Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded constraint-induced movement therapy

So this works for severe hand hemiparesis. Write up a protocol on this and get it distributed around the world. That is what leaders would do. 
https://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J78670&phrase=no&rec=136670&article_source=Rehab&international=0&international_language=&international_location=
Restorative Neurology and Neuroscience , Volume 36(2) , Pgs. 225-244.

NARIC Accession Number: J78670.  What's this?
ISSN: 0922-6028.
Author(s): Uswatte, Gitendra; Taub, Edward; Bowman, Mary H.; Delgado, Adriana; Byrson, Camille; Morris, David M.; McKay, Staci; Barman, Joydip; Mark, Victor W..
Project Number: H133G050222.
Publication Year: 2018.
Number of Pages: 20.
Abstract: Study evaluated the efficacy of an expanded form of constraint-induced movement therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper-extremity hemiparesis, suitable for treating severe hemiparesis. Twenty-one adults with severe upper-extremity hemiparesis (with little or no capacity to make movements with the more-affected hand) were randomly assigned to eCIMT, a placebo-control procedure, or usual care. The participants who received usual care were crossed over to eCIMT four months after enrollment. The CIMT protocol was altered to include fitting of orthotics and adaptive equipment, selected neurodevelopmental techniques, and electromyography-triggered functional electrical stimulation. Treatment was given for 15 consecutive weekdays with 6 hours of therapy scheduled daily for the immediate eCIMT group and 3.5 hours daily for the cross-over eCIMT group. At post-treatment, the immediate eCIMT group showed significant gains relative to the combination of the control groups on the Grade-4/5 Motor Activity Log (MAL) and a convergent measure, the Canadian Occupational Performance Measure. At 1-year follow-up, the MAL gains in the immediate eCIMT group were only 13 percent less than at post-treatment. The short- and long-term outcomes of the crossover eCIMT group were similar to those of the immediate eCIMT group. The results suggest that eCIMT produces a large, meaningful, and persistent improvement in everyday use of the more-affected arm in adults with severe upper-extremity hemiparesis long after stroke.
Descriptor Terms: EXERCISE, HEMIPLEGIA, LIMBS, MOTOR SKILLS, OUTCOMES, PHYSICAL THERAPY, REHABILITATION SERVICES, STROKE.


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Citation: Uswatte, Gitendra, Taub, Edward, Bowman, Mary H., Delgado, Adriana, Byrson, Camille, Morris, David M., McKay, Staci, Barman, Joydip, Mark, Victor W.. (2018). Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded constraint-induced movement therapy.  Restorative Neurology and Neuroscience , 36(2), Pgs. 225-244. Retrieved 6/21/2018, from REHABDATA database.