Comparison of Frequency & Duration of Task Practice During Constraint Induced Movement Therapy
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke is a very serious medical condition, classically categorized as a neurological
      disorder that occurs due to obstructed blood flow to specific parts of the brain, and
      resultant death of that area.This obstructed blood supply results in compromised function of
      that part of the brain, resulting in paralysis or interference with the normal function of
      the body controlled by that specific region of the brain. Stroke is usually of two types i.e.
      Ischemic and hemorrhagic. Ischemic stroke results in reduced or complete obstruction in blood
      flow in the vessels resulting in ischemia, while a hemorrhagic stroke occurs due to rupture
      of blood carrying vessels and results in clotting. CIMT has proven effective in
      rehabilitation of motor functions of lower limbs in many pieces of evidence but still, the
      evidence is less as compared to the upper extremity. Evidence about improvement in balance
      and gait using CIMT is very little. In some studies, hours of daily practice for the task has
      used as a total therapeutic dose measurement. While, in other studies, repetitions of the
      task have used to calculate the total amount of therapeutic intervention. This study will
      evaluate the effects of frequency and duration of the task in CIMT on motor functions, gait &
      balance of lower limb stroke patients by intervention using these two protocols of CIMT.
    

Detailed description: 
      Stroke is a very serious medical condition, classically categorized as a neurological
      disorder that occurs due to obstructed blood flow to specific parts of the brain, and
      resultant death of that area. This obstructed blood supply results in compromised function of
      that part of the brain, resulting in paralysis or interference with the normal function of
      the body controlled by that specific region of the brain. Stroke is usually of two types i.e.
      Ischemic and hemorrhagic. Ischemic stroke results in reduced or complete obstruction in blood
      flow in the vessels resulting in ischemia, while a hemorrhagic stroke occurs due to rupture
      of blood carrying vessels and results in clotting. Both types reduce the supply of oxygen to
      the parts of the brain and result in cognitive and physical disabilities. Most common
      physical disabilities e.g. moving certain parts, swallowing, speaking, bowel bladder,
      coordination & balance. Other commonly occurring underlying disabilities range from
      cognitive, emotional to behavioural issues. Constrained Induced Moment Therapy (CIMT) is a
      therapeutic intervention involving the family of techniques, used most commonly to treat
      physical disabilities in patients of stroke. These techniques involve restraint of the intact
      or normal limb over an extended period, in combination with several movement repetitions of
      task-specific training by the affected limb and lead to improved functional status. Frequency
      and duration of tasks performed by affected limbs can affect outcomes effectively.
      Physiologically brain has characteristics of plasticity, which is the basis for CIMT as a
      treatment. The neurophysiological mechanism that is believed to be underline treatment
      benefits of CIMT includes overcoming learned outcomes and plastic reorganization of the
      brain. The brain changes itself when effected extremity is used intensively and repetitively.
      The physiological effects of CIMT are explained as cortical reorganization, dendritic
      branching, redundancy learned and synaptic strength Evidence on CIMT interventions for lower
      limb was quite rare. But many pieces of research supported that CIMT can be used as an
      equally effective intervention for a lower limb as it is being used for the upper limb.
      Constraining the lower extremity was difficult and complex as compared to the upper
      extremity. Improved functional status of the lower limb by treating with CIMT was accompanied
      by less balance, coordination and short stepped gate. Some researchers focused on repetitions
      while others focused on forced movements. All the evidence showed improved functional level
      in the post-stroke lower limb.

      Stroke can be managed by a variety of different techniques, one of which is
      constraint-induced movement therapy (CIMT). This form of rehabilitation focuses on the
      intensive use of the affected limb while restricting the use of the unaffected limb. The
      types of restraints used include a splint, a sling, a glove, a mitt and a combination of a
      sling and a resting hand splint. CIMT has been more commonly practised in the upper limb but
      after positive results were obtained from the upper extremity protocol, a protocol was
      developed for the lower extremity as well. A vast number of studies have shown the success of
      CIMT in treating the reduction of upper limb use in the practical world after traumatic brain
      injury, cerebral palsy, multiple sclerosis and stroke. A specially adapted form of CIMT for
      the lower limb has also been successful in treating deficits in the lower limb after spinal
      cord injury and stroke
    

Intervention name(s): Standard physiotherapy neuro-rehabilitation; Repetition-CIMT; Hour-CIMT
Intervention type(s): Other; Other; Other
Intervention description(s): Treatment interventions which will be used for this group Passive range of movement exercises. Therapeutic positioning of the lower limb. Strengthening exercise for the lower limb. Over-ground gait training 5 times a week for 4 weeks. First week= 30 min exercise Second week= 1hour exercise Third week= 1hour and 30 min exercise Fourth week= 2 hours exercise All the treatment protocols will be applied to the patient for 5 times a week for consecutive 4 weeks. Interventions will be performed in the clinic and through home-based exercises using patient education; In this group of patients, the CIMT technique will be used for treatment. Following tasks will be performed by the patient, the unaffected limb will be constrained using a tight knee brace for about3 hr.
Sit-to-Stand
Forward and Backward stepping
Stair Climbing and Descending (only the first stair will be used)
Side-to-Side stepping with the affected limb
Each task will be performed 10 times per session in the first week and 2 sessions a day. In the second week, each task will be performed 20 times per session for 2 sessions a day. In the third week, each task will be performed 30 times per session for 2 sessions a day.In the fourth week, each task will be performed 40 times per session for 2 sessions a day. The session will be held 5 days in a week for the period of consecutive 4 weeks. Total of 1000 repetitions of the above mentions tasks will be performed in 4 weeks' study time by every participant; A task that performed by the participants in this group will be the same as performed by the rep-CIMT group. The unaffected limb will be in constrained for 3 hours. (15) Sessions will be held 5 days in the week for a period of consecutive 4 weeks.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: stroke; constraint induced movement therapy; rehabilitation