A kinematic study of modified constraint-induced movement therapy in patients with stroke.
Resource
台灣醫學 v.10 n.3 pp.319-327
Formosan Journal of Medicine v.10 n.3 pp.319-327
Journal
台灣醫學,v.10
Journal Issue
n.3
Pages
319-327
Date Issued
2006
Date
2006
Author(s)
HUANG, YA-YING
WU, CHING-YI
HONG, WEI-HSIEN
CHEN, CHIA-LING
LIN, KEH-CHUNG
Abstract
Constraint-induced movement therapy (CIMT) refers to repetitive and intensive training of the affected arm and restraint of the unaffected arm for two to three weeks. This study employed a modified CIMT (mCIMT) program and examined the effectiveness of this program in stroke patients at subacute and chronic stages. Twenty-six patients with unilateral stroke (18 males and 8 females, 0.5 to 101 months , mean age 51.58 years), recruited from the rehabilitation wards at two medical centers, signed informed consent forms approved by the Institutional Review Board and participated in this study. These patients were randomly assigned to one of two groups. Thirteen of the patients served as the mCIMT group, received 2 hours training for the affected limb and 6 hours restraint for the unaffected hand per day for three weeks, and the others as the conventional rehabilitation group received one and a half hour traditional occupational training without any restraint for three weeks. Kinematic performance of the reach and reach-to-grasp movements was measured before and immediately after treatments. Analyses of covariance were employed to test the treatment effects. During the desk bell task involving reaching with the affected arm to ring the bell, the mCIMT group showed that initiation of reaching motor acts was earlier (F=4.42, df=1, 23, p=0.024), and the path of the movement was smoother (F= 3.03, df=1, 23,p=0.048) and more direct (F=5.13, df=1, 23, p=0.017) after treatment than the conventional group. During the task involving reaching to grasp a can of coke, the movements made by the patinets in the mCIMT group were more forceful than those by the traditional rehabilitation group( F=4.65, df=1, 16, p=.024). These findings suggested that the mCIMT with shorter intervention and restraint periods per day still improved some aspects of the reach and the reach- to-grasp movements, in comparison with the conventional treatment approach. The findings also suggested that kinematic analysis may help to detect changes in movement process. Further study combining kinematic analysis and brain image technique to identify the relation of movement reorganization patterns and motor recovery after stroke rehabilitation is warranted.
Subjects
stroke
rehabilitation
motor control
kinematic analysis
reaching movements
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