Stroke Patients Retain One-Arm Therapy Benefit for Two Years


ATLANTA, Dec. 11 -- Stroke patients given constraint-induced movement therapy for 14 days had substantial improvement in function and quality of life for up to two years, found clinicians here.The treatment, which takes advantage of the one-sided nature of stroke symptoms, involves constraining the "good" arm for about six hours daily in order to force use of the "bad" arm. Such therapy was associated with significant improvement in arm strength (P<0.0001), said Steven L. Wolf, Ph.D., of the Center for Rehabilitation Medicine at Emory University, and colleagues.
Moreover, after 24 months there were also improvements in social participation measured by the stroke impact scale, Dr. Wolf and colleagues reported online in Lancet Neurology.
It suggests that "initial gains in hand function and use contribute to secondary changes in functional use of the hand, resulting in increased strength and improved ability in activities of daily living," they wrote.
"Collectively, these results highlight the possibility of further improvements in the arm of mild to moderately impaired stroke survivors beyond one year following a two-week [constraint-induced movement therapy] intervention," they continued.
The two-year results confirmed and extended the 12-month results previously reported by the EXCITE (Extremity Constraint-Induced Movement Therapy Evaluation) investigators.
Despite improvement in measures of function, strength, and dexterity, constraint-induced movement therapy did not improve either memory or cognitive function.
"The absence of change in this domain is not surprising because constraint-induced movement therapy does not target cognitive function," they wrote. "Generally, stroke survivors in this follow-up study achieved a higher quality of life that persisted, which is an ultimate goal of rehabilitation."
The trial randomized 106 stroke patients to the constraint-induced intervention plus usual therapy. Ninety-eight patients completed constraint therapy and 70 patients were evaluable at 24 months.
During the two-week intervention, patients wore a padded, protected mitt on their less-impaired hand for 90% of waking hours.
Patients were assessed at four months, eight months, 12 months, 16 months, 20 months, and 24 months using the Wolf motor function test, a motor activity log, and the stroke impact scale.
Although strength and dexterity contribute to improved functioning, Dr. Wolf said, "upper limb function, and not strength or dexterity independently, seems to have the strongest link to health-related quality of life or participation."
And when stroke patients increase participation in social activity, it has the added benefit of improving their overall well-being, Dr. Wolf and colleagues wrote.
The EXCITE study was funded by National Institutes of Health Center for Medical Rehabilitation Research and the National Institute of Neurological Disorders and Stroke.
Primary source: Lancet NeurologySource reference:Wolf S, et al "Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomized trial" Lancet Neurol 2008; 7: 33-40.