One of the most devastating effects of stroke is the loss of mobility in one or more of a patient's limbs. But research from the Emory University School of Medicine in Atlanta, Georgia, indicates some stroke victims benefit from being forced to use their impaired arms and hands.
Dr. Steven Wolf studied several hundred patients, three to nine months after they had a stroke. Half of them participated in standard physical therapy, which is aimed at strengthening the arm or hand unaffected by the stroke. The other half of the patients were given what Wolf calls Constraint Induced Movement Therapy.
"[That] involves one-on-one training of patients for several hours a day over the course of two weeks," he explains, "making the patient use their impaired arm and hand by immobilizing their better hand in a sling with a cuff around the end of the sling so they couldn't use it at all."
Wolf found that therapy helped all the patients. But those who had their healthy arms constrained had significantly more improvement. Their arms and hands got stronger and they were able to do everyday tasks almost twice as fast. "They are almost all home-based tasks: putting on your socks, washing, combing your hair, brushing your teeth, using utensils to eat. And so on."
Wolf says stroke patients who retain some movement in their upper extremities could benefit from Constraint Induced Movement Therapy. And he says that at a time when there are fewer resources available to rehabilitate stroke patients, it's important to research effective, low-cost therapies.
"One of the unique features of Constraint Induced Movement Therapy is that it meets those criteria. It doesn't take much instrumentation at all. Simply a mitt that is worn on the better hand, a series of tasks, a responsibility on the part of the patient, family and if possible therapist to cooperate, and a willingness and desire to persist [beyond the two weeks of training]." He says if that regimen is followed, eventually the use of the hand is incorporated into everyday activities.
Wolf says in his next study, he'll work with patients a few weeks, rather than a few months after their strokes. His paper appeared in the Journal of the American Medical Society.