Dr. Sobha Saseendrababu*
Introduction: Stroke is the most common cause of disability in the adult and elderly population and one of the major causes of hospitalization. Impairment of upper limb function is among the most common motor disabilities and it has a great impact on functional and social independence of patients and thus these disabilities represent a major public health problem. Constraint Induced Movement Therapy is an intervention that has been used mainly for the treatment of the upper extremities for stroke patients. When a person’s brain is damaged by a stroke, it often becomes more difficult to move an arm. Therefore, the person tends to use the arm less. This leads to shrinkage of the regions of the brain that control arm movement. Movement of the arm gets even more difficult. Constraint Induced Movement Therapy produces a large rewiring of the brain; that is after treatment, more of the brain works to move the weaker arm than before the therapy. The study was intended to identify the effect of Modified Constraint Induced Movement Therapy on motor performance and daily functions in patients one to nine months after stroke.
Major objectives of the study were,
1. To evaluate changes in motor performance of the upper extremity after Modified constraint Induced Movement therapy.
2. To evaluate changes in fine motor movements of the hand after Modified constraint Induced Movement therapy.
3. To identify changes in daily living functions in patients treated with Modified constraint Induced Movement therapy.
Materials and methods
The sample for the study were adult male and female persons one to nine months after stroke with hemiparesis or hemiplegia with age range from 40-80 years who attended the Neurology Department, Medical College, Thiruvananthapuram. After considering the inclusion and exclusion criteria the patients are grouped to two groups by using simple randomization technique. Total 210 patients were selected for the study with 105 in each experimental and control group. Both the groups were assessed by Fugl Meyer Assessment, Action Research Arm Test and the Barthel Index. The experimental group received standard therapy offered in the hospital along with the Modified Constraint Induced Movement Therapy. The control group received the standard therapy offered in the hospital. Follow up assessments were done in the 6th and 10th week by using the same assessment tools. Pre and post assessments were done by the neurologist.
In this study Modified Constraint Induced Movement Therapy means
1. Structured therapy emphasizing affected arm use in the functional task practice for 30 minutes /days for 3 days per weeks for 10 weeks
2. Less affected or unaffected arm restraint 5 days per weeks for 5 hours Structured therapy includes functional practice sessions approached in small steps of progressively increasing difficulty and multiple repetitions of functional task. It is divided into 5 sessions each with 2 weeks duration.
The patient is instructed to wear a constraint sling for 5 hours per day, 5 days a week for 10 weeks. The purpose of the sling was to act as a reminder to refrain from using his less affected or non-affected hand for functional activities. However, the sling allows them to use that arm for gross movement and support for a loss of balance if needed.
The findings of the study showed that the group treated with Modified constraint Induced Movement Therapy had highly significant improvement in the motor performance of the upper extremity as measured by the Fugl Meyer Assessment (p=0.000), fine motor movements of the hand, especially grasp, grip, pinch and gross movement function indicated by the Action Research arm Test score (p=0.000) and improved ability in meeting the activities of daily living as measured by the Barthel Index score (p=0.000).
Conclusion: This study proved that Modified constraint Induced Movement Therapy is more effective in improving the motor performance of the upper extremity, fine motor movements of the hand and thereby increasing the ability to meet activities of daily living in stroke patients.
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