Article

Constraint-induced movement therapy (CIMT) has proven effective in
increasing functional use of the affected arm in patients with chronic stroke.
The mechanism of CIMT is not well understood. OBJECTIVE: To demonstrate, in a
proof-of-concept study, the feasibility of using kinematic measures in
conjunction with clinical outcome measures to better understand the mechanism of
recovery in chronic stroke patients with mild to moderate motor impairments who
undergo CIMT. METHODS: A total of 10 patients with chronic stroke were enrolled
in a modified CIMT protocol over 2 weeks. Treatment response was assessed with
the Action Research Arm Test (ARAT), the Upper-Extremity Fugl-Meyer score
(FM-UE), and kinematic analysis of visually guided arm and wrist movements. All
assessments were performed twice before the therapeutic intervention and once
afterward. RESULTS: There was a clinically meaningful improvement in ARAT from
the second pre-CIMT session to the post-CIMT session compared with the change
between the 2 pre-CIMT sessions. In contrast, FM-UE and kinematic measures showed
no meaningful improvements. CONCLUSIONS: Functional improvement in the affected
arm after CIMT in patients with chronic stroke appears to be mediated through
compensatory strategies rather than a decrease in impairment or return to more
normal motor control. We suggest that future large-scale studies of new
interventions for neurorehabilitation track performance using kinematic analyses
as well as clinical scales.

Langue : ANGLAIS