Contribution of the shaping and restraint components of Constraint-Induced Movement therapy to Treatment Outcome

Issue title: Constraint-Induced Movement therapy

Guest editors: Edward Taubx and Gitendra Uswattey

Article type: Research Article

Authors: Uswatte, Gitendra^{a; b; *} | Taub, Edward^a | Morris, David^b | Barman, Joydip^a | Crago, Jean^c

Affiliations: [a] Department of Psychology, School of Social & Behavioral Sciences, University of Alabama at Birmingham, AL, USA | [b] Department of Physical Therapy, School of Health Related Professions, University of Alabama at Birmingham, AL, USA | [c] Outpatient Rehabilitation Department, Spain Rehabilitation Center, University of Alabama at Birmingham, AL, USA | [x] Department of Psychology, School of Social & Behavioral Sciences, University of Alabama at Birmingham, AL, USA | [y] Department of Physical Therapy, School of Health Related Professions, University of Alabama at Birmingham, AL, USA

Correspondence: [*] Address for correspondence: Gitendra Uswatte, Ph.D., Assistant Professor of Psychology, University of Alabama at Birmingham, 1530 3rd Ave S., CH415, Birmingham, AL 35294, USA. Tel.: +1 205 975 5089; Fax: +1 205 975 6140; E-mail: guswatte@uab.edu

Abstract: Two important components of Constraint-Induced Movement therapy are thought to be intense training of the more-impaired arm and physical restraint of the less-impaired arm. This preliminary study examined the effects of type of training (task-practice, shaping) and restraint (sling, half-glove, no restraint) on treatment outcomes. Seventeen individuals at least 1-year post-stroke with mild/moderate upper extremity motor deficit were consecutively assigned to Sling and Task-practice, Sling and Shaping, Half-glove and Shaping, and Shaping Only groups. Task-practice involved repetitive more-impaired arm training on functional tasks for 6 hr/day for 10 consecutive weekdays. Shaping differed from task-practice in that task demands were progressively increased and immediate performance feedback was provided frequently and systematically. “Sling” groups placed the less-impaired arm in a resting hand-splint/sling assembly for most waking hours over the 2-week intervention, while the “Half-glove” group wore a modified gardening glove as a reminder not to use the more affected arm in the life situation. There were no between-group differences in outcome at post-treatment, although two-years afterwards Sling & Task-practice and Half-glove & Shaping participants showed larger and smaller retention of gains, respectively, than those in the Sling & Shaping group. Thus, long-term outcomes may have been affected by type of more-impaired arm motor training and less-impaired arm restraint. These variables, however, were confounded with between-group differences in training intensity, limiting confidence in this conclusion.

Keywords: Stroke, arm, rehabilitation, clinical trials, treatment outcome

DOI: 10.3233/NRE-2006-21206

Journal: NeuroRehabilitation, vol. 21, no. 2, pp. 147-156, 2006