Authors (including presenting author) :
Tsui SY (1)
Affiliation :
(1) Occupational Therapy Department, The Hong Kong Buddhist Hospital
Introduction :
Stroke is the leading cause of disability globally. Constraint-Induced Movement Therapy (CIMT) is a rehabilitation technique for stroke hemiplegic upper limb. CIMT contains 3 components:
(1) Constraint of unaffected upper limb with a mitt for 90% of total hours awake
(2) Intensive use of hemiplegic upper limb for 6 hours a day for 2 weeks
(3) Task practice in patient’s real-life environment.
CIMT requires high self-compliance with long duration wearing restrictive device and training. Patients expressed more interest to CIMT if the programme involves more weeks with shorter practice sessions. Modified CIMT (mCIMT) was developed to improve practicality and cost-effectiveness. This systematic review aims to evaluate the effect of mCIMT compared to conventional therapy and suggest a protocol.
Methodology :
A systematic literature search was performed from October to December 2020 using 3 electronic databases. Keywords were “Constraint-Induced Movement Therapy”, “stroke”, “upper extremity”. Randomized controlled trials (RCT) in recent 10 years with inclusion of mCIMT and conventional therapy were selected by one reviewer.
Result & Outcome :
Results: 6 RCTs were included for analysis. The effectiveness of mCIMT was evaluated in movement quality, movement rate, daily function and stroke severity. Significant improvement was seen in movement quality after both mCIMT and conventional therapy, with better performance in mCIMT. Both mCIMT and conventional therapy exhibited favourable effect on upper limb movement rate. Among the studies measuring movement rate, 50% of them found more rewarding effect in mCIMT. Little evidence supported the effect of mCIMT in daily function.
Summarizing the protocols in included studies, the minimal effective dose of mCIMT on hemiplegic upper limb training was 1 hour per session, with 3 sessions per week, for 2 weeks. The minimal time of unaffected limb constraint with a mitt was 2 hours daily.
Conclusion: mCIMT is a safe and feasible intervention for hemiplegic upper limb rehabilitation of stroke. mCIMT effectively enhances hemiplegic upper extremity movement quality, movement rate and daily function after stroke. Superiority of mCIMT was seen to a certain extent in movement quality and rate. A minimum dose of 1 hour per session, with 3 sessions per week, for 2 weeks is recommended in mCIMT training, together with a minimal time of unaffected limb constraint with a mitt of 2 hours daily.
