Article

Background and Objective Favorable prognosis of the upper limb depends on
preservation or return of voluntary finger extension (FE) early after stroke. The
present study aimed to determine the effects of modified constraint-induced
movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation
(EMG-NMS) on upper limb capacity early poststroke. Methods A total of 159
ischemic stroke patients were included: 58 patients with a favorable prognosis
(>10 degrees of FE) were randomly allocated to 3 weeks of mCIMT or usual care
only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS
or usual care only. Both interventions started within 14 days poststroke, lasted
up until 5 weeks, focused at preservation or return of FE. Results Upper limb
capacity was measured with the Action Research Arm Test (ARAT), assessed weekly
within the first 5 weeks poststroke and at postassessments at 8, 12, and 26
weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after
5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P < .05), but
not after 26 weeks. We did not find statistically significant differences between
mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of
the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions
Three weeks of early mCIMT is superior to usual care in terms of regaining upper
limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in
patients with an unfavorable prognosis is not beneficial. Despite meaningful
improvements in upper limb capacity, no evidence was found that the
time-dependent neurological improvements early poststroke are significantly
influenced by either mCIMT or EMG-NMS.
CI - (c) The Author(s) 2016.

Langue : ANGLAIS