July 10, 2000
Volume 52, No. 37
Study examines stroke therapy
By Lillian Kim
Anyone who's ever broken an arm or sprained a wrist knows it's possible, if not preferable, to eat, brush one's teeth-even write, in a pinch- with the other hand. You have to, so you do.
This is the basic principle behind constraint-induced therapy, also known as "forced-use therapy," in which stroke patients are taught to regain use of their impaired arms by limiting their use of the good limbs.
As a concept, it belongs to the "I coulda thought of that" category. Often, however, stroke rehabilitation has focused on teaching patients how to rely on their stronger limbs, even if they retain some use of the impaired limbs. Thus, a "learned disuse" develops.
"Patients don't learn strategies for regaining use of their involved limbs," said Steven Wolf, director of Research Programs in Emory University's Department of Rehabilitation Medicine, in which he also is a professor.
Wolf is the principal investigator of a five-year, multisite study that will look at the effectiveness of constraint-induced therapy in people who have had a stroke three to six months previously. Edward Taub, professor of psychology at the University of Alabama at Birmingham, is co-principal investigator. Taub is responsible for the original animal model and clinical conceptualization upon which this trial is based.
The therapy regimen is relatively brief, but intensive. For two weeks, subjects will be required to wear a splint, bound with tape, on their "good" arms during waking hours. Forced to use their "bad" arms, the participants will practice various functional activities under the guidance of a rehabilitation expert.
The study is believed to be the first multicenter clinical trial of a physical rehabilitation intervention to improve motor function after stroke. The trial is funded by a $7.5 million grant from the National Center for Medical Rehabilitation and Research, part of the National Institute of Child Health and Human Development of the National Institutes of Health in Bethesda, Md.
Until now, research into constraint-induced therapy for stroke rehabilitation has centered on chronic stroke patients, defined as those who experienced stroke more than a year previously, since any observed benefits could be attributed with greater confidence to the therapy instead of the patients' natural recovery process. A number of studies have demonstrated the therapy's effectiveness in this group.
"The next step was to apply this therapy closer to the time that patients sustain their strokes, while their systems are still plastic," said Wolf, also a professor of geriatrics and an associate professor of cell biology.
To that end, the study will recruit sub-acute stroke patients who have experienced stroke three to six months previously. Most of these patients, who represent at least 20-25 percent of the stroke population, can walk, either with or without a cane or other assist device. many may have the capability of moving their impaired arms, but aren't using them.
A total of 240 patients will be recruited at seven research sites.