Constraint - Induced Movement Therapy: Determinants and Correlates of Duration of Adherence to Restraint use Among Stroke Survivors with Hemiparesis

Olumide Olasunkanmi Dada, Arinola Olasumbo Sanya

Abstract


Background: Constraint-Induced Movement Therapy (CIMT) was developed to improve purposeful movement of the stroke-affected extremity by restrictingthe use of the unaffected extremity. The two main components of CIMT are the training of the more-impaired arm to perform functional tasks, and the restraint of the less-impaired arm. One challenge that the application of CIMT faces is in ensuring adherence to the use of restraint.

Purpose: There is a need to determine the factors that may influence adherence, as this would allow CIMT to be delivered more effectively, and prevent situations where unrealistic expectations are placed on stroke–affected individuals.

Methods: Thirty stroke survivors with hemiparesis who met the inclusion criteria were consecutively recruited from the physiotherapy out-patient clinics, using a purposive sampling technique. A structured questionnaire was used to obtain information on clinical and socio-demographic parameters. The participants were given a restraint and an adherence time log-book, to make a daily record during the period they wore the restraint. The adherence time logbook was collected at the end of every week of the 3-week study. Motor function and functional use of the upper limb were measured using Motricity Index and Motor Activity Log respectively. Data was analysed using mean and standard deviations, independent t-test and Spearman rho; p was significant at 0.05.

Results: Gender (p=0.73) and side affected/handedness (p=0.79) had no significant influence on the percentage duration of adherence to restraint use (DARU). The influence of socio-economic status was seen, with the participants of middle socio-economic status adhering for longer duration (p=0.02). Age had weak and no significant correlation with percentage DARU (p=0.55). There was significantly fair correlation between motor function/functional use at any stage (p=0.55) and the corresponding percentage duration of adherence to restraint use, except the functional use in the first week (p=0.44).

Conclusion: Socio-economic status should be considered when applying CIMT.

DOI: 10.5463/dcid.v22i3.84

 


Keywords


Motor function; Functional use; Socio-demographic parameters

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References


Adamson J, Beswick A, Ebrahim S (2004). Is stroke the most common cause of disability?. J Stroke Cerebrovasc, Vol. 13 (4), p. 171-177. DOI: 10.1016

Bach-y-Rita P (2001). Theoretical and practical considerations in the restoration of function after stroke. Top Stroke Rehabil, 8(3): p. 1-15. http://dx.doi.org/10.1310/8T1T-ETXU-8PDF-9X7F

Bonnifer N, Anderson KM (2003). Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia. Phys Ther, 83:384-398. PMid:12665409

Brogårdh C, Persson A, Sjölund B (2007). Intra-and inter-rater reliability of the Sollerman hand function test in patients with chronic stroke. Disabil Rehabil 29: 145–154. http://dx.doi.org/10.1080/09638280600747603

Chollet F, et al (2011). Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol, Vol. 10 (2), p. 123 - 130. http://dx.doi.org/10.1016/S1474-4422(10)70314-8

Harris JE, Eng JJ (2006). Individuals with the dominant hand affected following stroke demonstrate less impairment than those with the non-dominant hand affected. Neurorehab Neural Re, 20(3), p. 380-389. http://dx.doi.org/10.1177/1545968305284528. PMid:16885424

Johnston M, Kirshblum S, Zorawitz R, Walker J (1993). Prediction of outcomes following rehabilitation of stroke patients. Neurorehabil; 2: p. 51-76.

Krakauer JW (2005). Arm Function after Stroke: From Physiology to Recovery. Semin Neurol, Vol. 25(4). http://dx.doi.org/10.1055/s-2005-923533. PMid:16341995

McCombe WS, Whitall J (2005). Hand dominance and side of stroke affect rehabilitation in chronic stroke. Clin Rehabil. 19(5), p. 544-51. http://dx.doi.org/10.1191/0269215505cr829oa. PMid:16119411

Odell K, Wollack J, Flynn M (2005). Functional outcomes in patients with right hemisphere brain damage. Aphasiology. 19, p. 807– 830. http://dx.doi.org/10.1080/02687030500239226

Page SJ, Levine P, Sisto S, Bond Q, Johnston MV (2002). Stroke patients’ and therapists’ opinions of constraint-induced movement therapy. Clin Rehabil, 16: p. 55– 60. http://dx.doi.org/10.1191/0269215502cr473oa. PMid:11837526

Schaechter JD, Moore CI, Connell BD, Rosen BR, Dijkhuizen RM (2006). Structural and functional plasticity in the somatosensory cortex of chronic stroke patients. Brain; 129, p. 2722–2733. http://dx.doi.org/10.1093/brain/awl214. PMid:16921177

Suputtitada A, Suwanwela NC, Tumvitee S (2004). Effectiveness of Constraint-induced Movement Therapy in Chronic Stroke Patients. J Med Assoc Thai; 87(12), p. 1482-90. PMid:15822545

Taub E, Uswatte G, Pidikiti R (1999). Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation-a clinical review. J Rehabil Res Dev, 36: p. 237-251. PMid:10659807

Viriyavejakul A (1990). Stroke in Asia: an epidemiological consideration Clin Neuropharmacol; 13(Suppl 3):S26-33. PMid:2093416

Winstein C, Miller J, Blanton S, Morris D, Uswatte G, Taub E, Nichols D, Wolf S (2003). Methods for a multi-site randomised trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from cerebrovascular stroke. Neurorehab Neural Re, 17:137–152. http://dx.doi.org/10.1177/0888439003255511

Wolf SL, Winstein CJ, Miller P, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D (2006). Effect of Constraint-Induced Movement Therapy on Upper Extremity Function 3 to 9 Months After Stroke: The EXCITE Randomised Clinical Trial JAMA; 296(17): p. 2095-2104.




DOI: https://doi.org/10.5463/dcid.v22i3.84



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