Original article
The Effects of Constraint-Induced Therapy on Kinematic Outcomes and Compensatory Movement Patterns: An Exploratory Study

https://doi.org/10.1016/j.apmr.2008.09.574Get rights and content

Abstract

Massie C, Malcolm MP, Greene D, Thaut M. The effects of constraint-induced therapy on kinematic outcomes and compensatory movement patterns: an exploratory study.

Objective

To determine changes in kinematic variables and compensatory movement patterns of survivors of stroke completing constraint-induced therapy (CIT).

Design

Pre-post, case series.

Setting

Clinical rehabilitation research laboratory.

Participants

Men (n=7) and women (n=3) with unilateral stroke occurring at least 9 months prior to study entry with moderate, stable motor deficits.

Intervention

Participants completed 10 consecutive weekdays of CIT for 6 hours a day comprised of trainer-supervised, functionally based activities using massed practice.

Main Outcome Measures

Kinematic measures included movement time, average velocity, trajectory stability, shoulder abduction, and segmental contribution. Functional measures included Wolf Motor Function Test (WMFT) performance time and functional ability scores and Motor Activity Log (MAL) “how-well” scores. All measures were administered before and after the 2-week CIT intervention.

Results

Movement time, average velocity, and trajectory stability significantly improved after CIT. Participants used more shoulder flexion to reach after CIT, but also demonstrated increased compensatory shoulder abduction. Functional scores also significantly improved, including WMFT performance time and functional ability and MAL scores. There was no change in trunk movement or amount of elbow extension.

Conclusions

CIT improved motor capacities in the hemiparetic arm as reflected in the functional outcomes and in some kinematic measures. Participants' reliance on common compensatory movements was not beneficially affected by CIT. The results of this study demonstrate that while functional capacity and some movement strategies in the hemiparetic arm improve after CIT, participants may not overcome their reliance on common compensatory movement patterns. Based on these findings, this study suggests that CIT may encourage subjects to generate movement through compensatory and/or synergy-dominated movement rather than promote the normalization of motor control. This outcome highlights the need to develop CIT further as an intervention that improves functional capacity and more normative movement strategies.

Section snippets

Participants

A convenience sample of participants enrolled in a separate randomized controlled CIT study was used for this study. Ten participants (3 female; 5 left cerebral vascular accident) with a mean age ± SD of 61±14.7 years participated and gave written consent in accordance with the policies of the local institutional review board. Table 1 summarizes participant demographics. Participants were recruited from the community and met the following inclusion criteria: at least 9 months poststroke of

Unaffected reach

Data from the unaffected side (n=4; participants 2, 7, 8, 10) are presented to illustrate differences between unaffected and stroke-affected reaching patterns. Figure 2A (top panel) illustrates the reaching strategy of a representative participant (participant 10, presented as a mirror-image) and the segmental contribution to the total reaching movement. With the unaffected arm, the trunk remained relatively stable in a neutral position and contributed very little to the overall reaching

Discussion

A limited number of studies have employed objective and quantitative measures to investigate change in movement patterns after CIT, and these studies have focused primarily on modified CIT protocols and spatiotemporal parameters of movement.15, 16, 18, 21 The goal of our study was to expand on this previous work by examining those parameters that are perhaps most clinically meaningful—for example, how motor patterns and strategies change in relation to common compensatory movements. While we

Conclusions

The results of this study demonstrate that spatiotemporal parameters of movement improved after CIT, and there was greater use of the shoulder during reach. However, while functional capacity and some movement strategies in the hemiparetic arm improved after CIT, participants did not overcome their reliance on common compensatory movement patterns. After CIT, shoulder abduction was more pronounced, and subjects continued to rely on trunk movement to accomplish reach. Based on these findings,

Acknowledgment

We thank Gary Kenyon, MS, for his support of kinematic data collection procedures.

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    From a thesis submitted to the Academic Faculty of Colorado State University in partial fulfillment of the requirements for the degree of Master of Science.

    Supported by the National Institutes of Health (grant no. 1RO1 HD045751-01A0) and a Scholarship Advancement Award, Department of Occupational Therapy, Colorado State University.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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