Posts Tagged constraint-induced therapy

[Abstract] Unilateral vs. Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial



To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke.


A single-blind, randomized controlled trial


Four hospitals


Forty-four outpatients with chronic stroke and mild to moderate motor impairment.


UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and the BRT. The intervention frequency for the 3 groups was 90 min/day, 3 days/week, for 6 weeks.

Outcome measures

Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment, and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment.


The results favored BHT over UHT on the FMA total score and distal score at the posttest (p = .03 and .04) and follow-up (p = .01 and .047) assessment, and BHT over RT on the follow-up FMA distal scores (p = .03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL, as compared to the BHT group (p<.01).


BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.

via Unilateral vs. Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial – Archives of Physical Medicine and Rehabilitation

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[Abstract] Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?

Provisional Abstract
Background and Purpose
Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on healthcare resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is founded in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible due to patients’ environmental factors. This paper addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy.

Summary of Key Points
We provide an overview of TH and present evidence that a web-supported program used in conjunction with Constraint Induced Therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, ‘LifeCIT’ is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial measurement units and mechanomyography sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained.

Recommendations for Clinical Practice
We propose that wearable sensor technologies and TH programs have the potential to provide cost-effective, intensive, home-based stroke rehabilitation.

Source: JUST ACCEPTED: “Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?” |

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[ARTICLE] Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke | Full Text

Journal of NeuroEngineering and Rehabilitation (JNER)

Published: 22 March 2016



The combination of robot-assisted therapy (RT) and a modified form of constraint-induced therapy (mCIT) shows promise for improving motor function of patients with stroke. However, whether the changes of motor control strategies are concomitant with the improvements in motor function after combination of RT and mCIT (RT + mCIT) is unclear. This study investigated the effects of the sequential combination of RT + mCIT compared with RT alone on the strategies of motor control measured by kinematic analysis and on motor function and daily performance measured by clinical scales.


The study enrolled 34 patients with chronic stroke. The data were derived from part of a single-blinded randomized controlled trial. Participants in the RT + mCIT and RT groups received 20 therapy sessions (90 to 105 min/day, 5 days for 4 weeks). Patients in the RT + mCIT group received 10 RT sessions for first 2 weeks and 10 mCIT sessions for the next 2 weeks. The Bi-Manu-Track was used in RT sessions to provide bilateral practice of wrist and forearm movements. The primary outcome was kinematic variables in a task of reaching to press a desk bell. Secondary outcomes included scores on the Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living. All outcome measures were administered before and after intervention.


RT + mCIT and RT demonstrated different benefits on motor control strategies. RT + mCIT uniquely improved motor control strategies by reducing shoulder abduction, increasing elbow extension, and decreasing trunk compensatory movement during the reaching task. Motor function and quality of the affected limb was improved, and patients achieved greater independence in instrumental activities of daily living. Force generation at movement initiation was improved in the patients who received RT.


A combination of RT and mCIT could be an effective approach to improve stroke rehabilitation outcomes, achieving better motor control strategies, motor function, and functional independence of instrumental activities of daily living.

Trial registration NCT01727648


Stroke remains a leading cause of permanent motor disability worldwide [1]. Persistent impairment of the upper extremity (UE) occurs in up to two-thirds of patients after stroke [2]. UE paresis can lead to deficits in motor control [3], motor dysfunction [4], and participation in activities of daily living (ADL) [5]. Developing and providing effective therapeutic techniques to improve UE motor control and recovery is crucial.

Robot-assisted therapy (RT) is an emerging intervention approach that provides high-intensity, high-repetition, and task-specific training to enhance motor learning and control in patients with stroke [6, 7]. Systemic reviews have indicated that RT improves UE muscle strength and motor function of patients with moderate to severe motor impairment after stroke [8,9]. A recent review suggested that the assessment of movement kinematics should be included in RT studies to identify modulation in motor control strategies [10]. Previous studies found that RT can improve motor control strategies in patients with stroke, including greater movement efficacy [1113], better movement smoothness of the affected UE [13], and more use of the preplanned control strategy [13]. However, no consistent findings on patients’ participation in ADL were observed after RT [8, 1417]. How to optimize or transfer the treatment benefits of RT on motor function and motor control strategies into participation in ADL warrants further investigation. An approach using RT monotherapy may not optimally address this need.

Constraint-induced therapy (CIT), one most investigated approaches to rehabilitation, was developed to overcome the learned nonuse phenomenon and enhance functional use of the affected arm after stroke [18, 19]. Treatment components of CIT include repetitive and intensive task practice, behavioral shaping techniques, restraint of the unaffected UE, and transfer package [20, 21]. Modified and distributed CIT, which are not as intensive as the original CIT, have been developed and validated [20, 22, 23]. The benefits of the original CIT and its modified versions have been well demonstrated to improve motor function, arm-hand activities, and daily performance of patients with stroke [19, 24, 25].

