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Constraint-Induced Movement Therapy During Early Stroke Rehabilitation

Departments of Physical Medicine and Rehabilitation, Baylor College of Medicine/University of Texas-Houston Medical School, Houston, TX, corwin.boake{at}uth.tmc.edu

Elizabeth A. Noser, MD

Department of Neurology Stroke Program, University of Texas-Houston Medical School, Houston, TX

Tony Ro, PhD

Department of Psychology, Rice University, Houston, TX

Sarah Baraniuk, PhD

University of Texas-Houston School of Public Health, Houston, TX

Mary Gaber, OTR

Department of Physical Medicine and Rehabilitation, Memorial Hermann Hospital, Houston, TX

Ruth Johnson, MA

Department of Psychology, Rice University, Houston, TX

Eva T. Salmeron, MD

Departments of Physical Medicine and Rehabilitation, Baylor College of Medicine/University of Texas-Houston Medical School, Houston, TX

Thao M. Tran, MD

Departments of Physical Medicine and Rehabilitation, Baylor College of Medicine/University of Texas-Houston Medical School, Houston, TX

Jenny M. Lai, MD

Departments of Physical Medicine and Rehabilitation, Baylor College of Medicine/University of Texas-Houston Medical School, Houston, TX

Edward Taub, PhD

Department of Psychology, University of Alabama at Birmingham, Birmingham, AL

Lemuel A. Moye, PhD

University of Texas-Houston School of Public Health, Houston, TX

James C. Grotta, MD

Department of Neurology Stroke Program, University of Texas-Houston Medical School, Houston, TX

Harvey S. Levin, PhD

Departments of Physical Medicine and Rehabilitation, Baylor College of Medicine/University of Texas-Houston Medical School, Houston, TX

Background. Limited data are available about the effectiveness of early rehabilitation after stroke.

Objective. This is the 1st randomized controlled trial of constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome.

Methods. Within 2 weeks after stroke, 23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day. Motor function of the affected UE was blindly assessed before treatment, after treatment, and 3 months after stroke. Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand.

Results. Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy. All outcome comparisons showed trends favoring CIMT over intensive traditional therapy, but none was statistically significant except for improvements in the Fugl-Meyer (FM) UE motor scale immediately following treatment and in reported quality of hand function at 3 months. Improvement in UE motor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where responses of the affected hand were evoked by TMS.

Conclusions. Future trials of CIMT during early stroke rehabilitation need greater statistical power, more inclusive eligibility criteria, and improved experimental control over treatment intensity. The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3 months after stroke is associated with increased motor excitability of the affected cerebral hemisphere.

Key Words: Stroke • Cerebrovascular disorders • Hemiplegia • Randomized controlled trial • Rehabilitation • Transcranial magnetic stimulation

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