Results of the national stroke rehabilitation study known as EXCITE (Extremity Constraint-Induced Therapy Evaluation) will be highlighted in presentations at the Neuroscience 2007 meeting, the annual meeting of the Society for Neuroscience held in San Diego.
The EXCITE trial enrolled more than 200 patients who had suffered predominantly from ischemic stroke (the most common form, in which a blood vessel becomes clogged) within the previous three to nine months. The study involved restraining the less-impaired hand and/or arm with an immobilizing mitt during working hours in an effort to encourage use of the affected extremity -- a technique called constraint-induced movement therapy (CIMT).
Patients then engaged in daily repetitive tasks and behavioral shaping sessions, which included training in tasks such as opening a lock, turning a doorknob or pouring a drink. Participants were assigned to receive either the CIMT technique or usual and customary care.
Many stroke patients who received the CIMT therapy showed significant improvement in arm and hand function, according to data from the seven-center national study led by Emory University researchers.
"The basic principal behind constraint-induced therapy is re-teaching a patient to regain use of his or her impaired limb by limiting their use of the good one," said Steven L. Wolf, PhD, professor of rehabilitation medicine at Emory University School of Medicine and the study's principal investigator. "Often, stroke rehabilitation has primarily focused on teaching patients how to better rely on their stronger limbs, even if they retain some use in the impaired limbs -- creating a learned disuse."
According to Dr. Wolf, until now research into constraint-induced therapy for stroke rehabilitation has centered primarily on chronic stroke patients, defined as those who experienced stroke more than a year previously. The EXCITE trial represents the first national, randomized, single-blinded study to test the effects of therapy on patients with the ability to initiate movement at the wrist and fingers, and who had experienced a first stroke within three to nine months prior to enrollment.
Patients were evaluated using the Wolf Motor Function Test, a measure of laboratory time and strength-based ability and quality of movement (functional ability). Additionally, the Motor Activity Log measured how well and how often 30 common daily activities were performed.
Investigators found that over the course of a year from the beginning of therapy, the CIMT group showed greater improvements than the control group in regaining function, including a 52 versus 26 percent reduction in time to complete a task and a 24 versus 13 percent increase in the proportion of tasks performed more than 50 percent of the time with the partially paralyzed arm, compared to pre-stroke levels.
Poster presentations highlighting the EXCITE trial during the national meeting will include:
Emory University recently established a new constraint-induced therapy clinic, offering rehabilitation programs for patients who have suffered from a stroke and have experienced weakness or immobility in a hand and/or arm. The program uses evidenced-based, innovative therapeutic approaches such as constraint-induced therapy to facilitate upper extremity recovery after stroke.
- The relationship of intensity of constraint induced movement therapy to improvement in the Wolf Motor Function Test
- Task-oriented training: an analysis of the components of training from the EXCITE trial
- Objective assessment of spontaneous use of the affected arm after constraint-induced movement therapy
Each year more than 700,000 Americans suffer from stroke, and approximately 85 percent of stroke survivors experience partial paralysis on one side of the body. The annual health care cost for stroke care is approximately $35 billion.