1000 Section - Evaluation of the Effectiveness of Constraint-Induced Movement Therapy for the Upper Limb in Patients After First Ischemic Stroke

Objectives : Stroke is a leading cause of long-term disability, frequently causing upper limb motor deficits.Constraint-Induced Movement Therapy (CIMT) addresses upper limb deficits in stroke survivors by forcing the use of the paretic limb.This study evaluated CIMT's effectiveness in first-time ischemic stroke patients, specifically analyzing how rehabilitation timing and the side of hemiparesis influence functional recovery.

Design: The study included 20 patients(69.6±11.8 years)hospitalized at the Department of Neurological Rehabilitation Jonscher Hospital in Lodz. Inclusion criteria were: first ischemic stroke within the last 6 months, preserved verbal-logical contact, and no prior botulinum toxin treatment or trauma in the affected limb.Measurements were taken at admission and discharge following the 4-week hospitalization, which included standard kinesiotherapy combined with CIMT (min. 1.5 hours daily of task-oriented exercises with the non-affected limb restrained).Outcome measures included: Box and Blocks Test(BBT), Rivermead Motor Assessment Scale 3(RMA-3), LUNA EMG Rehabilitation Robot: measurement of active shoulder flexion range of motion (ROM) and muscle tension maintenance(2-and 8-sec. trials).

Results: Post-intervention analysis revealed statistically significant improvements across all examined parameters(p< 0.05):BBT scores increased significantly in both Trial 1(mean change +9.4 blocks, p=0.0001) and Trial 2(mean change +10.3 blocks, p=0.0001); RMA-3 scores improved from a baseline of 6.4±3.2 to 9.2±2.4 points(p< 0.0001); active shoulder flexion ROM increased by an average of 14.1±9.7 degrees(p< 0.0001). Significant improvements were also observed in sustained muscle tension tasks for both 2-sec.(p< 0.0001) and 8-sec.(p=0.0001) intervals.The side of hemiparesis significantly differentiated outcomes; patients with right-sided hemiparesis showed significantly greater improvement in BBT Trial 1(p=0.0154) and LUNA tension tests compared to those with left-sided hemiparesis.

Conclusion: CIMT combined with standard rehabilitation significantly improves upper limb motor function, dexterity, and ROM in patients after a first ischemic stroke.The side of hemiparesis influences the degree of recovery in specific manual and strength-based tasks, which may necessitate tailored therapeutic approaches for left vs. right-sided paresis.