Abstract

Rodrigo Rivas1,2, Arlette Doussoulin3, José Luis Saiz4, Sarah Blanton5 1Universidad de La Frontera, Departamento de Especialidades Médicas, Temuco, Chile, 2Clínica Alemana Temuco, Servicio de Medicina Física y Rehabilitación, Temuco, Chile, 3Universidad de La Frontera, Departamento de Pediatría y Cirugía Infantil, Temuco, Chile, 4Universidad de La Frontera, Departamento de Psicología, Temuco, Chile, 5Rehabilitation Center, Emory University, Atlanta, USA Background: Constraint-Induced Movement Therapy (CIMT) is a therapeutic strategy that has been show to improve the function of the upper limb affected by stroke. Although an extensive body of literature supports the positive impact of CIMT on neuroplasticity and the recovery of function, most research has evaluated an individual mode of delivery. However, evidence is limited for the application of CIMT protocol in a group setting. Objective: To determine the effectiveness of a modified version of CIMT in a group setting as compared to individual, one-on-one basis on the quantity and quality of movement of the paretic upper limb. Methods: Forty seven participants were analyzed and 36 patients were included. They were randomized into either a group or individual application of CIMT. The hemiparetic upper extremity quantity and quality of movement was evaluated using the self-reported, Motor Activity Log and each participant’s clinical record at baseline, pre-treatment and posttreatment. Inclusion Criteria: Aged between 18 and 80 years, a single event of stroke confirmed by brain CT, with further evolution to 6 months the ability to sit independently, NIH Stroke Scale: 5 - 14 points, <2 points in the modified Ashworth scale, <4 points on the VAS, ability to perform a functional test of 20° of wrist extension and 10º in the extension of the fingers. Exclusion Criteria: Patients who may compromise sensory (visualauditory), orthopedic limitations (use of cane), severe aphasia, failure to complete the inclusion criteria. The data were analyzed through an analysis of variance with a mixed factorial design 2x2. All patients signed informed consent. Results: The median age 52.7±6.1 years, male were 66.7%, ischemic stroke were 63.9%, time since stroke 576±237 days. VAS: 1.55±1.18, modified Ashworth scale: 1.02±0.57. The median quantity and quality of movements (MAL) were in group pre-treatment (median): 1.79 and posttreatment (median): 3.09 and individual pre-treatment (median) 1.51, and post-treatment (median): 2.69. Subsequent to evaluate the groups after the intervention, it is important to note that while both methods improved the quantity and quality of movement, significant differences in favor of group mode with a value of p = 0.04.