Effective targets for constraint-induced movement therapy for patients with upper-extremity impairment after stroke

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 It 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 Cl 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.