Effects of Modified Constraint-induced Movement Therapy and Patient Participation for Therapy on Functional Outcome, Spatial Attention and Brain Reorganization in Patients with Stroke

• Main Authors: Hsin-Ying Chung, 鍾心穎
• Other Authors: Keh-Chung Lin
• Format: Others
• Language: en_US
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/15298098430828472877

碩士 === 國立臺灣大學 === 職能治療研究所 === 94 === Background and Purpose: The modified constraint-induced movement therapy (mCIMT) recently applied on patients with stroke was considered to be an efficient treatment to improve motor function. However, the effects of the mCIMT on other dominances including spatial attention and brain reorganization are still uncertain. Besides, the level of participation may also be a variable of efficacy and efficiency of the intervention. This study was to compare the effects of mCIMT with the conventional occupational therapy on motor function, unilateral neglect, kinematics analysis, and brain reorganization. Methods: The present study was a quasi-experimental, two-group pretest-posttest design. Twenty six stroke patients with moderate to mild motor deficit were recruited from rehabilitation department of hospital. 12 participants received mCIMT and 14 participants received conventional occupational therapy and interventions were both 2 hours per day, 5 days per week, and for 3 consecutive weeks. Outcome measures including the Fugl-Meyer Assessment (FMA), the Motor Activity Log (MAL) were used to evaluate the motor function of upper extremity. Movement performances on reaching were measured by kinematics system. The unilateral neglect test battery was used to test the spatial attention and the Pittsburgh Rehabilitation Participation Scale (PRPS) was adopted to determine the level of participation of each participant. Brain reorganization was explored by functional magnetic resonance imaging (fMRI). Data was analyzed by different methods: (1) for outcome measures of motor function (the FMA and the MAL), effectiveness index was calculated and one-tailed t tests were used to compare the differences between group and effect size r and power were also calculated. For the PRPS scores, average of each group is tested by one-tailed t test. (2) For kinematics information, ANCOVA was used to test the study hypothesis and the effect size f and power were calculated for each dependent variable. (3) For fMRI data, the Wilcoxon Signed Ranks test was used to test the changes from pre-test to post-test of each group. The correlation between clinical measures and brain activation characteristic was conducted using Pearson’s coefficient. Significance level was set at p < 0.05 Results: Under similar participation level, the mCIMT group exhibited significant better motor improvement and more powerful and energy efficiency during the reaching tasks than the conventional group. There was no significant different between two groups in the unilateral neglect test battery. 7 participants (3 of mCIMT group) took the session of fMRI. Both groups shifted the brain activation to the ipsilateral hemisphere during more-affected hand performance with different patterns. The mCIMT group exhibited trend on increasing total ipsilateral regions of interest (ROIs) activation and the conventional group significantly decreased contralateral cortex (especially sensorimotor cortex,SMC) activation. Participants were pooled to analyze the correlation between motor improvement and brain activation. More contralateral premotor cortex (PMC) activation voxels positively related to more improvement of the FMA and the MAL. Conclusions: The mCIMT may be an efficient intervention to motor function and brain reorganization.