Limits...
CI Therapy is Beneficial to Patients with Chronic Low-Functioning Hemiparesis after Stroke.

Sterr A, O'Neill D, Dean PJ, Herron KA - Front Neurol (2014)

Bottom Line: The whole-group analysis showed a significant treatment effect, which was largely sustained after 1 year.The sub-group analysis revealed a mixed picture; while improvements against the baseline period were observed in all four subgroups, 180 min of daily shaping training coupled with the constraint yielded better outcome on the MAL but not the WMFT, while for 90 min of training the level of improvement was similar for those who wore the constraint and those who did not.The absence of clear differences between the four treatment variants points to a complex relationship between the length of daily shaping training and the constraint in this patient group, which is likely to be mediated by fatigue and/or compliance with the constraint.

View Article: PubMed Central - PubMed

Affiliation: School of Psychology, University of Surrey , Guildford , UK.

ABSTRACT
CI therapy is effective in patients with relatively good levels of residual arm function but its applicability to patients with low-functioning hemiparesis is not entirely clear. In the present study, we examined the feasibility and efficacy of the CI therapy concept in patients with very limited upper arm function prior to treatment, and further tested how the length of daily shaping training and constraining the good arm affects treatment outcome. In a baseline-controlled design, 65 chronic patients were treated with 2 weeks of modified CI therapy. Patients were randomly allocated to four treatment groups receiving 90 or 180 min of daily shaping training applied with or without constraint, respectively. Outcome was measured through the Reliable Change Index, which was calculated for parameters of motor function, health, and psychological wellbeing. Follow-up data were collected at 6 and 12 months. Two analyses were conducted, a whole-group analysis across all 65 participants and a sub-group analysis contrasting the four treatment variants. The whole-group analysis showed a significant treatment effect, which was largely sustained after 1 year. The sub-group analysis revealed a mixed picture; while improvements against the baseline period were observed in all four subgroups, 180 min of daily shaping training coupled with the constraint yielded better outcome on the MAL but not the WMFT, while for 90 min of training the level of improvement was similar for those who wore the constraint and those who did not. Together these results suggest that, at least in those patients available for follow-up measures, modified CI therapy induces sustained improvements in motor function in patients with chronic low-functioning hemiparesis. The absence of clear differences between the four treatment variants points to a complex relationship between the length of daily shaping training and the constraint in this patient group, which is likely to be mediated by fatigue and/or compliance with the constraint.

No MeSH data available.


Related in: MedlinePlus

Summary of the trial and group allocation. Note that (1) all patients received the allocated treatment, (2) the n for “patients lost” refers to the number of participants having completed the MAL, (3) for attending the follow-up did not necessarily completed all tests; a full breakdown of n per test is given in the supplementary materials, and (4) the cause for drop out were difficulties/unwillingness to traveling to the University (many patients had come from further afield).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4202624&req=5

Figure 1: Summary of the trial and group allocation. Note that (1) all patients received the allocated treatment, (2) the n for “patients lost” refers to the number of participants having completed the MAL, (3) for attending the follow-up did not necessarily completed all tests; a full breakdown of n per test is given in the supplementary materials, and (4) the cause for drop out were difficulties/unwillingness to traveling to the University (many patients had come from further afield).

Mentions: Patients were recruited via local general practitioners (GPs), self-help groups, and newspaper advertisements. Eighty-two patients with first-ever stroke and chronic hemiplegia for a minimum of 1 year were screened. Sixty-five of these participants (mean age was 54.4 ± 1.5 years; 38 male and 27 female; 36 left and 29 right hemiparesis; chronicity = 4.3 ± 0.4 years with range = 1–14.9 years) participated in the study and complete the actual treatment phase. Due to drop outs, the N reduced to 34 at the 6-months follow-up and 23 at the 12-months follow-up (see Figure 1 for summary). Patients were recruited on the basis of the presentation of their motor deficits rather than lesion location. Confirmation of a unilateral thalamic or cortical stroke was obtained from the GP, but no specific lesion information was available to us.


