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Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study [with consumer summary]
Lin K-C, Wu C-Y, Wei T-H, Lee C-Y, Liu J-S
Clinical Rehabilitation 2007 Dec;21(12):1075-1086
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. DESIGN: Two-group randomized controlled trial with pretreatment and posttreatment measures. SETTING: Rehabilitation clinics. SUBJECTS: Thirty-two chronic stroke patients (21 men, 11 women; mean age 57.9 years, range 43 to 81 years) 13 to 26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. INTERVENTION: Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. MAIN MEASURES: Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. RESULTS: There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (p = 0.018) more efficiently and depended more on the feedforward control of reaching (p = 0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (p < 0.0001) and the Functional Independence Measure (p = 0.016). CONCLUSIONS: In addition to improving functional use of the affected arm and daily functioning, modified constraint-induced movement therapy improved motor control strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.

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