Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol

Background/Aim: Currently, there are limited evidence-based protocols for improving upper extremity (UE) motor function after stroke. The Keys protocol, a distributed form of constraint-induced movement therapy (CIMT), delivers CIMT components in fewer hours per day over an extended period, fitting outpatient rehabilitation schedules and third-party payor models. This pilot study aimed to assess the effectiveness of the Keys protocol in enhancing UE capacity and performance poststroke. Methods: Ten adults with chronic stroke (>6 months) participated in an 8-week intervention. The protocol included 22 supervised training sessions (1.5 h each): 4 days/week for 4 weeks, 2 days/week for weeks 5-6, and 1 day/week for weeks 7-8. Participants wore a restraint mitt on the less-affected UE during waking hours and used an adapted transfer package. Outcome measures included the Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), Stroke Impact Scale (SIS), and Zung Depression Scale, assessed pre-treatment, mid-treatment (4 weeks), and posttreatment. Results: Significant improvements were observed in SIS Strength, ADLs/IADLs, Mobility, and Hand Function domains, exceeding MCID thresholds. Memory and Communication domains improved significantly at the 3-month follow-up. WMFT performance times improved, with fewer incomplete tasks. MAL scores for Amount of Use and Quality of Movement increased across all time points. Depressive symptoms significantly decreased posttreatment. Conclusions: The Keys protocol effectively improves UE use, motor function, mood, and quality of life, with the greatest gains observed mid-intervention. These findings support its feasibility and potential for outpatient stroke rehabilitation