An examination of constraint-induced therapy as a method to intensify intervention and improve functional outcome during the rehabilitation phase of stroke

Ploughman, Michelle (2003) An examination of constraint-induced therapy as a method to intensify intervention and improve functional outcome during the rehabilitation phase of stroke. Masters thesis, Memorial University of Newfoundland.

[English] PDF (Migrated (PDF/A Conversion) from original format: (application/pdf)) - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. Download (52MB) [English] PDF - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. (Original Version)

Abstract

Studies have shown that constraint-induced therapy (CIT) improves recovery of the impaired upper extremity and influences neuroplastic changes in the recovering brain, primarily in chronic stroke populations and when paired with six hours of additional therapy per day. A protocol of mitten constraint was developed in which subjects, during the rehabilitation phase of stroke, wore a mitten on the sound hand rather than a sling and splint as used previously, gradually increasing wearing time, without hours of additional therapy. The purpose of this exploratory study was to evaluate the effectiveness of this constraint protocol and compliance to the treatment. Subjects were randomly assigned to CIT plus conventional therapy or conventional therapy only. Upper extremity, lower extremity and trunk motor control and strength were evaluated along with shoulder pain, compliance and level of dependence on caregivers. CIT appeared to significantly improve recovery of postural control and augmented recovery of the impaired upper extremity. The constraint protocol was most effective in male subjects and subjects with left hemiplegia. Compliance varied according to level of disability on admission but was not related to overall recovery. CIT did not induce increased dependence on caregivers and was not associated with adverse events however there was a trend toward increased hemiplegic shoulder pain in some subgroups that was associated with poorer outcome. It was concluded that this constraint protocol was a clinically relevant and practical method to apply CIT in the acute rehabilitation setting.

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