Therapies that combine RT with other rehabilitation approaches have been developed to optimize the treatment effects of RT [2629]. The combination of RT and conventional therapy led to significant gains in arm function of patients, but different combination sequences showed benefits in different outcomes [27]. In addition, RT combined with repetitive task practice was effective in enhancing hand function and stroke recovery of patients [28]. To the best of our knowledge, only one study has investigated the treatment effects of sequencing the combination of RT and a modified form of CIT (mCIT) in patients with stroke [29]. The results indicated that the sequential combination of RT and mCIT led to better motor and functional ability measured by clinical scales compared with RT alone or conventional rehabilitation [29]. However, whether the changes in motor control strategies are responsible for the improvements in motor function after the sequential combination therapy remains unclear.

Kinematic analysis has been recommended as a sound measure to provide objective and sensitive evaluations on spatial and temporal characteristics of UE movements [8]. More importantly, kinematics can capture motor control strategies that cannot be detected by clinical scales [30]. Thus, kinematic analysis enables us to understand whether the behavioral improvement is due to a true change in the end point control and joint motion or is a result of compensation. Kinematic measures, along with clinical assessments, can better clarify the motor control strategies underlying the motor improvements of stroke patients [31, 32].

This study investigated the effects of the sequential combination of RT and mCIT (RT + mCIT), compared with RT alone, focusing on motor control strategies measured by kinematic analysis and on motor and ADL functions using clinical measures. We hypothesized that (1) RT + mCIT would lead to different benefits on the motor control strategies compared with and RT alone and that (2) RT + mCIT would contribute to better performances in ADL than RT alone.

Continue —-> Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 Graphic representation of the angular strategy variables: (a) shoulder flexion (ShFlex) in the sagittal plane and elbow extension (ElbExt) in the sagittal plane; (b) shoulder abduction (ShAbd) in the frontal plane; and (c) trunk flexion in sagittal (TrunkFlex) plane

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[WEB SITE] Constraint-Induced Therapy Effective in Home Use

Published on August 26, 2015

Stroke patients affected by an upper-extremity movement dysfunction reported comparatively high levels of effectiveness from constraint-induced movement therapy (CIMT) in improving their daily activities. But in measures of motor function, CIMT fared no better than standard therapy, according to a study published recently in The Lancet Neurology.

The study, led by Anne Barzel, MD, was conducted in Germany and used study subjects from 71 therapy practices in northern Germany. One group of therapy practices was assigned at random to provide 4 weeks of home-based CIMT to study subjects, while another group provided 4 weeks of standard therapy.

Study subjects were qualified for the research based on having mild to moderate impairment of arm function at least 6 months after stroke. Study subjects in both groups received 5 hours of professional therapist contact in 4 weeks, according to a summary published in The Lancet Neurology.

Patients in the standard therapy group received conventional physical or occupational therapy, but additional home training was not obligatory. In the home CIMT group, therapists used the time allotted with the study subjects to instruct and supervise the study subjects as well as their coaches, who were a family member or friend.

According to the summary in The Lancet Neurology, there were two primary outcomes—the first of which was quality of movement, assessed by the Motor Activity Log (MAL-QOM, assessor-assisted self-reported). The second outcome was performance time, assessed by the Wolf Motor Function Test (WMFT-PT, assessor-reported).

Study subjects were assessed at 4 weeks. The researchers reported that study subjects in the home-based CIMT group demonstrated greater improvement than patients in the standard therapy group. The researchers note that while both groups also improved in motor function performance time, the extent of that improvement between the two groups was not significant.

“Home-based CIMT can enhance the perceived use of the stroke-affected arm in daily activities more effectively than conventional therapy but was not superior with respect to motor function,” the authors conclude.

Source: Constraint-Induced Therapy Effective in Home Use – Rehab Managment

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[ARTICLE] The Role of Task-Specific Training in Rehabilitation Therapies

…Task-oriented therapy is important. It makes intuitive sense that the best way to relearn a given task is to train specifically for that task. In animals, functional reorganization is greater for tasks that are meaningful to the animal. Repetition alone, without usefulness or meaning in terms of function, is not enough to produce increased motor cortical representations. In humans, less intense but task-specific training regimens with the more affected limb can produce cortical reorganization and associated, meaningful functional improvements…

via Topics in Stroke Rehabilitation – online access – Volume 12 – Number 3/Summer 2005 – Animal and Clinical Research in Stroke Recovery and Rehabilitation – The Role of Task-Specific Training in Rehabilitation Therapies.

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