Constraint-induced movement therapy protocols using the number of repetitions of task practice: a systematic review of feasibility and effects

Abdullahi, Auwal; Candan, Sevim Acaröz; Tomruk, Melda Soysal; Yakasai, Abdulsalam Mohammed; Truijen, Steven; Saeys, Wim

doi:10.1007/s10072-021-05267-2

Cited by 6 publications

(3 citation statements)

References 48 publications

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“… 22 , 38 The promising results in the present study may be attributable to the 60 hours of exercise each participant carried out, based on the dose-response relationship demonstrated by Lohse et al 44 Lohse et al reported that large doses (on average, 57 hours) of various types of therapy led to clinically meaningful improvements. Abdullahi et al 45 reported similar results when they quantified treatments by the number of repetitions given (range between 45–1280 per day). However, using hours or number of repetitions does not factor in the quality of tasks performed or the ability to use improved functions for ADL.…”

Section: Discussionmentioning

confidence: 69%

Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke

Marklund¹,

Sefastsson²,

Fure³

et al. 2023

Eur J Phys Rehabil Med

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BACKGROUND To regain the ability to walk is one of the most commonly stated goals for people who have had a stroke due to its importance in everyday life. Walking ability affects patients’ mobility, self-care, and social lives. Constraint-induced movement therapy (CIMT) is known to be effective in improving upper extremity outcomes post-stroke. However, there is insufficient evidence regarding its efficacy in improving lower extremity outcomes AIM To investigate whether a highly intensive CIMT for lower extremity (LE-CIMT) function post-stroke can improve motor function, functional mobility, and walking ability. Furthermore, it also aimed to investigate whether age, gender, stroke type, more-affected side, or time after stroke onset affect the efficacy of LE-CIMT on walking ability outcomes. DESIGN Longitudinal cohort study. SETTING Outpatient clinic in Stockholm, Sweden. POPULATION A total of 147 patients mean age 51 years (68% males; 57% right-sided hemiparesis), at the sub-acute or chronic phases post-stroke who had not previously undergone LE-CIMT. METHODS All patients received LE-CIMT for 6 hours per day over 2 weeks. The Fugl-Meyer Assessment (FMA) of the lower extremity, Timed Up and Go (TUG) test, Ten-Meter Walk Test (10MWT), and six-Minute Walk Test (6MWT) were used to assess functional outcomes before and directly after the 2-week treatment was complete as well at 3-month post-intervention. RESULTS Compared to baseline values, FMA (P<0.001), TUG (P<0.001), 10MWT (P<0.001) and 6MWT (P<0.001) scores were statistically significantly improved directly after the LE-CIMT intervention. These improvements persisted at the 3-month post-intervention follow-up. Those who completed the intervention 1-6 months after stroke onset had statistically significant larger improvements in 10MWT compared to those who received the intervention later than 6 months after stroke onset. Age, gender, stroke type, and more-affected side did not impact 10MWT results. CONCLUSIONS In an outpatient clinic setting, high-intensity LE-CIMT statistically significant improved motor function, functional mobility, and walking ability in middle-aged patients in the sub-acute and chronic post-stroke phases. However, studies with more robust designs need to be conducted to deepen the understanding of the efficacy of LE-CIMT. CLINICAL REHABILITATION IMPACT High-intensity LE-CIMT may be a feasible and useful treatment option in outpatient clinics to improve post-stroke walking ability.

