Constraint Induced Movement Therapy

Stroke Rehabilitation: A Novel Treatment Pays Off | dba-newsletter.org

In a landmark study, researchers at the University of Alabama at Birmingham used a randomized controlled trial — the gold standard method for evaluating the effectiveness of a treatment — to show that immobilizing the good arm of stroke patients and intensively exercising the weakened arm actually improved recovery, even when performed long after the stroke occurred. At one level, randomized controlled trials in the field of rehabilitation medicine have been so rare that the publication of each and every one should be applauded. At another level, the outcome of this study is so satisfying in terms of what we think we know about brain physiology (function) that even if the results turn out not to be true, they ought to be.

A controlled trial is one in which there is a comparison group of patients that is either untreated or is treated differently. When a controlled trial is also randomized, it means that upon entering the study, participants agree to be assigned to one group or the other based on the equivalent of a coin-toss. Randomization eliminates bias that might otherwise come from (knowingly or unknowingly) assigning more promising patients to one group and less promising patients to the other.

Publishing their results in the March 2006 online issue of Stroke, a medical journal, Edward Taub, PhD, and co-workers studied 21 patients treated with “constraint-induced movement therapy” (CI) and compared their outcomes to another 20 stroke patients who received placebo treatment.

In strokes a loss of circulation damages a portion of the brain, resulting in impairment of whatever mental or bodily function that part of the brain controls. Strokes often cause weakness in an arm with or without concurrent numbness. Strokes are the leading cause of long-term disability in the U.S.

The researchers included stroke victims in their study who had mild to moderate impairment in use of their affected arms, but excluded those with severe impairment. The research subjects varied widely in age, averaging in their fifties. The investigators selected patients whose stroke had occurred a minimum of one year earlier with an average interval between stroke and treatment of 4.5 years. Patients with concurrent numbness were included, but those with poor walking or balance were excluded, as were patients with excessive confusion or too much additional impairment caused by other medical conditions.

The CI treatment was administered over a 2-week span, during which the good arm was immobilized about 90% of the time with an arm-sling and a hand-splint. CI patients had 10 weekday sessions with therapists, lasting 6 hours each. During those sessions, patients received one-on-one therapy that was individualized to their needs and abilities and involved specific, practical tasks of gradually increasing difficulty. The therapists praised patients each time their performances improved even just slightly. By contrast, placebo-treated patients received a more general program of physical fitness, cognitive and relaxation exercises over the same schedule.

Constraint-induced Movement Therapy

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Handbook of clinical neurology, Stroke. investigation and management