Effects of Distributed Constraint-Induced Therapy in Stroke Survivors with Unilateral Neglect: Kinematic Analysis and Clinical Assessments
Date Issued
2009
Date
2009
Author(s)
Hsiang-Ting Li
Abstract
Background: Unilateral neglect is a common disorder in right-hemisphere stroke patients and produced impact on reaching performances of both arms and on motor recovery of the more affected arm. Distributed constraint induced therapy (dCIT) has received much attention to become a new treatment of unilateral neglect. However the effects of dCIT in stroke patients with unilateral neglect remained uncertain. We proposed that dCIT could induce reduction of neglect and thus lead improvements in the related motor deficits. The objective of the present study was to investigate whether unilateral neglect patients would benefit more from dCIT, compared with controlled treatment.ethods: 11 patients with unilateral neglect following stroke were recruited and were allocated randomly to dCIT group (2-hour practice in weekdays for 3 consecutive weeks and constraint of the less affected arm for 6 hours per day) and controlled treatment group (traditional rehabilitation for equivalent intensity and duration). We used kinematic analysis and clinical assessments (the Functional Independence Measure, the Fugl-Meyer Assessment, the Action Research Arm Test, and the Motor Activity Log) to investigate the outcomes of reaching movements towards contralesional space, and functional and motor improvements.esults: There were no significant differences between the groups at pretreatment. Patients receiving dCIT showed significant improvements of the less affected arm in reaction time (P=0.020), movement time (P=0.017), and peak velocity (P=0.013) and showed greater improvement in preplanned motor control (p=0.052; effect size η2=0.334). For the more affected arm, there were no significant differences in the kinematic variables, though the dCIT produced a moderate to large effect on better motor control strategy (P =0.188; effect size η2=0.113). Patients after dCIT showed significant improvement in independence in daily functional tasks, especially in motor domain (FIM, P=0.017; FIM_motor, P=0.009) and improvement in functional use of the more affected arm (AOU of MAL, P=0.015; QOM of MAL, P=0.023). Though patients in dCIT group showed greater tendency in motor improvement measured by FMA, it failed to reach significant level (P =0.295; effect size η2=0.044). The two groups showed a non significant and small effect of ARAT (P =0.395; effect size η2=0.011).onclusions: After three-week dCIT intervention, compared with CT, patients presented much more independence in activities of daily living and had better motor performance while reaching with the less affected arm toward the contralesional space. Additionally, patients were facilitated to spontaneously use the more affected arm and perform better in functional activities.
Subjects
Unilateral neglect
functional independence
kinematic analysis
reaching movement
stroke
File(s)![Thumbnail Image]()
Loading...
Name
ntu-98-R96429012-1.pdf
Size
23.32 KB
Format
Adobe PDF
Checksum
(MD5):d42c7649423df5a186b9b0419ea904b0