Modified Constraint Induced Movement Therapy for Lower Extremities’ Rehabilitation in Patients with Stroke: A Narrative Review of Literature

The first sentence on learned nonuse already tells me they don't understand the problem. The problem is usually dead brain; this is not dead brain rehab.

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist!

 Modified Constraint Induced Movement Therapy for Lower Extremities’ Rehabilitation in Patients with Stroke: A Narrative Review of Literature

Rumana Khatun A. Pathan1, Vivek H. Ramanandi2, Roshni G. Kachhadiya3,
Hemanshi N. Vekariya4
1,3,4Post graduate Student, SPB Physiotherapy College, Veer Narmad South Gujarat University, Surat, India.
2Associate Professor, SPB Physiotherapy College, Veer Narmad South Gujarat University, Surat, India.
Corresponding Author: Dr. Vivek H. Ramanandi
DOI: https://doi.org/10.52403/ijhsr.20240213

ABSTRACT

Background: Learned non-use is a common complication after stroke in patients who neglects the use
of the affected limb for longer periods. Modified Constraint Induced Movement Therapy (m-CIMT) is
a form of rehabilitation therapy that limits the unaffected side and through repeated and concentrated
training improve the function of the paretic side. Use of m-CIMT for lower extremities rehabilitation is
relatively less explored avenue. Aim of the present study was to review literature evaluating the
effectiveness of m-CIMT for recovery of lower extremities (LE) function in stroke patients.
Methodology: Articles published in English language from 2011 to 2022 were searched from various
online databases. Out of total 6 search results, 5 full texts were screened and selected for review based
on selection criteria. The review included randomized control trial, pilot study, and experimental study
designs.
Result: The review of available literature suggested that m-CIMT is an effective approach for LE
rehabilitation in stroke patient. It has showed promising results on outcomes such as gait parameters,
balance, ambulation, and symmetry.
Conclusion: Based on this review, it can be concluded that m-CIMT intervention is effective for
rehabilitation of paretic LE function in patient with stroke and therefore it may be used in addition to a
conventional treatment.

Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke

Then write this up as a stroke protocol AND DELIVER IT to all 10 million yearly stroke survivors and since this is chronic, those in the past, maybe 40-50 million. 

This printed research article is only the start of your job since we have fucking failures of stroke associations you can't dump the followup on them.

It has only been 4 years, WHERE THE FUCK IS THE PROTOCOL LOCATED? Survivors need to know. 

Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke

Journal of NeuroEngineering and Rehabilitation
 (2016) 13:31
DOI 10.1186/s12984-016-0138-5

Yu-wei Hsieh 1, 

Rong-jiuan Liing 2, 

Keh-chung Lin 2,3, 

Ching-yi Wu 1*, 

Tsan-hon Liou 4, 

Jui-chi Lin 4,
and Jen-wen Hung 5

Abstract

Background:
 The combination of robot-assisted therapy (RT) and a modified form of constraint-induced therapy(mCIT) shows promise for improving motor function of patients with stroke. However, whether the changes of motor control strategies are concomitant with the improvements in motor function after combination of RT andmCIT (RT + mCIT) is unclear. This study investigated the effects of the sequential combination of RT + mCIT compared with RT alone on the strategies of motor control measured by kinematic analysis and on motor function and daily performance measured by clinical scales.
Methods:
 The study enrolled 34 patients with chronic stroke. The data were derived from part of a single-blinded randomized controlled trial. Participants in the RT + mCIT and RT groups received 20 therapy sessions (90 to105 min/day, 5 days for 4 weeks). Patients in the RT + mCIT group received 10 RT sessions for first 2 weeks and 10mCIT sessions for the next 2 weeks. The Bi-Manu-Track was used in RT sessions to provide bilateral practice of wrist and forearm movements. The primary outcome was kinematic variables in a task of reaching to press a desk bell.Secondary outcomes included scores on the Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living. All outcome measures were administered before and after intervention.
Results:
 RT + mCIT and RT demonstrated different benefits on motor control strategies. RT + mCIT uniquely improved motor control strategies by reducing shoulder abduction, increasing elbow extension, and decreasing trunk compensatory movement during the reaching task. Motor function and quality of the affected limb was improved, and patients achieved greater independence in instrumental activities of daily living. Force generation at movement initiation was improved in the patients who received RT.
Conclusion:
 A combination of RT and mCIT could be an effective approach to improve stroke rehabilitation outcomes, achieving better motor control strategies, motor function, and functional independence of instrumental activities of daily living.
Trial registration:
 ClinicalTrials.gov. NCT01727648

