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November 6 , 2006
New movement therapy found effective in stroke patients' rehabilitation

BY lance Skelly

New findings from a national study led by Emory researchers has found that stroke patients benefit from therapy that encourages use of impaired arms and hands.

Stroke patients who receive constraint-induced movement therapy — a rehabilitative technique that restrains the less-impaired arm or hand — showed significant improvement in arm and hand function, according to the seven-center national study. The findings appear in the current issue of the Journal of the American Medical Association.

Known as the EXCITE trial, for Extremity Constraint-Induced Therapy Evaluation, the study enrolled 222 patients who had suffered from predominantly ischemic stroke within the previous three to nine months.

The study involved restraining the less-impaired hand or arm with an immobilizing mitt during working hours in an effort to encourage use of the affected extremity. Patients then engaged in daily repetitive tasks, which included training in efforts such as opening a lock, turning a doorknob or pouring a drink.

Investigators found that over the course of a year from the beginning of therapy, the CIMT group showed greater improvements than the control group in regaining function.

“The basic principal behind constraint-induced therapy is re-teaching a patient to regain use of his or her impaired limb by limiting their use of the good one,” said Steven Wolf, professor of rehabilitation medicine at Emory School of Medicine and the study’s principal investigator. “Often, stroke rehabilitation has primarily focused on teaching patients how to better rely on their stronger limbs, even if they retain some use in the impaired limbs — creating a learned disuse.”

Wolf said that until now, research into constraint-induced therapy for stroke rehabilitation has centered primarily on chronic stroke patients, defined as those who experienced stroke more than a year previously. The EXCITE trial represents the first national, randomized, single-blinded study to test the effects of therapy on patients with the ability to initiate movement at the wrist and fingers, and who had experienced a first stroke within three to nine months prior to enrollment.

“Administration of CIMT showed statistically significant improvements in motor ability and use compared with participants receiving customary care only,” Wolf said. “These findings suggest that further research exploring central nervous system changes that accompany observed motor gains and research on alternate models of CIMT delivery are warranted. CIMT should be considered as a valuable form of rehabilitation.”

Each year more than 700,000 Americans suffer from stroke, and approximately 85 percent of stroke survivors experience partial paralysis on one side of the body. The annual health care costs for stroke care are approximately $35 billion.

The study was supported by a National Institutes of Health grant from the National Center for Medical Rehabilitation Research and the National Institute of Neurological Diseases and Stroke.

“This is an example of two NIH institutes working together to address an important clinical problem,” said NIH Director Elias Zerhouni. “This study is likely to have a significant impact on clinical care for stroke survivors.”
In addition to Emory, other centers involved in the study include the University of Alabama at Birmingham, Washington University in St. Louis, the University of Florida, Ohio State University, University of Southern California, University of North Carolina at Chapel Hill and Wake Forest University.

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