Affiliations: Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
Correspondence:
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Address for correspondence: Tetsuo Koyama, MD, PhD, Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, 12-1 Imazu-Yamanaka-cho, Nishinomiya, Hyogo, Japan 663-8211. Tel.: +81 798 33 2211; Fax: +81 798 33 2438; E-mail: ytkoyama@bd6.so-net.ne.jp
Abstract: Objective:Examination of effectiveness of different sites of constraint-induced movement therapy (CI therapy) for upper-extremity impairment of patients after stroke. Subjects:Patients exhibiting moderate to slight upper-extremity impairment after stroke. Methods:The patients received a modified version of CI therapy for a cumulative total of 5 h daily for 10 days. Using Fugl-Meyer scores, shoulder/elbow/forearm, wrist and hand functions were separately assessed before and after treatment. To assess the site-specific effects of CI therapy, before and after scores were statistically compared at each site using Wilcoxon signed-rank tests. Relative effects were evaluated by paired comparison of the results at each site with, in turn, the results at every other site. Instances of single-score increments were, using standard chi-square tests, statistically isolated and compared. Results:Nineteen patients, 12–169 (median 31) months after stroke, were enrolled in this study and completed the protocol. Age range was 40–81 (median 65) years old and pretreatment Fugl-Meyer total scores spanned 31–64 (median 48). Analyses detected statistically significant improvements for wrist, hand and coordination but not for shoulder/elbow/forearm subcomponents. For the hand, at least single-point increments were observed in 74% of the population, while only 47% showed similar increments for the shoulder/elbow/forearm, and 53% for the wrist. Statistical analysis revealed that a higher proportion had increments in hand scores. Conclusions:Statistical analysis shows that CI therapy is most beneficial for treating hand function, suggesting an efficient application of this treatment.
