeutic elements (mass and repetitive practice with specific techniques), and both target improvement of the affected UL, although at first glance, the concept of BAT seems contradictory to the
concept of distributed CIT.24,25 It remains unclear whether BAT could be an alternative program through which to overcome the phenomenon of learned nonuse.18 In addition, Whitall25 claimed that exploring the relative effects of different research-supported training programs is important to the design and development of efficient and effective rehabilitation programs for stroke patients. To achieve this aim, there is a need for rigorous comparison between distributed CIT and BAT.26,27Although some investigations have examined the differences in treatment outcomes between unilateral and bilateral trainings,14,22,28 no research to date has studied the relative effects of distributed CIT versus BAT regarding to what extent and in what situations one approach may be more beneficial than the other. This study compared the relative effects of distributed CIT versus BAT versus control intervention on motor capacity, functional performance, and quality of life. We hypothesized that both distributed CIT and BAT would elicit better performance than control intervention. In addition, distributed CIT and BAT may produce differential benefits regarding specific outcome measures (eg, motor function, use of the affected arm in real-world situation, etc).
Conclusion.
BAT may uniquely improve proximal UL motor impairment. In contrast, distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis.
Keywords:
Controlled clinical trial; Stroke rehabilitation; Constraint-induced therapy; Bilateral arm training; Upper extremity; Quality of life
Upper limb (UL) hemiparesis is a major factor restricting functional recovery in more than 85% of stroke patients.1,2 Unsuccessful use of the affected UL in stroke patients may cause “learned nonuse phenomenon,” in which patients habitually rely on their unaffected UL to accomplish daily activities.3 Constraint-induced therapy (CIT)4,5 has been found to be effective for over-coming learned nonuse.2 CIT involves restraint of the unaffected UL over an extended period of time (90% of waking hours) in combination with repetition of task-specific intensive training of the affected UL (6 hours/session, 5 sessions/week, for 2 weeks).3,5 However, such an intensive training schedule might not be acceptable for many patients.6 Distributed or modified forms of CIT were developed.7-9 These forms decreased the training hours for each session (0.5 to 3 hours/session) and restraint hours per day (5 to 9 hours/day), and distributed these sessions to a long duration (3 to 10 weeks). Several studies have demonstrated the benefits of CIT or its derivatives (distributed or modified CIT), relative to traditional rehabilitation or control intervention, in improving motor capacity, functional performance, and quality of life.3-5,8-12An alternative treatment program that is gaining increasing atten-tion is bilateral arm training (BAT), which employs the repetitive practice of symmetrical bilateral movement (0.3 to 2.25 hours/day, 3 to 5 days/week, for 2 to 8 weeks) to improve motor performance of the affected UL.13,14 There are a variety of forms of BAT.15 Some involve robot-assisted and repetitive movement training,13,16-18 whereas others employ repetitive practice of functional tasks.19-22 Some studies have revealed that BAT reduces UL impairment (evaluated by Fugl–Meyer Assessment [FMA]) when compared with traditional rehabilitation,13,17,21-23 whereas others claim that BAT did not confer benefits on performance of impaired UL18,21,22 and had limited effects on functional independence19,23 and spontaneous use of the affected hand.18 Small sample sizes, differential degrees of initial impairment, and insufficient intensity of treatment may each have contributed to the lack of significant effects.Distributed CIT and BAT share similar key therapeutic elements (mass and repetitive practice with specific techniques), and both target improvement of the affected UL, although at first glance, the concept of BAT seems contradictory to the
concept of distributed CIT.24,25 It remains unclear whether BAT could be an alternative program through which to overcome the phenomenon of learned nonuse.18 In addition, Whitall25 claimed that exploring the relative effects of different research-supported training programs is important to the design and development of efficient and effective rehabilitation programs for stroke patients. To achieve this aim, there is a need for rigorous comparison between distributed CIT and BAT.26,27Although some investigations have examined the differences in treatment outcomes between unilateral and bilateral trainings,14,22,28 no research to date has studied the relative effects of distributed CIT versus BAT regarding to what extent and in what situations one approach may be more beneficial than the other. This study compared the relative effects of distributed CIT versus BAT versus control intervention on motor capacity, functional performance, and quality of life. We hypothesized that both distributed CIT and BAT would elicit better performance than control intervention. In addition, distributed CIT and BAT may produce differential benefits regarding specific outcome measures (eg, motor function, use of the affected arm in real-world situation, etc).
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