The Effects of Constraint-Induced Movement Therapy and Modified Constraint-Induc

by Elizabeth Ballor, Megan Haskin, Jill Killingbeck & Ashley Morrow

Constraint-induced movement therapy (CIMT) and modified constraint induced movement therapy (mCIMT) are promising approaches for the treatment of hemiparesis and learned non-use following a cerebrovascular accident.  CIMT involves forcing the use of the affected limb through exercises and everyday use in efforts to improve function of a partially paralyzed upper extremity in clients who have experienced a stroke.  The unaffected limb is immobilized by a constraint as part of an intense treatment protocol that involves therapy for six hours a day, five days a week, for two weeks, as well as in a home program, with a goal of forcing movement of the affected extremity (Caimmi et al., 2008). mCIMT consists of a similar protocol of therapy, consisting of three hours a day of therapy, five days a week, for two weeks, including a home protocol as well.   

The purpose of this study was to examine the effects of CIMT and mCIMT on quality of life among persons demonstrating learned nonuse of an affected upper extremity status post CVA.  Quality of life is an individual's global feelings of well-being and satisfaction within the cultural context and value system within which one resides (Campos & Johnson, 1990). For the purposes of this study, quality of life was measured using the Stroke Impact Scale.  This scale assesses how a stroke has affected an individual's health and daily living after experiencing a CVA.

A mixed methods approach, consisting of both qualitative and quantitative methodology, was used to examine the impact of CIMT and mCIMT on quality of life for persons demonstrating upper extremity learned nonuse following a CVA.

Quantitative Results

Eight participants (four who received CIMT and four who received mCIMT) were evaluated in regards to their quality of life pre and post-intervention using the Stroke Impact Scale. On average, the CIMT participants increased their overall perception of quality of life by 24.3 percent pre- to post- testing.  In comparison, the mCIMT participants increased their overall quality of life perception by an average 17.9 percent pre- to post- intervention. Overall, both the CIMT and mCIMT groups showed an increase in their perceived quality of life.

Qualitative Results

Qualitative data was collected via focus groups, clients' journals, and daily progress notes.  The qualitative data demonstrated that overall, there was a perceived positive change within the clients in their quality of life from pre to post-intervention in both the CIMT and mCIMT groups.  Seven themes were gained from the data analysis of the qualitative portion of the study.  The data was collected from daily journals, daily notes, and a focus group for which both CIMT and mCIMT participants were present.  The themes identified included: 1) change of lifestyle; 2) positive improvement; 3) "I want to see how far I can go"; 4) "Yes, I got what I expected"; 5) decreased pain; 6) "It's like having a job again"; and 7) overall enjoyment. 

Interpretation of Results

The Stroke Impact Scale showed improvement in all areas of quality of life in both CIMT and mCIMT groups. However, the CIMT group showed greater gains than the mCIMT group over the assessment areas. The data collected suggested that both CIMT and mCIMT can produce increased overall gains in quality of life among persons demonstrating learned nonuse of an affected upper extremity status post CVA.

Future Recommendations

Future recommendations for research in the impact of CIMT/mCIMT on clients with stroke include investigation into (a) the adjustment of roles and (b) the effects of a follow-up CIMT/mCIMT program with adults.  Role adjustment was shown to be a great impacting factor for participants' quality of life in this study.  Performance within these roles was very important to participants.  A follow-up program may show additional benefits for experienced clients to maintain and increase the improvements gained through this program.  In addition, examining and utilizing a consistent warm up phase may show to be beneficial for optimal results in future studies.  Examination of these areas may further contribute to the knowledge of the most effective way to use CIMT protocol.

Acknowledgements

The researchers would like to thank Donald Earley, OTD, MA, OTRL, associate professor of Occupational Therapy,  for the CIMT/mCIMT training, continuous support, guidance, and vast knowledge throughout the treatment sessions.  We would also like to thank Ellen Herlache, MA, OTRL, Research Coordinator for the Occupational Therapy program, for supervising during the treatment sessions, and guidance throughout the research project design, implementation, and statistical analysis portion of our study.  In addition, we thank Jill Ewend, OTRL, Simulation Learning Laboratory Associate for the OT department, for her supervision and assistance during the treatment sessions. We would like to thank J.J. Boehm for his assistance with advertising.  Finally, we would like to thank our participants.  Without their commitment and cooperation, our study would have not taken place.