Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMAupper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity func-* Corresponding author. D. Sethy et al. 2 tioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001); while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.
Background: Post-stroke survivors experience significant challenges with their functional health. Despite advances in neuro-rehabilitation, they cannot participate in meaningful daily life activities, leading to disability. Many intervention approaches are applied in stroke rehabilitation to make them independent and lead a quality life. Objectives: The objective of this pilot study was to investigate the effect of the Metacognitive Strategy Training (MCST) on Conventional Occupational Rehabilitation Therapy on improving independence and reducing the disability of post-stroke survivors. Materials and methods: Thirty subjects with post-stroke syndrome participated in an exploratory, double-blind, randomized controlled trial with pre-post and follow-up studies. Subjects were randomized over two intervention groups. Group-1 received MCST with conventional therapy (n=15), and Group-2 conventional therapy only (n=15). The Functional Independence Measure (FIM) measures independence at baseline (Time1), post-intervention (Time2), and after six months (Time3). Results: Changes in Functional Independence Measure scores for the two groups over six months showed significant effects of group (F(1,24)=9.422, p<0.005), time (F(1.160, 27.848)=21.449, p<0.0001) but time and group interaction was not significantly affected (F(1.160, 27.848)=0.172, p=0.719). Post hoc analysis with a Bonferroni adjustment revealed that FIM was statistically significantly increased from pre-intervention to post-intervention (22.597 (95% CI, 34.511 to 10.683), p<0.0001), and from pre-intervention to six month follow up. (24.203 (95% CI,37.554 to 10.853), p=0.0001), but not from post-intervention to six months (1.606 (95% CI, -5.988 to 2.776), p=1.000). Conclusion: MCST has better efficiency in reducing disability and improving the independence of post-stroke survivors in the long term.
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