Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy

Abstract

Background and purpose: Constraint-induced movement therapy is a set of treatments for rehabilitating motor function after central nervous system damage. We assessed the roles of its 2 main components.

Methods: A 2 × 2 factorial components analysis with random assignment was conducted. The 2 factors were type of training and presence/absence of a set of techniques to facilitate transfer of therapeutic gains from the laboratory to the life situation (Transfer Package; TP). Participants (N=40) were outpatients ≥ 1-year after stroke with hemiparesis. The different treatments, which in each case targeted the more affected arm, lasted 3.5 hours/d for 10 weekdays. Spontaneous use of the more affected arm in daily life and maximum motor capacity of that arm in the laboratory were assessed with the Motor Activity Log and the Wolf Motor Function Test, respectively.

Results: Use of the TP, regardless of the type of training received, resulted in Motor Activity Log gains that were 2.4 times as large as the gains in its absence (P<0.01). These clinical results parallel previously reported effects of the TP on neuroplastic change. Both the TP and training by shaping enhanced gains on the Wolf Motor Function Test (P<0.05). The Motor Activity Log gains were retained without loss 1 year after treatment. An additional substudy (N=10) showed that a single component of the TP, weekly telephone contact with participants for 1 month after treatment, doubled Motor Activity Log scores at 6-month follow-up.

Conclusions: The TP is a method for enhancing both spontaneous use of a more affected arm after chronic stroke and its maximum motor capacity. Shaping enhances the latter.

Conflict of interest statement

Conflicts of Interest

None of the authors have financial relationships relevant to this article.

Figures

Figure 1

Trial profile. Shaping=training with shaping, Repetition=repetitive task practice, +TP=presence of Transfer Package, -TP=absence of Transfer Package.

Figure 2

Treatment outcome for real-world spontaneous use of more-affected arm (MAL) and the maximum motor capacity of that extremity (WMFT Performance Rate). MAL outcomes at post- treatment and 1-year follow-up are graphed in Panel A and Panel B, respectively. WMFT post-treatment outcomes are graphed in Panel C. For all 3 panels, change from pre-treatment is plotted. MAL=Motor Activity Log, WMFT=Wolf Motor Function Test.

Figure 3

Real-world CI therapy outcome for groups from study 1 with the TP (Shaping+TP, Repetition+TP), no TP (Shaping-TP, Repetition-TP), and no TP during treatment but with phone contact in follow-up only (Study 2 participants). Study 2 participants, who did not receive the TP during treatment, had virtually the same pre- to post-treatment MAL gains as the -TP groups in Study 1, which were less than half of the MAL gains made by +TP groups in Study 1.. After treatment, Study 2 participants had four weekly phone calls for the first month post-treatment in which the MAL and problem solving were carried out. Six months after treatment approximately half the difference in spontaneous use of the more-affected arm between the - TP and +TP groups had been bridged. Change from pre-treatment is plotted.