ContextSingle-site studies suggest that a 2-week program of constraint-induced movement therapy (CIMT) for patients more than 1 year after stroke who maintain some hand and wrist movement can improve upper extremity function that persists for at least 1 year.ObjectiveTo compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months.Design and SettingThe Extremity Constraint Induced Therapy Evaluation (EXCITE) trial, a prospective, single-blind, randomized, multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003.ParticipantsTwo hundred twenty-two individuals with predominantly ischemic stroke.InterventionsParticipants were assigned to receive either CIMT (n = 106; wearing a restraining mitt on the less-affected hand while engaging in repetitive task practice and behavioral shaping with the hemiplegic hand) or usual and customary care (n = 116; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions); patients were stratified by sex, prestroke dominant side, side of stroke, and level of paretic arm function.Main Outcome MeasuresThe Wolf Motor Function Test (WMFT), a measure of laboratory time and strength-based ability and quality of movement (functional ability), and the Motor Activity Log (MAL), a measure of how well and how often 30 common daily activities are performed.ResultsFrom baseline to 12 months, the CIMT group showed greater improvements than the control group in both the WMFT Performance Time (decrease in mean time from 19.3 seconds to 9.3 seconds [52% reduction] vs from 24.0 seconds to 17.7 seconds [26% reduction]; between-group difference, 34% [95% confidence interval {CI}, 12%-51%]; P<.001) and in the MAL Amount of Use (on a 0-5 scale, increase from 1.21 to 2.13 vs from 1.15 to 1.65; between-group difference, 0.43 [95% CI, 0.05-0.80]; P<.001) and MAL Quality of Movement (on a 0-5 scale, increase from 1.26 to 2.23 vs 1.18 to 1.66; between-group difference, 0.48 [95% CI, 0.13-0.84]; P<.001). The CIMT group achieved a decrease of 19.5 in self-perceived hand function difficulty (Stroke Impact Scale hand domain) vs a decrease of 10.1 for the control group (between-group difference, 9.42 [95% CI, 0.27-18.57]; P=.05).ConclusionAmong patients who had a stroke within the previous 3 to 9 months, CIMT produced statistically significant and clinically relevant improvements in arm motor function that persisted for at least 1 year.Trial Registrationclinicaltrials.gov Identifier: NCT00057018

https://jamanetwork.com/journals/jama/articlepdf/203876/joc60147_2095_2104.pdf

Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.

Measurement of recovery after stroke is becoming increasingly important with the advent of new treatment options under investigation in stroke rehabilitation research. The Fugl-Meyer scale was developed as the first quantitative evaluative instrument for measuring sensorimotor stroke recovery, based on Twitchell and Brunnstrom’s concept of sequential stages of motor return in the hemiplegic stroke patient. The Fugl-Meyer is a well-designed, feasible and efficient clinical examination method that has been tested widely in the stroke population. Its primary value is the 100-point motor domain, which has received the most extensive evaluation. Excellent interrater and intrarater reliability and construct validity have been demonstrated, and preliminary evidence suggests that the Fugl-Meyer assessment is responsive to change. Limitations of the motor domain include a ceiling effect, omission of some potentially relevant items, and weighting of the arm more than the leg. Further study should test performance o...

The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties

Context Single-sitestudiessuggestthata2-weekprogramofconstraint-inducedmove-ment therapy (CIMT) for patients more than 1 year after stroke who maintain somehand and wrist movement can improve upper extremity function that persists for atleast 1 year.Objective To compare the effects of a 2-week multisite program of CIMT vs usualandcustomarycareonimprovementinupperextremityfunctionamongpatientswhohad a first stroke within the previous 3 to 9 months.Design and Setting The Extremity Constraint Induced Therapy Evaluation(EXCITE) trial, a prospective, single-blind, randomized, multisite clinical trial con-ducted at 7 US academic institutions between January 2001 and January 2003.Participants Twohundredtwenty-twoindividualswithpredominantlyischemicstroke.Interventions Participants were assigned to receive either CIMT (n=106; wearinga restraining mitt on the less-affected hand while engaging in repetitive task practiceandbehavioralshapingwiththehemiplegichand)orusualandcustomarycare(n=116;rangingfromnotreatmentafterconcludingformalrehabilitationtopharmacologicorphysiotherapeutic interventions); patients were stratified by sex, prestroke dominantside, side of stroke, and level of paretic arm function.Main Outcome Measures The Wolf Motor Function Test (WMFT), a measure oflaboratory time and strength-based ability and quality of movement (functional abil-ity),andtheMotorActivityLog(MAL),ameasureofhowwellandhowoften30com-mon daily activities are performed.Results From baseline to 12 months, the CIMT group showed greater improve-ments than the control group in both the WMFT Performance Time (decrease inmean time from 19.3 seconds to 9.3 seconds [52% reduction] vs from 24.0 sec-onds to 17.7 seconds [26% reduction]; between-group difference, 34% [95% con-fidence interval {CI}, 12%-51%];

Effect of Constraint-Induced Movement Therapy on Upper Extremity Function 3 to 9 Months After Stroke

The authors' goal is to apply robotics and automation technology to assist, enhance, quantify, and document neurorehabilitation. This paper reviews a clinical trial involving 20 stroke patients with a prototype robot-aided rehabilitation facility developed at the Massachusetts Institute of Technology, Cambridge, (MIT) and tested at Burke Rehabilitation Hospital, White Plains, NY. It also presents the authors' approach to analyze kinematic data collected in the robot-aided assessment procedure. In particular, they present evidence (1) that robot-aided therapy does not have adverse effects, (2) that patients tolerate the procedure, and (3) that peripheral manipulation of the impaired limb may influence brain recovery. These results are based on standard clinical assessment procedures. The authors also present one approach using kinematic data in a robot-aided assessment procedure.

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Robot-aided neurorehabilitation

Background and Purpose The limited walking ability that follows a stroke restricts the patient’s independent mobility about the home and community, a significant social handicap. To improve the in-hospital prediction of functional outcome, the relationships between impairment, disability, and handicap were assessed with clinical measures in 147 stroke patients. Methods The patients’ level of functional walking ability at home and in the community was assigned by expert clinicians to one of the six categories of a modified Hoffer Functional Ambulation scale at least 3 months after discharge. A 19-item questionnaire was further used to assess current customary mobility of the subjects. Functional muscle strength and proprioception were tested, and walking velocity was measured. Results The significant indicators of impairment, upright motor control knee flexion and extension strength, differentiated household from community ambulators. The addition of velocity improved the functional prediction. Propriocept...

Classification of Walking Handicap in the Stroke Population

A system for evaluation of motor function, balance, some sensation qualities and joint function in hemiplegic patients is described in detail. The system applies a cumulative numerical score. A series of hemiplegic patients has been followed from within one week post-stroke and throughout one year. When initially nearly flaccid hemiparalysis prevails, the motor recovery, if any occur, follows a definable course. The findings in this study substantiate the validity of ontogenetic principles as applicable to the assessment of motor behaviour in hemiplegic patients, and foocus the importance of early therapeutic measures against contractures.

Fugl-Meyer Ar

Papers

The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance.