Characterizing the Protocol for Early Modified Constraint‐induced Movement Therapy in the EXPLICIT‐Stroke Trial

Abstract

Constraint-induced movement therapy (CIMT) is a commonly used rehabilitation intervention to improve upper limb function after stroke. CIMT was originally developed for patients with a chronic upper limb paresis. Although there are indications that exercise interventions should start as early as possible after stroke, only a few randomized controlled trials have been published on either CIMT or modified forms of CIMT (mCIMT) during the acute phase after stroke. The implementation of (m)CIMT in published studies is very heterogeneous in terms of content, timing and intensity of therapy. Moreover, mCIMT studies often fail to provide a detailed description of the protocol applied. The purpose of the present paper is therefore to describe the essential elements of the mCIMT protocol as developed for the EXplaining PLastICITy after stroke (EXPLICIT-stroke) study. The EXPLICIT-stroke mCIMT protocol emphasizes restoring body functions, while preventing the development of compensatory movement strategies. More specifically, the intervention aims to improve active wrist -and finger extension, which is assumed to be a key factor for upper limb function. The intervention starts within 2 weeks after stroke onset. The protocol retains two of the three key elements of the original CIMT protocol, that is, repetitive training and the constraining element. Repetitive task training is applied for 1 hour per working day, and the patients wear a mitt for at least 3 hours per day for three consecutive weeks.

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

“…One hour of mCIMT therapy was chosen to not overload patients in the early phase poststroke. 16,17 Patients were instructed to wear a padded safety mitt (Sammons Preston #6727; Sammons Preston, Inc, Bolingbrook, IL, USA) for 3 hours per working day, during 3 consecutive weeks and lasting up until 5 weeks poststroke. Details of the mCIMT treatment protocol have been described previously.…”

“…Details of the mCIMT treatment protocol have been described previously. 17 Patients allocated to the EMG-NMS group received two sessions of 30 minutes stimulation of the finger extensors each working day, for 3 weeks, using the Stiwell-Med4system (Ottobock Healthcare Products GmbH, Vienna, Austria). Active participation of the patient was required to reach the EMG threshold during the dorsiflexion movement of fingers and wrist in order to trigger the NMS.…”

The Effect of Modified Constraint-Induced Movement Therapy on Upper Extremity Function of a Patient With Severe Acquired Brain Injury

“…Review and meta-analysis studies have shown that modified CIMT has the most effect on motor function in patients with acute stroke because it is possible to recover and restore nerves in this period [16,29]. However, although four years had passed since the brain injury in the study case, there was an improvement in the qualitative and quantitative aspects of her movement and upper limb function in daily living activities.…”

“…The patient should use problem-solving skills and self-monitoring to transfer the interventions to daily living activities, but these patients refuse to use the affected hand due to motor and functional limitations; hence, in the long term, they will not get acceptable outcome from this intervention [29]. However, studies using transcranial magnetic stimulation have shown an increase in short-term [32] and long-term [33] activity of cerebral cortex after modified CIMT.…”

The optimization of restoration approaches of advanced hand activity using the sensorial glove and the mCIMT method

“…Двигательная терапия принудительного ограничения активности здоровой конечности (англ. : constraint-induced movement therapy -CIMT) и его модификации (mCIMT) призваны сократить дефицит и повысить производительность движения, а также улучшить функциональность паретичной руки путем ограничения использования здоровой конечности при выполнении повседневных задач [9][10][11][12][13][14]. Классический протокол CIMTтерапии предполагает выполнение описанных выше тренировок в режиме 60 ч интенсивных индивидуальных занятий (6 ч в день в течение 2 нед) [4,13].…”