Ann Rehabil Med.  2016 Dec;40(6):998-1009. 10.5535/arm.2016.40.6.998.

Can Short-Term Constraint-Induced Movement Therapy Combined With Visual Biofeedback Training Improve Hemiplegic Upper Limb Function of Subacute Stroke Patients?

• Seok H
• Lee SY
• Kim J
• Yeo J
• Kang H

• KMID: 2371331
• DOI: http://doi.org/10.5535/arm.2016.40.6.998

Abstract

OBJECTIVE
To Investigate the synergic effects of short-term constraint-induced movement therapy (CIMT) and visual biofeedback training (VBT) in subacute stroke patients.
METHODS
Thirty-two subacute stroke patients were enrolled and randomly assigned to one of three groups: short-term CIMT with VBT, VBT only, and control groups. We applied CIMT for an hour daily during VBT instead of the ordinary restraint time, referred to as 'short-term' CIMT. Short-term CIMT with VBT group received simultaneous VBT with CIMT, whereas the VBT the only group received VBT without CIMT for an hour a day for 2 weeks. The control group received conventional occupational therapy (OT) alone. Patients underwent the Purdue Pegboard Test, the JAMAR grip strength test, the Wolf Motor Function Test, the Fugl-Meyer Assessment (upper extremity), Motricity index and the Korean version of Modified Barthel Index test to evaluate motor functions of the hemiplegic upper limb at baseline, post-treatment, and 2 weeks after treatment.
RESULTS
No significant differences were observed between short-term CIMT with VBT and VBT only groups. Both groups showed significantly higher scores compared to the control group in the WMFT and FMA tests. However, the short-term CIMT with VBT group showed significant improvement (p<0.05) compared with the control group in both grasp and pad pinch at post-treatment and 2 weeks after treatment while the VBT only group did not.
CONCLUSION
Short-term CIMT with VBT group did not show significant improvement of hemiplegic upper limb function of subacute stroke patients, compared to VBT only group. Larger sample sizes and different restraint times would be needed to clarify the effect.

Keyword

Constraint-induced movement therapy; Biofeedback; Stroke

MeSH Terms

Biofeedback, Psychology*
Hand Strength
Humans
Occupational Therapy
Sample Size
Stroke*
Upper Extremity*
Wolves

Figure

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  Fig. 1 The flowchart of the study. CIMT, constraint-induced movement therapy; VBT, visual biofeedback training.

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  Fig. 2 Four possible motions in E-LINK program. (A) Disc grip. (B) Tip pinch. (C) Lateral pinch. (D) Wrist flexion and extension.

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  Fig. 3 The patient with right hemiparesis received 'behavior simulation.' The patient held a disc grip by finger flexors. (A) The patient tried to put the spoon in the bowl by forearm pronation. (B) On the other hand, the patient was required to supinate his forearm for getting the spoon to the mouth. There were three patients with left hemiparesis. (C) One received short-term CIMT and VBT simultaneously. (D) Another patient received only VBT. (E) Both patients participated in the catch balls' game. The other patient received conventional occupational therapy. CIMT, constraint-induced movement therapy; VBT, visual biofeedback training.

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  Fig. 4 This figure shows sequential changes in clinical parameters at post-treatment and 2 weeks after treatment in each group. Changes in grasp (A), pad pinch (B), WMFT (C), and FMA (upper extremity) (D). CIMT, constraint-induced movement therapy; VBT, visual biofeedback training; WMFT, Wolf Motor Function Test; FMA, Fugl-Meyer Assessment. a)p<0.05 (short-term CIMT with VBT group vs. control group), b)p<0.05 (VBT only group vs. control group), c)p<0.017 by the Mann-Whitney U test for post-hoc analysis.

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