A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong

OBJECTIVE: To investigate the beneficial effect of constraint-induced movement therapy in improving the function of hemiplegic upper extremity in the early subacute stroke patients. DESIGN: A prospective, single-blinded, randomized controlled study comparing the effectiveness of constraint-induced movement therapy or control treatment at post intervention and 12 weeks follow-up. SUBJECTS: The inclusion criteria were 2-16 weeks after stroke, hemiparesis of the affected limb, minimal function of > or =20 degrees wrist extension and > or =10 degrees extension of all digits and Mini-Mental State Examination score > or =17. INTERVENTIONS: The intervention group underwent a programme of 10 days upper extremity training (4 hours per day) with the unaffected limb being restrained ina shoulder sling and the control group received an equivalent duration of conventional rehabilitation therapy. MAIN MEASURES: Functional level for hemiparetic upper extremity, Motor Activity Log, Action Research Arm Test and modified Barthel Index. RESULTS: There were 23 and 20 subjects respectively in the constraint-induced movement therapy and control groups. Significant improvements were seen at post intervention and 12 weeks after constraint-induced movement therapy in functional level for hemiparetic upper extremity (P= 0.001), and in the ;amount of use' (P= 0.001) and ;how well' (P= 0.021) subscales of the Motor Activity Log. The total Action Research Arm Test score, grasp (P= 0.004), grip (P= 0.004), pinch (P= 0.032) and gross (P= 0.006) components showed significant improvement over the control group at post intervention. The grip component (P=0.019) and the total Action Research Arm Test score (P= 0.009) were superior to the control group at 12 weeks. CONCLUSION: Significant improvement in hand function could be achieved with constraint-induced movement therapy in subacute stroke patients, which was maintained up to 12 week follow-up.