Background and Purpose. Recent research has identified Constraint-Induced (Cl) Movement Therapy as a new approach to the rehabilitation of movement of the more affected upper extremity in patients post-stroke. Cl therapy has been shown to increase the quality of movement, speed of movement, and amount of use of the more-affected upper extremity for this patient population. Based on research in neuroscience and behavioral psychology, Cl therapy involves constraining movements of the less-affected extremity with a protective safety mitt or sling for 90% of waking hours for 10 to 14 days, while intensively training the more-affected arm and hand for six hours each day. Although current CI therapy research has documented significant, functional improvements in the hemiparetic upper extremity in patients following a stroke, applying this lengthy, six -hour daily treatment for two weeks may be unrealistic in today's healthcare system. Therefore, the purpose of this study was to examine the effects of CI therapy performed over a shortened period: five days.
Subjects. Three subjects were selected via convenience sampling. Patients A and B presented with adequate motor capabilities of the more-affected arm and hand to participate fully in CI therapy. Therefore, both patients wore a protective safety mitt for 90% of waking hours and underwent six hours of intensive, task-practice training on each of the five treatment days. Patient C presented with severe limitations in motor function. As a result, Patient C would have been unable to carry out typical activities of daily living with the less-affected extremity constrained. Therefore, Patient C did not wear the protective safety mitt during the five-day treatment. Patient C's massed-practice treatment also varied from the typical task-practice protocol. Instead of task-oriented activities, researchers performed neurodevelopment techniques and utilized bimanual activities during Patient C's six-hour daily treatment sessions to facilitate improvements in motor function.
Methods. The Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT) were used to analyze changes in the quality of movement, speed of movement, force production, and amount of use of the more-affected upper extremity for each patient. Range of motion measurements and manual muscle testing grades were also used to describe changes in motor abilities for Patient C. Data was analyzed using descriptive statistics.
Results. Calculated results from the MAL and the WMFT for Patients A and B indicate that the more-affected upper extremity improved in all four categories of motor function from pre-treatment to post-treatment and from pre-treatment to follow-up (three months). All of Patient A's MAL and WMFT scores improved from post-treatment to follow-up except the quality of movement score on the MAL which regressed from post-treatment to follow-up. All of Patient B's WMFT scores improved from post-treatment to followup, but both MAL scores decreased, indicating a decrease in the self-reported amount of use and the quality of movement compared to post-treatment scores. Patient C's passive range of motion, active range of motion, and manual muscle testing grades all improved from pre-treatment to post-treatment and from post-treatment to follow-up testing. However, no significant functional improvements occurred following 30 hours of intense, massed-practice treatment for Patient C.
Discussion and Conclusion. Five days of CI therapy can produce improvements in quality of movement, speed of movement, force production, and amount of use of the more-affected upper extremity for patients post-stroke with adequate motor capabilities. Moreover, patients presenting with more severe deficits following stroke may demonstrate improvements in motor function following participation in massed-practice therapy. Ultimately, researchers concluded that 10 days of therapy are not required for beneficial outcomes from CI therapy. Massed-practice of activities challenging the motor abilities of the patient appears to be essential for promoting improvements in motor function. Factors which may influence the benefits patients experience following CI therapy include patient personality, internal and external motivators, and understanding of the theories underlining massed-practice treatments. Rehabilitation specialists who consider these and other factors which contribute to each patient's unique presentation may successfully select a massed-practice treatment protocol appropriate for achieving functional return.
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