Constraint-induced movement therapy after stroke

Abstract

Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for treating stroke patients in the previous decades. This review describes the current evidence regarding: original CIMT and modified versions of CIMT (mCIMT). Meta-analysis showed strong evidence favoring both types of CIMT in terms of motor function, arm-hand activities and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas no evidence was found for constraining alone (Forced Use (FU) therapy). No evidence was found that type of CIMT, intensity of practice or timing did affect outcome. Although the underlying mechanism that drive (m)CIMT is still poorly understood, recent kinematic conducted studies suggests that improvements introduced by original CIMT or mCIMT are mainly based on adaptation by learning to optimize the use of intact end-effectors by selecting patients with some voluntary motor control of wrist and finger extensors post stroke.

Impacto de la rehabilitación neurológica a través de la terapia de restricción inducida modificada en la mejora del apoyo social en usuarios con ataque cerebro vascular

“…Si bien, existen numerosas estrategias de intervención que buscan rehabilitar a los usuarios con patologías de esta naturaleza 22 , la innovadora terapia de restricción inducida destaca, ya que posee amplia evidencia científica 9 , demostrando ser efectiva en la rehabilitación de la extremidad superior a través de ejercicios que simulan tareas funcionales que están directamente relacionadas con las demandas de la vida diaria 23 e induciendo reorganización cortical en la zona lesionada 10 . En relación a la modalidad de intervención "colectiva", son limitados los estudios que evalúan sus efectos sobre el apoyo social percibido 2,24 .…”

“…Diversas estrategias terapéuticas son utilizadas en este proceso; una de ellas es la Terapia de Restricción Inducida (TRI), técnica conductual aplicada en modalidad individual durante 6 h. La TRI, basada en amplia evidencia científica 8,9 , ha demostrado ser efectiva en la rehabilitación de la extremidad superior induciendo una reorganización cortical en la zona lesionada 10 , permitiendo una mejor percepción del uso del brazo en actividades de la vida diaria (AVD) y transfiriendo estas mejoras al mundo real del usuario 11 . El propósito de esta terapia es mejorar la función sensitivo-motora de la extremidad superior, buscando reducir la discapacidad y promover la participación social 7 .…”

Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial

“…constraint-induced therapy [28] and motor imagery [11]). Such findings have shaped the concept of personalised stroke rehabilitation [29] and differential prognosis [30].…”

Critique of Home Constraint-Induced Movement Therapy Trial

“…The small effects of the Home CIMT intervention may be a reflection of the relatively small dose of therapy, which was far less than what would normally be offered. 2,3,11 It is also hard to know whether the home therapy was delivered as intensive or frequent as reported, this factor was largely uncontrolled. It would be helpful to understand in greater depth the training of therapists and coaches; from the article, it seemed to be minimal and there was no followup with coaches or therapists by the study staff to clarify any queries with protocols.…”

“…To remediate these limitations, there have been calls for modified versions of CIMT that are less intensive, lower cost, and easier to deliver. 3 Recent work by Barzel et al 4 attempted to advance the understanding of modified forms of CIMT by applying this therapy in the home setting. Home CIMT includes the basic elements of CIMT including repetitive training, transfer of activities, and constraint of the nonparetic hand.…”