[THESIS] Arm function and constraint-induced movement in early post-stroke rehabilitation – Full Txt PDF

Summary

Constraint-induced movement therapy (CIMT) is a treatment for mild-to-moderate upper extremity motor dysfunction in post-stroke patients. The key treatment goal of this therapy is overcoming learned nonuse of the more affected arm. It consists of the following 3 components: (1) repetitive task-oriented training; (2) adherence-enhancing behavioral strategies (transfer package); and (3) constraining use of the less affected arm, usually achieved with a restraining mitt. Behavioral procedures such as behavioral contract, systematic feedback, and encouraging real-world problem solving are used to enhance the transfer of gained motor skills to daily activities. However, as the ideal time to initiate post-stroke treatment remains uncertain, more information is needed regarding the effects of CIMT and arm use in the early stages of stroke recovery. This thesis aimed to:

1. examine the correlations between arm motor impairment and real world arm use and its relationship with dependency in self-care activities in patients in the stroke unit. (Paper I)
2. assess the effects of modified CIMT applied within 28 days after stroke occurrence (Paper II)
3. review existing literature for the effects of CIMT on body function, activity, and participation in post-stroke patients (Paper III)

In Paper I, we found a high correlation between motor impairment and the patient’s actual use of the more affected arm. Further findings revealed that both the Fugl-Meyer motor assessment scores and arm use are related to dependency in self-care activities, but the finding might be confounded by lower extremity motor function. In Paper II, we found that CIMT initiated within 28 days after stroke occurrence was safe and feasible but did not improve long-term motor function. However, there was a significant effect on movement speed immediately after the treatment, and CIMT might promote a faster recovery compared to standard care. There were no differences between the groups with respect to reduced arm motor impairment or increased arm use. In the systematic review and metaanalysis conducted in Paper III, we found that CIMT can improve arm motor function and arm motor activities and may have a lasting effect on arm motor activity. The effects were especially stable in the sub-acute and chronic groups, and CIMT is therefore advocated for selected patients in these post-stroke stages.

Taken together, our study revealed that early CMIT has an immediate effect on timed measures of arm activity but does not improve long-term motor activity. The meta-analysis also showed uncertain effects of CIMT in the early post-stroke phase. This rehabilitative treatment should preferably be offered to patients in sub-acute and chronic stages after stroke. As learned nonuse might not be pronounced in the acute stage of stroke, the treatment should be aimed at preventing its development.

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