Stroke Rehab Technique Improves Arm, Hand Function

The therapy involves limiting the use of the 'good' arm

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By Amanda Gardner
HealthDay Reporter

TUESDAY, Oct. 31, 2006 (HealthDay News) -- An intensified type of "forced-use" therapy for stroke patients, which involves restraining the "good" arm or hand, helps improve function in the "bad" arm or hand.

But the findings only apply to patients who had a stroke within the previous three to nine months, says a study in the Nov. 1 issue of the Journal of the American Medical Association.

"This application, in our opinion, is not intended for all patients," said Steven Wolf, study lead author and professor of rehabilitation medicine at Emory University School of Medicine in Atlanta.

"This is a therapy which still seems to be for a select segment of the population," added Dr. Ira Rashbaum, chief of stroke rehabilitation at New York University Medical Center in New York City. "This is not a type of therapy that is able to be applied across-the-board. This is for people who have a reasonable amount of preserved strength in the arm and hand."

For this select segment, however, the technique may be used immediately.

"What this demonstrates is that for up to 30 percent of the stroke population at least three-to-nine months post stroke, this intervention should be used to help them gain independent use of impaired upper extremity," Wolf said.

More than 730,000 Americans have a new or recurrent stroke each year. Some 566,000 of these people survive, and 85 percent of those have impairment of an upper extremity immediately after the stroke. Between 55 percent and 75 percent of survivors continue to experience upper extremity limitations three to six months later.

The new study, involving 222 stroke survivors, looked at forced use or constraint-induced movement therapy (CIMT). CIMT is different from forced-use therapy in that it uses one-on-one training and reinforcement.

Roughly half the study participants were randomly assigned to CIMT, in which they were required to wear a restraining mitt on the less-affected hand while engaging in repetitive tasks with the other hand for two weeks. The rest of the participants were assigned to usual care. All participants had suffered their stroke three to nine months prior to the study.

At the end of one year, the members of the CIMT group showed greater improvements than the control group in two different measures of function. For one measure, the CIMT group showed a 34 percent reduction in the time it took to complete a task with the impaired arm or hand. For the other measure, the CIMT group saw a 65 percent increase in the proportion of tasks they could perform with the partially paralyzed arm. People in the CIMT group also reported that they had less trouble with hand function. The differences persisted for a year.

Wolf's group is now interested in studying when this therapy should be used -- sooner or later after the stroke? "The possibility of starting this earlier is very inviting because it doesn't look as if any adverse events will occur, and the plasticity of the brain might be greater sooner rather than later," he said. "The next study we want to do raises the bar to one-to-three months post-stroke."

It's also unclear what aspect of the therapy is providing the benefit, although it would appear that it's the intensity. That portion of the analysis is being completed, Wolf said.

More information

For more information on stroke, visit the American Stroke Association.

SOURCES: Steven L. Wolf, Ph.D., P.T., professor of rehabilitation medicine and medicine, and associate professor of cell biology, Emory University School of Medicine, Atlanta; Ira G. Rashbaum, M.D., chief of stroke rehabilitation, New York University Medical Center, and clinical associate professor of rehabilitation medicine, New York University School of Medicine, New York City; Nov. 1, 2006, Journal of the American Medical Association

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