Article

OBJECTIVE: To compare the effect of modified constraint-induced movement therapy
(mCIMT) to bimanual task-related training for patients in the subacute phase post
stroke. DESIGN: A single-blinded randomized controlled trial. SETTINGS: Inpatient
and outpatient rehabilitation clinics and the patient's home. SUBJECTS: Thirty
patients in the subacute phase post stroke (2-16 weeks) were randomized to
modified constraint-induced movement therapy with an emphasis on unimanual tasks,
or bimanual task-related training, emphasizing bimanual tasks. All trained with a
therapist 4 hours a week for four weeks, followed by a 2-3 hours daily
self-training program. Patients in the modified constraint-induced movement
therapy group were supposed to wear a restraining mitt on the unaffected hand for
4 hours a day for four weeks. MAIN MEASURES: Blinded assessments at pre and post
treatment and after three months with Action Research Arm Test as a primary
outcome measure, Nine-Hole Peg Test and Motor Activity Log. RESULTS: Power
calculations suggested an inclusion of 60 patients, but due to recruitment
difficulties the trial was stopped after an interim analysis at 30 patients.
There was no difference in change (P > 0.05) between the groups on any of the
measures, neither at post treatment nor at follow-up assessments. From
pre-intervention to follow-up assessment the modified constraint-induced movement
therapy group obtained a mean change score of 17.77 (14.66)
on Action Research
Arm Test, the bimanual group 15.47 (13.59). CONCLUSION: Bimanual training was as
effective as modified constraint-induced movement therapy in improving arm motor
function. Wearing a mitt seems unnecessary for most patients in the subacute
phase post stroke when focused affected arm training is provided.

Langue : ANGLAIS