Improving Arm Mobility and Use After Stroke
Condition: Cerebrovascular Accident
MeSH terms: Stroke
Study type: Interventional
Phase: Phase 3

Summary: 
      An individual suffering a stroke or other brain injury may lose function on one side of the
      body (partial paralysis). As the individual shifts activities to favor the unaffected side,
      the problem worsens. Constraint induced (CI) therapy forces the individual to use the
      neglected arm by restraining the good arm in a sling. This study examines the effectiveness
      of CI therapy for improving arm motion after stroke.
    

Detailed description: 
      Profoundly impaired motor dysfunction is a major consequence of stroke. As a result, a large
      number of the more than 700,000 people in America sustaining a stroke each year have
      limitations in motor ability and compromised quality of life. Therapeutic interventions
      designed to enhance motor function and promote independent use of an impaired upper extremity
      are quite limited.

      CI movement therapy, or "forced use," involves motor restriction of the less effected upper
      extremity for 2 weeks. Over this time, repetitive use of the more effected upper extremity is
      promoted for many hours a day. This treatment produces long lasting improvements in extremity
      use among patients who are more than 1 year post-stroke and who have an ability to initiate
      some extension in wrist and digit joints.

      This study will determine if CI therapy for a hemiparetic upper extremity in patients with
      sub-acute (3 to 9 months post-cerebral infarct) stroke will lead to functional improvements
      and enhanced quality of life measures more than usual care.

      Patients are randomized into a treatment or usual care group and stratified by movement
      capability into higher and lower functioning categories. Higher functioning patients are
      defined as those who have at least 20 degrees of active wrist extension and 10 degrees of
      active finger extension at each digit joint. Lower functioning patients are defined as those
      with at least 10 degrees of wrist extension and 10 degrees of extension at each thumb joint
      and all joints of two other digits. Patients randomized into the control group receive
      treatment one year later to permit replication efforts for findings using this therapy in
      patients with chronic stroke.

      The intervention consists of making patients use their impaired arms by constraining movement
      in the less impaired limb for most waking hours over a 2 week period. The constraint is a
      taped splint in which the hand rests to prevent limb use but enable protective responses. A
      micro-switch within the splint will permit monitoring of contact time (wearing). Each weekday
      for 2 weeks, patients come to the clinic/laboratory for specific task training. Evaluations
      in laboratory and actual use tests are made prior to treatment, 2 weeks later, and at 4 month
      intervals thereafter. Changes in psychosocial functioning will also be measured. Primary
      outcomes include the Wolf Motor Function Test and the Motor Activity Log. Secondary outcomes
      include Stroke Impact Scale, Actual Amount of Use Test, and accelerometry.
    

Intervention name(s): Constraint-induced movement therapy
Intervention type(s): Procedure
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single
Primary purpose: Treatment
Keywords: stroke; cerebrovascular accident; upper extremity; physical therapy; constraint-induced therapy