Effect of modified constraint induced movement therapy on upperextremity functions of stroke patients with right/left hemisphere damage: Single blind randomized controlled trial

Effect of Modified Constraint Induced Movement Therapy on Upper Extremity Functions of Stroke Patients with Right/Left Hemisphere Damage: Single Blind Randomized Controlled Trial Objective: To analyze the effect of modified constraint induced movement therapy on upper extremity functions and quality of life of subacute and chronic phase stroke patients with right/left hemispheric damage. Patients and Methods: A total of 40 patients (20 patients with right hemiplegia and 20 patients with left hemiplegia) were enrolled in our prospective, randomized controlled and single blinded trial. Patients were randomized in to three groups. The first group consists of 10 patients with right hemiplegia and the second group consists of 10 patients with left hemiplegia. First and second group of patients had 10 sessions of modified constraint induced movement therapy (mCIMT) as groups of 4 patients for 5 days a week. Each patient had modified constraint induced movement therapy 1 hour a day with professional support and performed home program by themselves 3 hours a day. Patients' less affected hands were limited by a glove for the %50 of the time they were awake. 10 patients with right hemiplegia and 10 patients with left hemiplegia formed the control group and these patients were in queue for inpatient rehabilitation programme. Patients were examined before treatment, just after treatment and 3 months after treatment using Box-Block Test, cubes lined, card turned and object gripped in 30 seconds, time it takes to grip and carry a water filled glass to their mouth and putting it back, Motor Activity Log (MAL), Stroke Impact Scale, Fugl-Meyer Motor Assessment Scale. Findings: There was statistically significant improvement in Fugl-Meyer Motor Assessment Scale results at 3 months after treatment compared to pre-treatment results in left hemiplegia group. (p=0,040) There was statistically significant improvement in Fugl-Meyer Motor Assessment Scale results in left hemiplegia group compared to stroke control group (p=0,002). There was statistically significant improvement in MAL-amount of use and quality of movement values at 2 weeks and 3 months after treatment compared to pre-treatment results in both left and right hemiplegia group (p<0.05). There was statistically significant improvement in MAL-amount of use and quality of movement values in both left and right hemiplegia mCIMT groups compared to stroke control group (p<0.05). There was statistically significant improvement in Box-Block Test results at 3 months after treatment compared to pre-treatment results in right and left hemiplegia groups (P=0,002, P=0,018). There was statistically significant improvement in Box-Block Test results in both left and right hemiplegia mCIMT groups compared to stroke control group (p=0,001, p=0,014). In both of the treatment groups there was statistically significant improvement in shaping and task specific exercise assessment parameters such as number of cubes lined, card turned and object gripped in 30 seconds, time it takes to grip and carry a water filled glass to their mouth and putting it back (p<0.05). There was no difference between level of improvement of right and left hemiplegia mCIMT groups. There was statistically significant improvement in Stroke Impact Scale - Physical function/strength results at 3 months after treatment compared to pre-treatment results only in left hemiplegia mCIMT group (p=0,037). There was statistically significant improvement in Stroke Impact Scale - Physical function/strength results in left hemiplegia groups compared to control group. (p=0,005) There were statistically significant improvements in Stroke Impact Scale – activities of daily living, hand function, stroke recovery in both treatment groups. (p<0.05) There were no statistically significant differences in Stroke Impact Scale – memory, emotion, communication, mobility, participation in both treatment groups. Results: In our study right and left hemiplegia mCIMT groups showed statistically significant improvement in Box-Block Test, MAL-amount of use and quality of movement, cubes lined, card turned and object gripped in 30 seconds, time it takes to grip and carry a water filled glass to their mouth and putting it back, Stroke Impact Scale – activities of daily living, hand function, stroke recovery parameters. There was improvement in Fugl-Meyer Motor Scale and Stroke Impact Scale - physical function/strength results of both groups but only left hemiplegia mCIMT group's improvement was statistically significant compared to control group. Level of improvement was similar in right and left hemiplegia mCIMT groups. Modified constraint induced movement therapy was found to be effective on motor functions and quality of life in right and left hemisphere damage and this positive impact was still present during the third month after therapy. Although this study underpins the effectiveness of the modified constraint induced movement therapy, further large-scale researches are needed in this field. Keywords: stroke, rehabilitation, upper extremity, motor recovery, constraint induced movement therapy