CI Therapy is Beneficial to Patients with Chronic Low-Functioning Hemiparesis after Stroke.

Sterr A, O'Neill D, Dean PJ, Herron KA - Front Neurol (2014)

Summary of the trial and group allocation. Note that (1) all patients received the allocated treatment, (2) the n for “patients lost” refers to the number of participants having completed the MAL, (3) for attending the follow-up did not necessarily completed all tests; a full breakdown of n per test is given in the supplementary materials, and (4) the cause for drop out were difficulties/unwillingness to traveling to the University (many patients had come from further afield).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4202624&req=5

Figure 1: Summary of the trial and group allocation. Note that (1) all patients received the allocated treatment, (2) the n for “patients lost” refers to the number of participants having completed the MAL, (3) for attending the follow-up did not necessarily completed all tests; a full breakdown of n per test is given in the supplementary materials, and (4) the cause for drop out were difficulties/unwillingness to traveling to the University (many patients had come from further afield).
Mentions: Patients were recruited via local general practitioners (GPs), self-help groups, and newspaper advertisements. Eighty-two patients with first-ever stroke and chronic hemiplegia for a minimum of 1 year were screened. Sixty-five of these participants (mean age was 54.4 ± 1.5 years; 38 male and 27 female; 36 left and 29 right hemiparesis; chronicity = 4.3 ± 0.4 years with range = 1–14.9 years) participated in the study and complete the actual treatment phase. Due to drop outs, the N reduced to 34 at the 6-months follow-up and 23 at the 12-months follow-up (see Figure 1 for summary). Patients were recruited on the basis of the presentation of their motor deficits rather than lesion location. Confirmation of a unilateral thalamic or cortical stroke was obtained from the GP, but no specific lesion information was available to us.

Bottom Line: The whole-group analysis showed a significant treatment effect, which was largely sustained after 1 year.The sub-group analysis revealed a mixed picture; while improvements against the baseline period were observed in all four subgroups, 180 min of daily shaping training coupled with the constraint yielded better outcome on the MAL but not the WMFT, while for 90 min of training the level of improvement was similar for those who wore the constraint and those who did not.The absence of clear differences between the four treatment variants points to a complex relationship between the length of daily shaping training and the constraint in this patient group, which is likely to be mediated by fatigue and/or compliance with the constraint.

View Article: PubMed Central - PubMed

Affiliation: School of Psychology, University of Surrey , Guildford , UK.

ABSTRACT
CI therapy is effective in patients with relatively good levels of residual arm function but its applicability to patients with low-functioning hemiparesis is not entirely clear. In the present study, we examined the feasibility and efficacy of the CI therapy concept in patients with very limited upper arm function prior to treatment, and further tested how the length of daily shaping training and constraining the good arm affects treatment outcome. In a baseline-controlled design, 65 chronic patients were treated with 2 weeks of modified CI therapy. Patients were randomly allocated to four treatment groups receiving 90 or 180 min of daily shaping training applied with or without constraint, respectively. Outcome was measured through the Reliable Change Index, which was calculated for parameters of motor function, health, and psychological wellbeing. Follow-up data were collected at 6 and 12 months. Two analyses were conducted, a whole-group analysis across all 65 participants and a sub-group analysis contrasting the four treatment variants. The whole-group analysis showed a significant treatment effect, which was largely sustained after 1 year. The sub-group analysis revealed a mixed picture; while improvements against the baseline period were observed in all four subgroups, 180 min of daily shaping training coupled with the constraint yielded better outcome on the MAL but not the WMFT, while for 90 min of training the level of improvement was similar for those who wore the constraint and those who did not. Together these results suggest that, at least in those patients available for follow-up measures, modified CI therapy induces sustained improvements in motor function in patients with chronic low-functioning hemiparesis. The absence of clear differences between the four treatment variants points to a complex relationship between the length of daily shaping training and the constraint in this patient group, which is likely to be mediated by fatigue and/or compliance with the constraint.

No MeSH data available.


Related in: MedlinePlus