Article

OBJECTIVE: To determine whether a combination of constraint-induced movement
therapy and physiotherapy in stroke patients using different constraint regimens
(sling versus voluntary constraint) changes or reduces motor deficits, the amount
of functional use of the arm and whether the effects of treatment continue after
12 months. DESIGN: Forty-seven stroke patients were stratified and randomly
divided into intensive physiotherapy programmes focused on regaining arm
functions. SETTING: Neurorehabilitation Unit of IInd Department of Neurology at
Institute of Psychiatry and Neurology in Warsaw. SUBJECT: Patients were randomly
allocated to: the sling-constraint group (n = 24) or to the voluntary-constraint
group (n = 23). Interventions: Massed practice with the paretic arm (5 hours/day
for 15 consecutive working days). Sling-constraint group had their arm
immobilized in a hemi-sling during therapy. In addition, individual, 1-hour
physiotherapy sessions were conducted in both groups. MAIN MEASURES: Rivermead
Motor Assessment (RMA) Arm scale, (0-15), Motor Activity Log - Quality of
Movement (MAL-QOM) (0-5 for 30 daily tasks). Results: There was no significant
difference between groups after therapy (MAL-QOM mean change for sling group
0.78, SD = 0.46 and for voluntary-constraint group 0.84, SD = 0.48; P = 0.687).
All treated patients retained mean gains in real-world arm use (MAL-QOM) mean
scores after 12 months follow-up compared with posttreatment values but there was
no significant difference between groups (comparison of estimated mean change of
MAL-QOM stated 0.23. 95% confidence interval = -0.04-0.50). CONCLUSION: Voluntary
activity constraint in the intact arm is equivalent to sling, standard constraint
during massed practice of paretic arm.

Langue : ANGLAIS