Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?

被引:251
|
作者
Dromerick, AW
Edwards, DF
Hahn, M
机构
[1] Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Program Occupat Therapy, St Louis, MO 63110 USA
关键词
cerebrovascular disorders; controlled clinical trials; motor activity; neuronal plasticity; rehabilitation;
D O I
10.1161/01.STR.31.12.2984
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Motor dysfunction after unilateral deafferentation in primates can be overcome by restraining the unaffected Limb. We asked whether a constraint-induced movement (CIM) program could be implemented within 2 weeks after stroke and whether CIM is more effective than traditional upper-extremity (UE) therapies during this period. Methods-Twenty-three persons were enrolled in a pilot randomized, controlled trial that compared CIM with traditional therapies. A blinded observer rated the primary end point, the Action Research Arm Test (ARA). Inclusion criteria were the following: ischemic stroke within 14 days, persistent hemiparesis, evidence of preserved cognitive function, and presence of a protective motor response. Differences between the groups were compared by using Student's t tests, ANCOVA, and Mann-Whitney U tests. Results-Twenty subjects completed the 14-day treatment. Two adverse outcomes, a recurrent stroke and a death, occurred in the traditional group; 1 CIM subject met rehabilitation goals and was discharged before completing 14 inpatient days. The CIM treatment group had significantly higher scores on total ARA and pinch subscale scores (P<0.05). Differences in the mean ARA grip, grasp, and gross movement subscale scores did not reach statistical significance. UE activities of daily living performance was not significantly different between groups, and no subject withdrew because of pain or frustration. Conclusions-A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatment. Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies.
引用
收藏
页码:2984 / 2988
页数:5
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