Effects of Modified Constraint-Induced Therapy versus Bilateral Movement Training on Upper Extremity Performance in Patients with Chronic Stroke: A Kinematic Analysis

Authors

Ya-Fen Chang
Wen-Chung Tsai
Chia-Ying Chung
Yin-Chou Lin
Yueh-Tsen Chen
Ching-Yi Wu
Ken-Chung Lin

Translated Title

改良式制動療法與雙側動作訓練對慢性中風病患之相對效應：運動學分析

Abstract

Background and Objective: Several evidence-based treatment programs for improving upper extremity functions such as constraint-induced therapy (CIT)/modified CIT (mCIT) and bilateral movement training (BMT) have been developed recently. The mCIT program combines restraint of the unaffected hand with intensive training of the affected hand, and BMT involves intensive bilateral training with symmetrical functional training. In this study, the relative efficacy of mCIT vs. BMT was compared by a kinematic analysis that quantitatively assessed motor control in high functioning stroke patients when performing unilateral and bilateral functional tasks.Methods: In a pretest-posttest, randomized controlled trial, twenty-three stroke patients were randomly allocated to either the mCIT group (6 hours restraint of the unaffected hand and 2 hours intensive training of the affected hand daily) or the BMT group (2 hours intensive bilateral training daily) for 5 days weekly over 3 weeks. Outcome measures included (1) kinematic analysis of reaching movement in unilateral and bilateral asymmetrical tasks and (2) the Fugl-Meyer Assessment (FMA) of motor impairment severity. Results: In comparison with the mCIT group, the BMT group revealed the following: better movement efficiency in the unilateral reach-to-grasp task; faster and smoother movement with greater force in the bilateral box-opening task; better temporal synchronization in the bilateral condition (p=.005~.014). The two groups did not significantly differ in FMA. Discussion: When controlling for duration and intensity, BMT was more effective than mCIT for improving motor control during both the unilateral and the bilateral asymmetrical tasks in chronic stroke patients with mild-to-moderate motor impairment. The BMT may facilitate coupling between the upper extremities and may cause the affected upper limb to assume the same movement characteristics of the unaffected upper limb, which would improve motor control of the affected upper limb during unilateral and bilateral asymmetric functional activities.

Language

Traditional Chinese

DOI Link

https://doi.org/10.6315/2009.37(1)02

First Page

19

Last Page

30

Recommended Citation

Chang, Ya-Fen; Tsai, Wen-Chung; Chung, Chia-Ying; Lin, Yin-Chou; Chen, Yueh-Tsen; Wu, Ching-Yi; and Lin, Ken-Chung (2009) "Effects of Modified Constraint-Induced Therapy versus Bilateral Movement Training on Upper Extremity Performance in Patients with Chronic Stroke: A Kinematic Analysis," Rehabilitation Practice and Science: Vol. 37: Iss. 1, Article 2.
DOI: https://doi.org/10.6315/2009.37(1)02
Available at: https://rps.researchcommons.org/journal/vol37/iss1/2