CIMT
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The Effectiveness of Constraint-Induced Therapy as a Stroke Intervention: A Meta-Analysis
Bjorklund & Fecht (2006)
Purpose
Provides an objective review on outcomes of constraint-induced movement therapy (CIMT) trials to create a comprehensive and concise summary of degree of improvement of upper extremity (UE) motor function in individuals with hemiparesis post-stroke.
Method
Identification of Studies
This meta-analysis includes 11 studies from the following databases: CINAHL, Cochrane Controlled Trials Register, PubMed, & Science Direct
Participants
- 179 subjects, 66 females and 113 males
- Age: 33-83 years old
- Stroke onset: 2 days to 17 years post-stroke
- 115 subjects were right-side hemi-paretic
- 48 subjects were left-side hemi=paretic
- out of 11 of the studies 2 were acute, 2 sub-acute, 2 sub-acute/chronic, and 5 were chronic studies
Exclusion Criteria
1) Sample size was less than 4 participants
2) No calculation of effect size
3) Assessment of function use were not used
4) diagnosis was not stroke
Inclusion Criteria
1) All participants were 18 years and older
2) Diagnosed with stroke and experiencing hemi-paraplegia
3) CIMT consisted of restraint of unaffected limb while intensive therapy was performed using affected limb
4) Control group
5) Use of outcome measure assessments
6) Calculation of effect size
Image 27. Office Worker
Image 28. Group of People
Image 29. Paper and Pencil
Outcome measures
1) Fugl-Meyer Assessment of Motor Recovery (FMA)
2) Action Research Arm Test (ARA)
3) Wolf Motor Function Test (WMFT)
4) Actual Amount of Use Test (AAUT)
5) Motor Assessment Log (MAL)
6) Functional Independence Measure (FIM)
7) Arm Motor Ability Test (AMAT)
Results
- CIMT group scored significantly higher in almost all outcome measures than control.
- CIMT group had higher frequencies on the amount of use of extremity in real life situations.
- TMS mapping demonstrated enhanced neuronal activity in damaged hemispheres
- Length of time to perform functional activity was shorter in CIMT group then control.
Discussion
Limitations
- Publication bias: selecting articles that have been published that yield significant results and overlooking those with insignificant ones.
- Lack of complete representation: not all databases includes studies from underdeveloped countries
- Inclusion of smaller studies: that may not have been subject to rigorous data analysis
- Lack of consideration of natural recovery.
- Some outcomes used in the studies may not yield high reliability and validity
Impact on Practice
As demonstrated from these trials, there is promise in the future of CIMT to suggest that CIMT continues to be an effective treatment for post-stroke individuals experiencing upper extremity hemiparesis. Some rehabilitation centres have gone the extra mile by incorporating occupation-based treatments to promote a meaningful and client-centred approach in the treatment.
Implications for Future Research
- comparison of different approaches of CIMT needs to be evaluated to ensure that the results obtained do not reflect the differences of approaches.
- examine the value that participants associate with the therapy.
- the specific mechanism by which CIMT induces improvements seen in participants needs to be further investigated
Image 30. Brain Clogs