Self-regulated Constraint-induced Movement Therapy in Subacute Stroke Patients

University of Western Sydney76 enrolled

Overview

Emerging research suggests the use of self-regulation (SR) strategies at improving functional regain in patients with brain injury. SR is proposed to produce an added effect to the effective constraint-induced movement therapy (CIMT). This study aimed to examine the efficacy of a self-regulated CIMT program (SR-CIMT) for function regain of patients with subacute stroke. It was hypothesized that participants receiving the combined treatment (SR and CIMT) would have a better functional regain.

Background - Emerging research suggests the use of self-regulation (SR) strategies at improving functional regain in patients with brain injury. SR is proposed to produce an added effect to the effective constraint-induced movement therapy (CIMT). Objective - This study aimed to examine the efficacy of a self-regulated CIMT program (SR-CIMT) for function regain of patients with sub-acute stroke. Methods - Seventy-six patients were randomly assigned to the self-regulated constraint-induced movement therapy (SR-CIMT; n=25), constraint-induced movement therapy (CIMT; n=27) or conventional functional rehabilitation (control; n=24) groups, and completed the trial. The SR-CIMT intervention was two-week therapist-guided training using the SR strategy to reflect on the relearning of functional tasks with CIMT. Outcome measurements were for upper limb function (Action Research Arm Test, ARAT, Fugl-Meyer Assessment, FMA), daily task performance (Lawton Instrumental Activities of Daily Living Scale, Lawton IADL) and self-perceived functional ability (Motor Activity Log, MAL) at pre and post intervention intervals, and at one month follow up.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Stroke

Interventions

Self-regulated constraint-induced movement therapyOTHER

There were 10 tasks to practice in total, they included fold laundry, put clothes on hanger, brush teeth, dress upper garment, dress lower garment in week one; and use telephone, prepare a cup of tea, sweep floor, wash towel, wash dishes in week two. In the 4 hours when the participants had their non-hemiplegic arm in the restrain, they received one hour therapist-guided training using SR strategy on task relearning as described above. Therefore, all participants received 10 one-hour therapist-guided training sessions (daily on weekdays, total two weeks). The intervention was delivered by occupational therapist. For the rest of the 3 hours in the restrain, the participants' wearing of the restrain was monitored by the nursing staff in the ward.

Constraint-induced movement therapyOTHER

They practised the same 10 tasks as in the SR-CIMT and control groups. The same as the experimental intervention group (SR-CIMT), in the 4 hours when the participants had their non-hemiplegic arm in the restrain, they received one hour therapist-guided training using the strategy on task relearning as described above. Therefore, all participants received 10 one-hour therapist-guided training sessions (daily on weekdays, total two weeks). The intervention was delivered by occupational therapist. For the rest of the 3 hours in the restrain, the participants' wearing of the restrain was monitored by the nursing staff in the ward.

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * sustained an ischemic type stroke with lesion in the primary or motor cortical areas resulting in hemiplegia, * had stroke onset of less than 3 months, * were aged above 60, and * had 10 degree active extension in metacarpophalangeal joint and interphalangeal joint, 20 degree active extension of wrist joint Exclusion Criteria: * had excessive spasticity in the affected limb, as defined by a score of 2 or more on the Modified Ashworth Scale, * had excessive pain in the affected limb, as defined by a score 4 or more using a Visual Analog Scale, * had a score below 19 on the Mini-Mental Status Examination (MMSE), and * had diagnosed of depression according to Diagnostic and Statistical Manual-IV (DSM-IV) criteria

Locations (2)

Shatin Hospital

Hong Kong, Hong Kong

Pok Oi Hospital

Yuen Long, Hong Kong

Outcomes

Primary Outcomes

Change from baseline in Lawton Instrumental Activities of Daily Living Scale after the intervention

Performance assessment on 8 daily tasks

Time frame: Baseline and after the intervention (2 weeks)

Change from baseline in Lawton Instrumental Activities of Daily Living Scale at one month after the intervention completed

Performance assessment on 8 daily tasks

Time frame: Baseline and one month after the intervention completed (1 month and 2 weeks)

Change from baseline in Action Research Arm Test after the intervention

Performance assessment on arm function

Time frame: Baseline and after the intervention (2 weeks)

Change from baseline in Action Research Arm Test at one month after the intervention completed

Performance assessment on arm function

Time frame: Baseline and one month after the intervention completed (1 month and 2 weeks)

Change from baseline in Fugl Meyer Assessment, upper extremity motor subsection after the intervention

Performance assessment on arm function

Time frame: Baseline and after the intervention (2 weeks)

Change from baseline in Fugl Meyer Assessment, upper extremity motor subsection at one month after the intervention completed

Performance assessment on arm function

Time frame: Baseline and one month after the intervention completed (1 month and 2 weeks)

Secondary Outcomes

Change from baseline in Motor Activity Log-28 after the intervention

Data from ClinicalTrials.gov

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