A Kinematic Study of Modified Constraint-induced Movement Therapy for Stroke Patients: The Effect of Stroke Laterality

• Main Authors: Chia-Yi Lee, 李佳宜
• Other Authors: 林克忠
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/69016475089152399924

碩士 === 國立臺灣大學 === 職能治療研究所 === 92 === Background and Purpose Stroke is the leading cause of disability and is frequently accompanied by substantial loss of motor function. A possible explanation for the substantial remaining motor deficit might be the occurrence of learned nonuse. Modified constraint-induced movement therapy (mCIMT) is a new rehabilitation approach to improving limb use in stroke patients. The main purposes of this study are: (1) to investigate whether mCIMT is more effective than traditional therapy in restoring motor function, improving activities of daily living functioning and promoting quality of life in stroke patients; (2) the influence of stroke laterality on the mCIMT treatment effects; (3) the impact of treatment on the less-affected arm. Methods Twenty-eight stroke patients were assigned to either the mCIMT group (immobilization of the less-affected arm 6-hour per day combined with intensive training of the affected arm 2-hour per weekday) or the control group of traditional treatment for a period of 3 weeks. The primary outcome measures involve the kinematic system to capture the spatio-temporal characteristics of reaching performance, and clinical measures including Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), Functional Independence Measure (FIM) and Stroke Impact Scale (SIS). Results Patients in the mCIMT group exhibited better reaching performance than control group in some experiemental tasks that was reflected by shorter reaction time, less normalized total displacement and greater percentage of reaching where peak velocity occurs. Results of the FMA, MAL and FIM also showed that mCIMT group had significant improvement of motor function and activity performance in real-life environment. The mCIMT group also showed significant improvement in the physical function domains in the SIS. In the mCIMTgroup, there is a trend that patients with right brain damage (RBD) had better motor efficiency and smoothness in reaching performance than patients with left brain damage (LBD). Patients with RBD also had significant improvement in FIM scores. There was no significant impact on the less-affected arm. Conclusion The finding of this study supported the therapeutic benefits of mCIMT on improving reaching performance and motor function and overcoming learned nonuse. The mCIMT might have better therapeutic effects for patients with right brain damage. Howerver, further studies are needed to confirm the effects of stroke laterality and the impact of mCIMT on the less-affected arm.