Constraint-induced movement therapy CI

Transcription

1 Jpn J Rehabil Med 2012 ; : Constraint-induced movement therapyci STEF Predictive Factors for Good Functional Recovery and the Effect of Constraint-induced Movement Therapy on Motor Function : An Assessment of Upper Extremity Function using STEF in a Large Sample Masashi HOSOMI, 1 Kenji SHIMADA, 2 Kenji MATSUMOTO, 3 Takashi TAKEBAYASHI, 1 Kohei MARUMOTO, 1 Kazuhisa DOMEN 1 Abstract Background : Constraint-induced movement therapy CI therapyis a rehabilitation treatment that effectively improves upper extremity function in patients with chronic hemiparesis after stroke. In Japan, no previous studies have shown the effects of CI therapy in a large size sample, and the Simple Test for Evaluating Hand Function STEF, a standard assessment tool for upper extremity function, is rarely used to evaluate the effects of CI therapy. Little is known regarding the factors capable of predicting the outcome of CI therapy. The present study aimed to examine potential predictors of outcomes after CI therapy and the effects of CI therapy using STEF. Methods : This study included patients with hemiparesis in the chronic stage of stroke 180 days from onset. We compared upper extremity function before and after CI therapy intervention, which involved 5 hours per day for 10 consecutive weekdays of training. We assessed upper extremity function using the STEF, Wolf Motor Function Test-functional ability scale WM- FT-FASbefore and after intervention, and investigated potential predictors age, gender, time since stroke, type of stroke, side of stroke, hand dominance, spasticity. Results : There were 107 subjects. Our comparison revealed that both STEF and WMFT-FAS scores improved significantly following intervention, from means of 31.3 to 42.7 points and 51.8 to 57.0 points, respectively. No significant predictors that influenced the functional outcome were identified. Conclusion : CI therapy is effective for improving upper extremity function. It is important not to exclude people from CI therapy based on any supposed predictors. Jpn J Rehabil Med. STEF CI CI STEF Wolf Motor Function Test - Functional Ability Scale WMFT-FAS mas CI CI Department Key words of Rehabilitation : rehabilitation Medicine, Hyogo College of Medicine at chronic stagestroke 2 upper limb functionpredictionspasticity 5 Sasayama Medical Center, Hyogo College of Medicine Kansai Rehabilitation Hospital mhosomi@hyo-med.ac.jp Jpn J Rehabil MedVOL. 49 NO

2 CI CI STEF Wolf Motor Function Test - Functional Ability Scale WMFT-FAS mas CI CI Key words : rehabilitation at chronic stagestroke upper limb functionpredictionspasticity Constraint-induced movement therapyci 1 Ostendorf Randomized Controlled TrialRCT CI CI Wolf Motor Function Test WMFT 6 Motor Activity LogMAL 7 CI 8 10 CI CI STEF 15,16 STEF Wolf Motor Function Test-Functional Activity ScaleWMFT-FAS CI CI Taub IP MP CI CI CI 180 CI 24 Jpn J Rehabil MedVOL. 49 NO

3 CI CI 18 Activities of Daily LivingADL task oriented CI 10 STEF 15,16 WMFT-FAS 6 mas 16 STEF 15, Wolf Motor Function Test Functional Ability ScaleFAS modified Ashworth ScalemAS 16 Grade 0 Grade 4 CI STEFWMFT-FASmAS STEF WMFT-FAS DSTEF DWMFT-FASDSTEF DWMFT-FAS 2 CI 8 10 mas CI 2 c 2 p0.05 IBM SPSS Statistics 19 mas Jpn J Rehabil MedVOL. 49 NO

4 STEF WMFT-FAS p0.01 mas p0.242 CI N DSTEF DWMFT 11 4 DSTEF DWMFT-FAS r r0.24p0.05 c 2 p STEFWMFT- FAS CI STEF WMFT-FAS Sirtori 19 CI WMFT Fugl- Meyer AssessmentFMAAction Research Arm TestARAT p p n.s preci postci pp-valuen.s.not significant 26 Jpn J Rehabil MedVOL. 49 NO