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Section: Discussionmentioning

confidence: 69%

Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke

Marklund¹,

Sefastsson²,

Fure³

et al. 2023

Eur J Phys Rehabil Med

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“…Through this process, CIMT is intended to improve the quantity and quality of movement in the impaired arm. 61 Standard CIMT is highly intense, including six to eight hours of training per day for two weeks. 62 However, the nature of this training makes compliance to a strict training regimen difficult.…”

Section: Overview Of Constraint-induced Movement Therapymentioning

confidence: 99%

The Effectiveness of Botulinum Toxin Injections to Treat Post-Stroke Arm Dysfunction

Tsai,

Sullivan

2023

J Stud Res

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This review was written to determine the effectiveness of Botulinum Toxin (BoNT) as a treatment for upper extremity dysfunction in post-stroke patients. As most patients survive a stroke, many are burdened with disability and impaired limb function. Seventy percent of stroke patients experience motor dysfunction in the arm, with thirty percent of patients suffering from upper extremity spasticity. Spasticity is a speed-dependent condition where certain muscles are abnormally stiff, resulting in involuntary contraction when the spastic muscle is used. BoNT treatment includes injections in localized muscles and is primarily used to treat spasticity by temporarily paralyzing the injected muscle. Seven systematic reviews/meta-analyses and ten randomized-controlled trials were used to determine the effectiveness of BoNT in post-stroke patients. Overall, BoNT is effective in reducing spasticity and may be effective in reducing pain. However, its ability to improve motor function is still unclear. In addition, there is mixed evidence on the most effective way to administer BoNT treatment, such as the proper dosage or combining BoNT with another therapy. The treatment’s effectiveness is well documented in the chronic stage of stroke but less so in the acute and subacute stages. More research is needed to determine the potential adverse effects of long-term exposure to BoNT and the most appropriate dose to administer.

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“… 1 Motor dysfunction caused by hemiparesis and fear associated with falling after stroke prevents survivors from practicing walking by themselves, contributing to a further decline in their walking capacity and perhaps overall physical deterioration. 2 Innumerable conventional rehabilitation therapies (CRTs) are used to remodel motor function (MF) in poststroke patients who have lower limb dyskinesia by repeatedly stimulating or performing movements, 3 – 5 improving the biomechanical performance of paralyzed limbs, 6 enhancing neuroplasticity, 7 , 8 and supporting the production of normal movement sequences. 9 Nevertheless, limited by patients’ muscle strength, fear of falling, training environment, and professional supervision, 10 some CRTs cannot be immediately included in stroke patients’ rehabilitation practice.…”

mentioning

confidence: 99%

Effects of Motor Imagery Training for Lower Limb Dysfunction in Patients With Stroke

Zhao¹,

Jiang

Zhang

et al. 2022

Am J Phys Med Rehabil

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Objective The aim of the study is to determine the effects of motor imagery training associated with conventional rehabilitation therapies on lower limb motor function recovery in poststroke patients. Design Comprehensive literature searches were performed to identify studies published before June 5, 2022. RevMan 5.3 software was used for meta-analysis. The quality of the included studies was assessed using the Cochrane risk-of-bias tool and the modified Jadad scale. The certainty of the evidence was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations system. Result Twenty-three trials and/or 1109 participants with motor imagery training ability were included in this review. Motor imagery training combined with conventional rehabilitation therapies versus conventional rehabilitation therapies demonstrated significant benefits in motor function, balance function, temporospatial gait variables (walking speed, stride length, and cadence) and activities of daily living. Subgroup analysis demonstrated that motor imagery training–conventional rehabilitation therapies had a better effect on improvement in motor function and activities of daily living in the acute phase and had a greater benefit on walking speed in the chronic phase. In addition, motor imagery training–conventional rehabilitation therapies resulted in greater improvements in stride length, cadence, walking ability, and balance function in the subacute phase. Conclusions Motor imagery training–conventional rehabilitation therapies have better effects on the recovery of lower limb motor function in poststroke patients than conventional rehabilitation therapies, which may be most beneficial for lower extremity motor function recovery in the first 7 days to 6 mos.

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Constraint-induced movement therapy protocols using the number of repetitions of task practice: a systematic review of feasibility and effects

Cited by 6 publications

References 48 publications

Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke

Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke

The Effectiveness of Botulinum Toxin Injections to Treat Post-Stroke Arm Dysfunction

Effects of Motor Imagery Training for Lower Limb Dysfunction in Patients With Stroke

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