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Stroke Rehab Technique Has Lasting Results

Constraint-induced movement therapy improves strength and quality of life, researchers say

TUESDAY, Dec. 11 (HealthDay News) -- With just two weeks of so-called constraint-induced movement therapy, some stroke patients can have significant improvement in the functioning of their affected hand and a better quality of life, a new study finds.

For the study, participants wore a mitt on the less-affected hand. This forced them to use their affected hand while doing a repetitive task -- such as grooming or eating -- with the hope of improving the use of their hand and rebuilding strength. The mitt was worn for most of their waking hours for two weeks.

"The folks who have extremity constraint-induced movement therapy have significant improvements in the use of their impaired upper extremity that persist after two weeks of training," said lead researcher Steven Wolf, a professor of rehabilitation medicine at Emory University School of Medicine.

The researchers found that these gains were still evident two years later. "Over two years, strength-based measures improved further, and many measures of quality of life improved substantially," Wolf said.

The report was published online Dec. 11 in The Lancet Neurology.

In the EXCITE (extremity constraint-induced movement therapy evaluation) trial, 106 patients were randomly assigned to extremity constraint-induced movement therapy or usual therapy, which ranged from no treatment after concluding formal rehabilitation to drugs or continued physiotherapy.

The new study was an extension of the EXCITE trial, which demonstrated that people who underwent extremity constraint-induced therapy had better results in hand function after one year, compared with people who received usual care.

Wolf's team found that two years after treatment, there was no decline in the improvements seen after one year. In fact, the participants continued to gain strength and improvement in ability, the researchers said.

Moreover, quality of life was significantly better two years after treatment. Improvements were seen in social participation, activities of daily living, and overall physical function, Wolf said.

Wolf said the restraint therapy can be used on about 30 percent of stroke patients -- or those with mild to moderate impairment. "People who will benefit are those who can begin to open their hand six weeks after the stroke," he said. "Extremity constraint-induced movement therapy can, over a short period of time, lead to improvements that are sustainable."

One stroke expert thinks the study results are impressive, but more research needs to be done before the technique is adopted widely.

"In stroke rehabilitation, we don't have a lot of things to offer these folks," said Dr. Michael W. O'Dell, acting chief of rehabilitation medicine at New York-Presbyterian Hospital, Weill Cornell Medical Center in New York City. "It's pretty remarkable that a treatment that was provided for two weeks, two years ago, is still having an effect on people's ability to function on a day-to-day basis."

O'Dell said it's important to note that the patients in the EXCITE trial did have some movement in the affected hand before the study began. "They were not the worst of the worst," he said. "But it's really encouraging that there is some possibility for further recovery."

O'Dell noted there are some drawbacks to extremity constraint-induced therapy. For one, insurance companies and Medicare won't pay for it. "It's too expensive," he said.

Also, the therapy is very frustrating for patients. "So, you have to have an incredibly motivated patient to do this," O'Dell said.

More information

To learn more about stroke, visit the American Stroke Association.

SOURCES: Steven Wolf, Ph.D., professor of rehabilitation medicine, Emory University School of Medicine, Atlanta; Michael W. O'Dell, M.D., acting chief of rehabilitation medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York City; Dec. 11, 2007, The Lancet Neurology, online

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