5 CI CI STEF WMFT-FAS STEF DSTEF10N DSTEF10N WMFT-FAS DWMFT4N DWMFT4N DSTEF10 N54 STEF DSTEF10 N53 p DWMFT4 N58 WMFT-FAS DWMFT4 N n.s n.s n.s n.s n.s n.s n.s n.s n.s n.s n.s n.s. mas n.s n.s. STEF n.s. WMFT-FAS n.s n.s. DSTEFCI STEF DWMFTCI WMFT-FAS pp-value p WMFT ARAT 6,20 STEF STEF 1 STEF CI CI CI rstef WMFT-FAS r0.80langhorne CI RCT 21 CI CI CI ,22 CI CI Sterr CI 25 CI Jpn J Rehabil MedVOL. 49 NO

6 STEF WMFT 6 WM- FT-FAS ADL STEF STEF CI STEF 3 STEF WMFT-FAS 6 26 QOL 27 CI 28,29 CI mas CI 28,29 Kagawa F FM CI 30 CI 31 CI CI CI MAL CI 8 10 MAL CI 8,9 8,9 6 MAL 9 CI CI 32 CI 33 CI CI CI CI CI 3,34,35 MAL CI MAL 28 Jpn J Rehabil MedVOL. 49 NO

7 CI MAL-amount of use CI Taub 17 36,37 CI 1Ostendorf CG, Wolf SL : Effect of forced use of the upper extremity of a hemiplegic patient on changes in function. Phys Ther 1981 ; : Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Devillé WL, Bouter LM : Forced use of the upper extremity in chronic stroke patients results from a single-blind randomized clinical trial. Stroke 1999 ; : Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D : Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke. JAMA 2006 ; : Lin KC, Wu CY, Liu JS : A randomized controlled trial of constraint-induced movement therapy after stroke. Acta Neurochir Suppl 2008 ; : ,,,, : 2009.,, 2009 ; pp ,,,,, : Wolf Motor Function Test ; : ,,,,, : Motor Activity Log ; : Fritz SL, Light KE, Clifford SN, Patterson TS, Behrman AL, Davis SB : Descriptive characteristics as potential predictors of outcomes following constraint-induced movement therapy for people after stroke. Phys Ther 2006 ; : Rijntjes M, Hobbeling V, Hamzei F, Dohse S, Ketels G, Liepert J, Weiller C : Individual factors in constraintinduced movement therapy after stroke. Neurorehabil Neural Repair 2005 ; : Park SW, Wolf SL, Blanton S, Winstein C, Nichols-Larsen DS : The EXCITE trial : predicting a clinically meaningful motor activity log outcome. Neurorehabil Neural Repair 2008 ; : Fritz SL, Light KE, Patterson TS, Behrman AL, Davis SB : Active finger extension predicts outcomes after constraint-induced movement therapy for individuals with hemiparesis after stroke. Stroke 2005 ; : ,,,,,,,,, : CI, Jpn J Rehabil Med 2009 ; Suppl: S ,,,,, : Constraint-induced movement therapy CI : CIWMFTSTEF ; : ,,,,, : CI ; : : STEF ; : ,, : :.,, Taub E, Uswatte G, King DK, Morris D, Crago JE, Chatterjee A : A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke 2006 ; : Hosomi M, Koyama T, Takebayashi T, Terayama S, Kodama N, Matsumoto K, Domen K : A modified method for constraint-induced movement therapy : a supervised self-training protocol. J Stroke Cerebrovasc Dis 2011 May 17 Epub ahead of print 19 Sirtori V, Corbetta D, Moja L, Gatti R : Constraintinduced movement therapy for upper extremities in stroke patients. Cochrane Database Syst Rev 2009 ; : CD ,,, : Action Research Arm Test ARAT,, ; : Langhorne P, Coupar F, Pollock A : Motor recovery after stroke : a systematic review. Lancet Neurol 2009 ; : Hakkennes S, Keating JL : Constraint-induced movement therapy following stroke : a systematic review of randomized controlled trials. Aust J Physiothe 2005 ; : Page SJ, Levine P, Sisto S, Bond Q, Johnston MV : Stroke patientsand therapistsopinions of constraint-induced movement therapy. Clin Rehabil 2002 ; : Sterr A, Elbert T, Berthold I, Kölbel S, Rockstroh B, Taub E : Long versus shorter daily constraint-induced movement therapy of chronic hemiparesis : an exploratory study. Arch Phys Med Rehabil 2002 ; : Brogårdh C, Lexell J : A 1-year follow-up after shortened constraint-induced movement therapy with and without Jpn J Rehabil MedVOL. 49 NO

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