Constraint induced movement therapy in MS may be equally effective as in stroke

November 19, 2013 Kim Kobata, PT, NCS

Constraint induced movement therapy (CIMT), formerly called “forced use” is a treatment for impaired function of an upper extremity. It has been established as an effective evidence-based form of treatment for rehab of impaired upper extremity (UE) function for post stroke hemiparesis. The core features of CIMT are massed practice (high repetitions) and to overcome learned non-use thru behavior modification. The typical training protocol involves a 2 week period of physical restraint of the less-involved side (90% of the waking hours) and intensive training (3 hours/day) focused on movement patterns of the involved hand and arm. The physical restraint is usually a padded mitt, sling or glove thereby restricting stronger arm use.

At a recent ECTRIMS/RIMS meeting, this form of therapy was presented as being equally effective in treatment of UE impairment from a CVA or MS. At a Denmark inpatient rehab center, 39 patients with moderate upper limb paresis due to a stroke or MS underwent group therapy 5 days a week for one hour each in a multidisciplinary team setting, with physical therapists, occupational therapists and art therapists for 4-5 weeks. The treatments consisted of training sessions encouraging use of the affected hand and were adapted for MS specific problems such as fatigue and/or bilateral involvement by allowing for work with both hands and for rest breaks or shorter treatments if fatigue limited participation.

Standard measures of arm function using the ARAT (Action Research Arm Test) and activities of daily living using the BI (Barthel index) were performed before and after treatment. There were no significant differences in RRMS, chronic progressive MS or CVA. ARAT measurements of grasp, grip, pinch and gross movement for both groups improved and there was small but not significant change in the BI. This was an observational study; further studies will need to be conducted to determine its efficacy and specific training protocols. However, this is an important study because CIMT has been shown to be effective for the stroke population for improving functional use of an impaired UE in activities of daily living in other research studies.  This study suggests that this type of behavioral modification (CIMT) may be equally effective in patients with affected upper extremity function from MS or a stroke and encourages the use of CIMT.

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