JOURNAL READING PRESENTATION

”Constraint-induced movement therapy and upper extremity function after stroke”

Pembimbing :
dr. Untung Gunarto, Sp.S

Disusun oleh :
Wininda Rina
G4A016010

NEUROLOGY DEPARTEMENT OF RSUD PROF. DR. MARGONO SOEKARDJO

MEDICINE FACULTY
JENDERAL SOEDIRMAN UNIVERSITY
PURWOKERTO
2017
BACKGROUND

Up to 55%-75% patient with stroke continue to experience hemiparesis of an upper

extremity immediately after stroke attack

Constraint-induced movement therapy (CIMT) is an approach encourages use of

the paretic upper extremity with ipsilesional limb restraint and training of
paretic arm . This approach is believed more effective than neurodevelopmental
tecniques

This study is The Extremity Constraint Induced Therapy Evaluation (EXCITE)

Trial to test a neurorehabilitation therapy among patient with stroke within 3 to 9
months prior to enrollment
METHOD

Study Outcome
Recruitment
Participants Measures
A first-time clinical Individuals were
the Wolf Motor Function
ischemic or recruited from 247 Test (WMFT) and (MAL)
hemorrhagic people

Higher or lower Participants were randomly

assigned to the The SIS (Stroke Impact
functioning motor experimental (CIMT) or Scale)
criteria control condition

Balance, ability to stand Measure at baseline,

from a sitting position and
Distribution of 4 posttreatment, and 4, 8,
standing at least 2 minutes. characteristics and 12-month
 STUDY DESIGN

• Participants in the intervention group were

taught to apply an instrumented protective
safety mitt and encouraged to wear it over
90% of their waking hours ( 2-week period).

• Participants were encouraged to practice 2-3

tasks daily at home about 30 minutes per task
after completing each therapy

Picture from :http://www.cimt.gr/wp-content/uploads/2014/04/taub2.jpg

Picture from :
• http://www.maryfreebed.com/rehabilitation/cimt/
• Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke. Stroke. 2001;32:1635-163
Data Analysis
• A repeated-measures analysis of variance model
• Least-square means
• Logarithmic transformation
• Poisson link function
• All statistical analyses were performed using SAS version 9.1
RESULT

• 240 participants, CIMT n=106 or control n=116

• Significant of comparision between CIMT and control group in improvement
streght item at 12 month follow up, WMFT perfomance time, MAL scale,
SIS hand fucntion domain, and improve from baseline after 12 month
(p<0.05)
• There no signifficant differences in gains between CIMT and control
participants on the WMFT Functional Ability scale at 12-month follow-up
• there no significant different in Higher and lower functioning participants
(p>0.05)
COMMENT
The EXCITE Trial is the first randomized multicenter trial and the largest trial

The limited improvement in control group suggests

that traditional neurorehabilitation interventions
have limited effectiveness in promoting motor
recovery within the dosing parameters typically used Our finding is
consistent with other
CIMT studies
Data from a transcranial magnetic stimulation study
indicate that following CIMT there is a substantial
increase in the amount of cerebral cortex
representation of paretic muscles
Limitation

1. Number of of lower-functioning individuals enrolled are smaller than higher

2. Only 48.9% of control group participants received other treatments throughout
the year
3. The investigation of essential aspects of CIMT, including the the intensive CIMT
schedule of delivery can be altered and is ultimately cost-effective, requires
further exploration.
4. Incomplete detailed information about the anatomical location of each stroke
Conclusion

• Administration of CIMT resulted in statistically significant and clinically

relevant improvements in paretic arm motor ability and use for patient who
had experienced a first stroke between 3 and 9 months prior.
• Improvements were present persisted for up to 1 year.
• These findings suggest that further research exploring central nervous
system changes and research on alternate models of CIMT.