Rehabilitation interventions for upper limb function in the first four weeks following stroke: a systematic review and meta-analysis of the evidence

Damn it all. Write this up into a fucking protocol so that these stupid meta-analysis and systematic reviews never need to be done again. A great stroke association president would take care of this problem, but since we have fucking failures of stroke associations failure will continue indefinitely.

Rehabilitation interventions for upper limb function in the first four weeks following stroke: a systematic review and meta-analysis of the evidence

Kimberley A. Wattchow, B. Physiotherapy (Hons)

School of Health Sciences, University of South Australia, Australia

Michelle N. McDonnell, PhD, B. App Sci Physio (Hons)Correspondence information about the author PhD, B. App Sci Physio (Hons) Michelle N. McDonnellEmail the author PhD, B. App Sci Physio (Hons) Michelle N. McDonnell

Senior Lecturer; Stroke and Rehabilitation Research Group, School of Health Sciences, University of South Australia, Australia

Susan L. Hillier, PhD, B. App Sci Physio

Associate Professor and Dean: Research, School of Health Sciences; Sansom Institute for Health Research, University of South Australia, Australia

DOI: http://dx.doi.org/10.1016/j.apmr.2017.06.014

• Abstract

Abstract

Objective

To investigate the therapeutic interventions reported in the research literature, and synthesize their effectiveness in improving upper limb (UL) function in the first four weeks post-stroke.

Data sources

Electronic databases, trial registries and hand searching was conducted, from inception until June 2016.

Study selection

Randomised controlled trials (RCTs), controlled trials and interventional studies with pre/post-test design were included for adults within four weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared to usual care, sham or another technique.

Data extraction

Two reviewers independently assessed eligibility of full texts, and methodologic quality of included studies using the Cochrane ‘Risk of bias tool’.

Data synthesis

104 trials (83 RCTs, 21 non-randomised studies) were included (n=5,225 participants). Meta-analyses of RCTs only (20 comparisons), and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardised mean difference, SMD 1.09, 95% confidence intervals, CI 0.21, 1.97) and task-specific training (SMD 0.37, 95% CI 0.05 to 0.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.

Conclusions

Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase post-stroke. Further high quality studies into the initial four weeks post-stroke are needed to determine therapies for targeted functional UL outcomes.
You came up with totally useless information, nothing here can be directly used to get survivors to 100% recovery.

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

Well shit, treating only the good candidates. What the fuck are those survivors supposed to do that don't have voluntary finger extension? Like me. They didn't even try mCIMT on unfavorable finger extension candidates. They are not even trying to solve the hard survivor cases. You better fucking hope you have a small stroke because researchers obviously do not even try to solve the hard cases.

Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke

The EXPLICIT-Stroke Randomized Clinical Trial

1. Gert Kwakkel, PhD1,2
2. Caroline Winters, MSc1
3. Erwin E. H. van Wegen, PhD1⇑
4. Rinske H. M. Nijland, PhD2
5. Annette A. A. van Kuijk, MD, PhD3
6. Anne Visser-Meily, MD, PhD4
7. Jurriaan de Groot, PhD5
8. Erwin de Vlugt, PhD6
9. J. Hans Arendzen, MD, PhD5
10. Alexander C. H. Geurts, MD, PhD3
11. Carel G. M. Meskers, MD, PhD1
12. on behalf of the EXPLICIT-Stroke Consortium

1. ¹Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
2. ²Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
3. ³Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
4. ⁴Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
5. ⁵Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
6. ⁶Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands

1. Erwin E. H. van Wegen, PhD, Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Email: e.vanwegen@vumc.nl

Abstract

Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke.  

Methods. A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE.  

Results. Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P < .05), but not after 26 weeks. We did not find statistically significant differences between mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions. Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial. Despite meaningful improvements in upper limb capacity, no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS.