Effects of Number of Repetitions and Number of Hours of Shaping Practice during Constraint-Induced Movement Therapy: A Randomized Controlled Trial

Abstract

Background Constraint-induced movement therapy (CIMT) is effective in improving motor outcomes after stroke. However, its existing protocols are resource-intensive and difficult to implement. The aim of this study is to design an easier CIMT protocol using number of repetitions of shaping practice. Method The study design was randomized controlled trial. Participants within 4 weeks after stroke were recruited at Murtala Muhammad Specialist Hospital. They were randomly assigned to groups A, B, C, and D. Group A received 3 hours of traditional therapy. Groups B, C, and D received modified CIMT consisting of 3 hours of shaping practice per session, 300 repetitions of shaping practice in 3 sessions, and 600 repetitions of shaping practice in 3 sessions per day, respectively, and constraint for 90% of the waking hours. All treatment protocols were administered 5 times per week for 4 weeks. The primary outcome was measured using upper limb Fugl-Meyer assessment, while the secondary outcome was measured using motor activity log, Wolf Motor Function Test, and upper limb self-efficacy test at baseline, 2 weeks, and 4 weeks after intervention. Result There were 48 participants 4 weeks after intervention. The result showed that there was no significant difference between groups at baseline (p > 0.05). Within-group improvements attained minimal clinically important difference (MCID) in modified CIMT and 300 repetitions and 600 repetitions groups. Conclusion Number of repetitions of shaping practice significantly improved motor function, real-world arm use, and upper limb self-efficacy after stroke. Therefore, it seems to be a simple alternative for the use of number of hours. Trial Registration This trial is registered with Pan African Clinical Trial Registry (registration number: PACTR201610001828172) (date of registration: 21/10/2016).

The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits

“…Task-specific practice Task specific practice (Tariah et al, 2010;Valkenborghs et al, 2017) with a sufficient number of movement repetitions could improve upper limb functions (Abdullahi, 2018). The findings of the present study demonstrated significant changes after the Bobath therapy programme in individuals with moderate to severe functional deficits because of chronic stroke who (before participating in the study) no longer received rehabilitation support.…”

“…Within 6 weeks each task had been practiced 1080 times, which was sufficient for those with moderate functional deficit. However, this may not be the case for those with severe deficits (Abdullahi, 2018). In a recent study, in case of severe deficit, upper limb function was found to improve after 20 sessions of the Bobath intervention over 4 weeks (Carvalho et al, 2018).…”

Movement Rehabilitation in Physiotherapy after Stroke: The Role of Constraint-Induced Movement Therapy

“…The protocols involve either modification of the task/shaping practice, constraint or both components of CIMT; or even the process or setting of its administration. These protocols include using hours as measure of intensity of task/shaping practice, using number of repetitions as measure of intensity of task/ shaping practice, home-based CIMT, use of automated constraint-induced therapy extension (AutoCITE), and CIMT without constraint [38,[47][48][49][50]. See Table 1 for the details of these different protocols.…”

“…In contrast, the protocol using number of repetition has been touted to be feasible, easier, and may provide better compliance and complements the transfer package component as it takes on the elements of self-management [45,56]. Recently, it has been shown to be as effective as the one using number of hours [48,49]. Furthermore, a virtual reality-amplified arm training of just 30 minutes Movement Rehabilitation in Physiotherapy after Stroke: The Role of Constraint-Induced… DOI: http://dx.doi.org /10.5772/intechopen.81081 proved very effective at improving motor outcomes at 6 weeks postintervention and 3 months follow-up [57].…”

“…Another possible perspective is to use the number of repetition as a measure of intensity of task/shaping practice during CIMT. Already, there are indications that these types of protocols seem to be easier and have similar effectiveness compared to the one using number of hours [48,49]. This is because number of repetition of task is important for motor recovery [45,51,58].…”