Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke?

Background and Purpose-Motor dysfunction after unilateral deafferentation i n primates can be overcome by restraining the unaffected Limb. We asked whe ther a constraint-induced movement (CIM) program could be implemented withi n 2 weeks after stroke and whether CIM is more effective than traditional u pper-extremity (UE) therapies during this period. Methods-Twenty-three persons were enrolled in a pilot randomized, controlle d trial that compared CIM with traditional therapies. A blinded observer ra ted the primary end point, the Action Research Arm Test (ARA). Inclusion cr iteria were the following: ischemic stroke within 14 days, persistent hemip aresis, evidence of preserved cognitive function, and presence of a protect ive motor response. Differences between the groups were compared by using S tudent's t tests, ANCOVA, and Mann-Whitney U tests. Results-Twenty subjects completed the 14-day treatment. Two adverse outcome s, a recurrent stroke and a death, occurred in the traditional group; 1 CIM subject met rehabilitation goals and was discharged before completing 14 i npatient days. The CIM treatment group had significantly higher scores on t otal ARA and pinch subscale scores (P<0.05). Differences in the mean ARA gr ip, grasp, and gross movement subscale scores did not reach statistical sig nificance. UE activities of daily living performance was not significantly different between groups, and no subject withdrew because of pain or frustr ation. Conclusions-A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatme nt. Long-term studies are needed to determine whether CIM early after strok e is superior to traditional therapies.