The Excite Trial: Relationship of intensity of constraint induced movement therapy to improvement in the wolf motor function test

Article type: Research Article

Authors: Wolf, Steven L. | Newton, Heather | Maddy, Douglas | Blanton, Sarah | Zhang, Qin | Winstein, Carolee J. | Morris, David M. | Light, Kathye

Affiliations: Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA | Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA | Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA | Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA | College of Public Health and Health Professions, Department of Physical Therapy, University of Florida, Gainesville, FL, USA

Note: [] Corresponding author: Prof. Steven L. Wolf, Ph.D., PT, FAPTA, Professor, Department of Rehabilitation Medicine, Professor of Geriatrics, Department of Medicine, Associate Professor, Department of Cell Biology, Emory University School of Medicine, Professor, Adult and Elder Health Nell Hodgson Woodruff School of Nursing at Emory University, 1441 Clifton Road NE, Atlanta, GA 30322, USA. Tel.: +1 404 712 4801; Fax: +1 404 712 5895; E-mail: swolf@emory.edu

Abstract: Purpose: To examine the relationship between change scores on the log mean Wolf Motor Function Test (lmWMFT) and the intensity of supervised Constraint Induced Movement Therapy (CIMT) in participants with subacute and chronic stroke. Methods: A retrospective analysis of data from 169 EXCITE participants who received CIMT either immediately after randomization or one year later was undertaken. During waking hours, participants wore a restraining mitt on the less affected extremity. The lmWMFT was administered before and after the two week treatment block. Results: Significant relationships were seen between the intensity of training and functional score in the immediate, lower functional group for whom more training in adaptive task practice resulted in poorer outcomes (p=0.01) and in the immediate, higher functioning group for whom more training in repetitive task practice resulted in poorer outcomes (p=0.02). Female participants in the immediate group showed less progress in lmWMFT scores with greater amounts of total training (p=0.01). Functional level, gender, and concordance did not modify any other relationship. Both higher functioning participants who trained within the normal ratio (N=50) and who were exposed to more than the prescribed adaptive task practice (N=11) experienced a significant improvement in the lmWMFT score (p=0.03 and p=0.02, respectively) compared to those higher functioning participants who experienced excessive repetitive task practice. Conclusion: Applying CIMT to a large sample of participants with stroke resulted in directionally inappropriate but significant relationships between intensity and lmWMFT scores in the immediate but not the delayed group. Our data also suggest that functional improvements observed in the EXCITE Trial might be attributable to training components other than the designated ratio of training approaches (adaptive and repetitive task practice).

Keywords: Stroke, constraint-induced therapy, intensity, rehabilitation, wolf motor function test, adaptive/shaping task practice

Journal: Restorative Neurology and Neuroscience, vol. 25, no. 5-6, pp. 549-562, 2007