Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke – a pilot randomized clinical trial

Abstract

The study design needs adaptation to accommodate the stringent inclusion criteria leading to prolonged study duration. Constraint induced therapy seems to be the optimal approach to improve arm and hand function and minimize the risk of shoulder pain for patients with minimal to moderate arm hand function after stroke in the intermediate term.

Constraint-induced movement therapy after stroke

“…References: (a) 33-35, 37, 38, 43, 45, 46, 49, 50, 57, 62, 64, 70, 71, 73, 80, 82; (b) 39, 42; (c) 55, 73; (d) 46, 82; (e) 46, 75; (f) 28; (g) 31, 33- 43, 45- 47, 51-56, 73, 75-78, 80-82; (h) 28; (i) 34, 37, 41, 43, 46, 52, 54, 55, 57, 61-64, 70-73, 75, 77, 78, 80-82; (j) 67, 69; (k) 28; (l) 34, 36, 37, 41, 43, 46, 49-52, 54, 55, 57, 61, 62, 64, 70-73, 75, 77, 78, 80-82; (m) 67, 69, 79; (n) 41, 47, 52, 54, 62-64, 66, 71; (o) 53, 81, 82; (p) 81, 82.…”

“…References: (a) 37, 46, 49, 50, 82; (b) 55, 73; (c) 28; (d) 37, 41, 42, 46, 48, 49, 50, 52, 53, 55, 73, 75, 78, 82; (e) 28 ; (f) 37, 41, 46, 49, 50, 52, 55, 73, 75, 78, 82; (g) 28; (h) 37, 41, 46, 49, 50, 52, 55, 73, 75, 78, 82; (i) 41, 52; (j) 28; (k) 28.…”

Management of Hemiplegic Shoulder Pain

“…Another relatively new rehabilitation technique has not only been shown to effectively treat mild to moderate arm and hand dysfunction after stroke, but also has been noted to potentially prevent HSP [35]. Constraint induced therapy as described by Taub et al [36] requires a patient to wear a restraining mitt on the unaffected upper limb for 90 % of waking hours.…”

“…This leads to functional recovery and prevention of learned disuse of the affected limb. Khan et al [35] found that constraint induced therapy and conventional neurological therapy based on Bobath's theory were equivalent with respect to improvement of arm and hand dysfunction in the short and intermediate term. Interestingly, people who received constraint induced therapy were at a lower risk of developing HSP at 6 months than those that received conventional therapy [35].…”

“…Khan et al [35] found that constraint induced therapy and conventional neurological therapy based on Bobath's theory were equivalent with respect to improvement of arm and hand dysfunction in the short and intermediate term. Interestingly, people who received constraint induced therapy were at a lower risk of developing HSP at 6 months than those that received conventional therapy [35]. It should be noted that other studies have shown low therapeutic compliance rates with constraint induced therapy and also that the benefits of this type of intensive program may not outweigh the considerable monetary and time costs needed to run it [37].…”