Stroke patients with mild to moderate impairments substantially regained use of upper limb function and show an improved quality of life two years after receiving constraint-induced movement therapy (CIMT). The findings, reported by Emory University researchers, appear online and in the January issue of The Lancet Neurology.
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 new findings provide hope to the many stroke survivors undergoing upper extremity stroke rehabilitation.
The results are a continuation of the EXCITE trial that 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).
Dr. Steven Wolf, PhD, professor of rehabilitation medicine at Emory University School of Medicine, and colleagues assessed whether the retention improvements in the EXCITE trial were retained 24 months after the two-week CIMT intervention. They found that the effects at 24 months after treatment did not decline from those at 12 months.
Moreover, strength showed continued improvement during the second year. They also found quality of life was significantly improved two years after the intervention, this included improvements in social participation, activities of daily living and overall physical function.
The findings suggest that higher functioning patients may have benefited more from CIMT than lower functioning patients because the largest long-term changes were recorded in the higher functioning group.
"We found that for a number of stroke survivors with mild to moderate stroke, perhaps comprising up to 30 percent of all stroke survivors, CIMT can be implemented successfully with long-lasting functional outcomes," says Dr. Wolf. "These results emphasize the importance of long-term follow-up in rehabilitation clinical trials to show the full extent of effects of therapeutic interventions."
The EXCITE trial 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. Patients then engaged in daily repetitive task 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.
Investigators initially 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 percent-versus 26 percent reduction in time to complete a task and a 24 percent-versus 13 percent increase in the proportion of tasks performed more than half of the time with the partially paralyzed arm, compared to pre-stroke levels.
"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," says Dr. Wolf. "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 recently 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.