Journal of Modern Rehabilitation 2016. 10(1):18-23.

Constraint-Induced Movement Therapy in Compared to Traditional Therapy in Chronic Post-stroke patients
Khadijeh Otadi, MohammadReza Hadian, Saeid Emamdoost, Mehri Ghasemi


Introduction: Constraint-induced movement therapy (CIMT) forces the use of the affected side by restraining the unaffected side. The purpose of this article is to explore the changes of motor and functional performance after modified CIMT (mCIMT) in comparison with traditional rehabilitation (TR) in chronic post-stroke patients.
Material and Methods: A total of 12 patients randomly assigned into two treatment groups. Six patients in the mCIMT group received intensive training in a more affected limb for 2 hours daily, 5 days/week using shaping method over a period of 21 days. Participants less affected limb were restrained in arm - hand splint with a target of wearing it for 5 hours daily. The patients in TR group received bimanual and unilateral activities, stretching, strengthening and coordination exercises of the impaired side, tone modification and coordination exercises of the affected side. The focus was to increase independence in activities of daily living activities  using  affected  side.  The  motor  activity  log (MAL),  wolf  motor  function  test (WMFT), and modified ashworth scale were measured at pre-test (1 day before training), post- test (1 day after training) and follow-up in 3 weeks after training.
Results: The  Friedman  test  found  significant differences  between  pre-test,  post-test,  and follow-up in MAL and WMFT in mCIMT group. Furthermore, mCIMT group showed significant decreased spasticity (P = 0.030) that measured by ash worth scale. The effect sizes between post-test and pre-test in the above-mentioned outcome measures were moderate to large in mCIMT, ranging from 0.3 to 0.76, but in TR group the effect size were small, ranging from 0 to 0.2.
Conclusion: Therefore, it seems that the mCIMT treatment was more effective than TR in improving some parameters.


Constraint-induced movement therapy; Motor activity log; Stroke; Wolf motor

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Barreca S. Management of the post stroke arm and hand: treatment recommendations of the 2001 consensus panel. Ontario, Canada: Heart and Stroke Foundation of Ontario; 2001. p. 61.

Hummelsheim H, Eickhof C. Repetitive sensorimotor training for arm and hand in a patient with locked-in syndrome. Scand J Rehabil Med 1999; 31(4): 250-6.

Wu CY, Chen CL, Tsai WC, Lin KC, Chou SH. Arandomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Arch Phys Med Rehabil 2007; 88(3): 273-8.

Duncan PW, Lai SM. Stroke recovery. Topics Stroke Rehabil 1997; 4(17): 51-8.

Richards L, Pohl P. Therapeutic interventions to improve upper extremity recovery and function. Clin Geriatr Med 1999; 15(4): 819-32.

van der Lee JH. Constraint-induced therapy for stroke: more of the same or something completely different? Curr Opin Neurol 2001; 14(6): 741-4.

Fleet A, Page SJ, MacKay-Lyons M, Boe SG.Modified constraint-induced movement therapy for upper extremity recovery post stroke: what is the evidence? Top Stroke Rehabil 2014; 21(4):319-31.

van Delden AE, Peper CE, Beek PJ, Kwakkel G.Unilateral versus bilateral upper limb exercise therapy after stroke: a systematic review. J Rehabil Med 2012; 44(2): 106-17.

van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke 1999; 30(11): 2369-75.

Suputtitada A, Suwanwela NC, Tumvitee S.Effectiveness of constraint-induced movement therapy in chronic stroke patients. J Med Assoc Thai 2004; 87(12): 1482-90.

Page SJ, Sisto S, Johnston MV, Levine P, Hughes M. Modified constraint-induced therapy in subacute stroke: a case report. Arch Phys Med Rehabil 2002; 83(2): 286-90.

Hakkennes S, Keating JL. Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials. Aust J Physiother 2005; 51(4): 221-31.

Shi YX, Tian JH, Yang KH, Zhao Y. Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper- extremity dysfunction after stroke: a systematic review and meta-analysis. Arch Phys Med Rehabil 2011; 92(6): 972-82.

Lannin N, Armstrong B. Does constraint induced movement therapy improve upper limb function following stroke? [Online]. [cited 2003]; Available from: URL: 15. Page SJ, Levine P, Leonard A, Szaflarski JP, Kissela BM. Modified constraint-induced therapy in chronic stroke: results of a single-blinded randomized controlled trial. Phys Ther 2008;88(3): 333-40.

Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke 2001; 32(7): 1635-9.

Dettmers C, Teske U, Hamzei F, Uswatte G, Taub E, Weiller C. Distributed form of constraint- induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil 2005; 86(2): 204-9.

Lin KC, Wu CY, Liu JS, Chen YT, Hsu CJ.Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabil Neural Repair 2009; 23(2):160-5.

Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceno CS, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 1993; 74(4): 347-54.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. Mahwah NJ: L. Erlbaum Associates; 1988.

Shaw G. A new paradigm for therapy: Study finds constraint therapy effective for stroke rehab. Neurology Today 2006; 6(22): 1-100.

Liepert J, Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E, et al. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett 1998; 250(1): 5-8.

Bonifer N, Anderson KM. Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia. Phys Ther 2003; 83(4): 384-98.

Roberts PS, Vegher JA, Gilewski M, Bender A, Riggs RV. Client-centered occupational therapy using constraint-induced therapy. J Stroke Cerebrovasc Dis 2005; 14(3): 115-21.

Liepert J, Bauder H, Miltner WH, Taub E, Weiller C. Treatment-Induced Cortical Reorganization After Stroke in Humans. Stroke 2000; 31: 1210-6.

Page SJ, Sisto SA, Levine P, Johnston MV, Hughes M. Modified constraint induced therapy: a randomized feasibility and efficacy study. J Rehabil Res Dev 2001; 38(5): 583-90.

Wolf SL. Revisiting constraint-induced movement therapy: are we too smitten with the mitten? Is all nonuse "learned"? and other quandaries. Phys Ther 2007; 87(9): 1212-23.

Diserens K, Perret N, Chatelain S, Bashir S, Ruegg D, Vuadens P, et al. The effect of repetitive arm cycling on post stroke spasticity and motor control: repetitive arm cycling and spasticity. J Neurol Sci 2007; 253(1-2): 18-24.


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