Effectiveness of constraint-induced movement therapy on activity and participation after stroke: a systematic review and meta-analysis of randomized controlled trials

Abstract

Constraint-induced movement therapy and modified constraint-induced movement therapy proved to be effective on affected hand mobility and to some extent self-care on the World Health Organization's International Classification of Functioning, Disability and Health activity and participation component, but further studies are needed to find out the optimal treatment protocols for constraint-induced movement therapy.

In-Home Delivery of Constraint-Induced Movement Therapy via Virtual Reality Gaming

“…21 Participants in this trial thus received doses of motor practice that are likely comparable or greater than the doses most frequently utilized among CI therapy studies demonstrating clinically meaningful improvement. 9 Overall, compliance with in-game MAL problemsolving and mitt use was poor. Qualitative feedback from participants suggested two main themes to explain these findings.…”

“…3 CI therapy substantially increases arm function and spontaneous use of the more affected arm [3][4][5] and promotes structural 6 and functional 7 brain plasticity. Despite a high level of evidence for effectiveness for improving arm function and use, [8][9][10] CI therapy remains inaccessible to most patients due to limited availability of treatment programs, limited insurance coverage, and high cost. 11 Broader challenges for persons poststroke, such as residing remotely from a treatment center or having limited access to transportation, likely contribute to the disparity in access to evidence-based rehabilitation and to overall dissatisfaction with upper limb recovery.…”

Examining the Use of Constraint-Induced Movement Therapy in Canadian Neurological Occupational and Physical Therapy

“…The treatment parameters reported by therapists who use non-traditional CIMT (see Figures 3 and 4) indicate variability in its delivery, which may reflect the integration of studies examining CIMT across the continuum from traditional to non-traditional protocols, resulting in limited consensus to the most effective and feasible protocol. 13,14,29 While useful in determining overall effectiveness, this approach becomes problematic when therapists try to implement a specific CIMT protocol clinically. The variability we observed suggests that many therapists opt to develop their own method by integrating different evidence-based protocols.…”

“…6,7 The need for this level of function and the corresponding capacity for active engagement with the treatment limits the number of people for whom CIMT is an appropriate intervention. 12 Despite evidence of CIMT's effectiveness in people who meet the criteria for treatment, 6,7,[13][14][15] questions abound regarding its clinical feasibility. [16][17][18] Prior articles have highlighted the fact that, even though CIMT is recommended for treating UE hemiparesis in national stroke care guidelines, 19 it is not being implemented as standard practice for stroke care.…”

Does Task-Oriented Practice Improve Upper Extremity Motor Recovery after Stroke? A Systematic Review

“…Motor impairments are a principal target of rehabilitation interventions, and many novel therapeutic approaches for motor recovery have emerged in recent decades [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Research has focused on lower limb motor impairment more than upper limb partly because lower limb interventions are more easily described, outcomes are more easily quantified, and mobility is considered a key functional consideration after stroke.…”