A Modified Method for Constraint-induced Movement Therapy: A Supervised Self-training Protocol

Background: Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that is effective for improving upper extremity function in patients with stroke hemiparesis. In standard protocols, the burdens are great on the patient, therapist, and in terms of health care costs, preventing the wider application of CI therapy. To address this, we developed a protocol based on self-training and examined its effects. Methods: Patients with chronic hemiparesis caused by a stroke (intracerebral hemorrhage or cerebral infarct) 180 days after disease onset were included in this study. We performed before and after comparisons after intervention. We assessed motor impairment in the shoulder, elbow, forearm, wrist, and hand with the Fugl-Meyer Assessment (FMA) and determined training tasks, taking into consideration the patient's primary complaint. We established direct supervision by the therapist and self-training to occupy 40% and 60% of the training period, respectively. With this protocol, training was conducted 5 hours per day for 10 consecutive weekdays. We assessed upper extremity function using the FMA, Wolf Motor Function Test (WMFT), and Motricity Index (MI) before and after intervention. Results: There were 40 subjects. Before and after intervention, scores for the FMA upper extremity items, WMFT functional ability scale, WMFT performance times, and MI showed significant improvements, from 49.35 +/- 10.1 (mean +/- SD) to 52.88 +/- 8.0 points, 3.48 +/- 0.65 to 3.72 +/- 0.67 points, 14.37 +/- 13.22 to 10.58 +/- 11.97 seconds, and 75.0 +/- 12.0 to 77.7 +/- 12.0 points, respectively. Conclusions: Our self-training-based CI therapy protocol is likely to be as effective for improving upper extremity function as the standard CI therapy. The method may contribute to the wider use of CI therapy.