EXCITing Stroke Rehabilitation Study Results

< Dec. 12, 2007 > -- The EXCITE (extremity constraint-induced movement therapy evaluation) trial is showing that constraint-induced movement therapy improves strength and quality of life.

In fact, with just two weeks of constraint-induced movement therapy, some stroke patients show significant improvement in  hand function. The report was published in The Lancet Neurology.

The main idea for the study was quite simple. Study participants wore a mitt on the hand that was less affected by the stroke, forcing them to use their affected hand while doing a repetitive task - such as grooming or eating - with the hope of improving the use of their hand and rebuilding strength. The mitt was worn for most of their waking hours for two weeks.

"The folks who have extremity constraint-induced movement therapy have significant improvements in the use of their impaired upper extremity that persist after two weeks of training," says lead researcher Dr. Steven Wolf, a professor of rehabilitation medicine at Emory University School of Medicine in Atlanta.

Improvements Last Two Years

For the study, 106 patients were randomly assigned to extremity constraint-induced movement therapy or usual therapy, which ranged from no treatment after concluding formal rehabilitation to medications or continued physiotherapy.

The new study was an extension of the EXCITE trial, which demonstrated that people who underwent extremity constraint-induced therapy had better results in hand function after one year, compared with people who received usual care.

Dr. Wolf's team found that two years after treatment, there was no decline in the improvements seen after one year. In fact, the participants continued to gain strength and improvement in ability, the researchers say.

Mild to Moderately Impaired Benefit Most

Dr. Wolf says the restraint therapy can be used on about 30 percent of stroke patients - or those with mild to moderate impairment. "People who will benefit are those who can begin to open their hand six weeks after the stroke," he says. "Extremity constraint-induced movement therapy can, over a short period of time, lead to improvements that are sustainable."

One stroke expert thinks the study results are impressive, but more research needs to be done before the technique is adopted widely.

Patient Frustration and Insurance Refusal - Two Barriers

"In stroke rehabilitation, we don't have a lot of things to offer these folks," says Dr. Michael W. O'Dell, acting chief of rehabilitation medicine at New York-Presbyterian Hospital, Weill Cornell Medical Center in New York City. "It's pretty remarkable that a treatment that was provided for two weeks, two years ago, is still having an effect on people's ability to function on a day-to-day basis."

Dr. O'Dell says it is important to note that the patients in the EXCITE trial did have some movement in the affected hand before the study began. "They were not the worst of the worst," he says. "But it's really encouraging that there is some possibility for further recovery."

Dr. O'Dell notes that there are some drawbacks to extremity constraint-induced therapy. For one, insurance companies and Medicare won't pay for it. "It's too expensive," he says.

Also, the therapy is very frustrating for patients. "So, you have to have an incredibly motivated patient to do this," according to Dr. O'Dell.

Always consult your physician for more information.

Getting Better After a Stroke

Rehabilitation after a stroke begins  as soon possible because deficits, such as loss of movement in a limb or impaired speech, are more easily regained if therapy starts sooner rather than later.

The outlook for stroke patients today is more hopeful than ever due to advances in both stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family, and rehabilitation staff works together as a team.

Family members must learn about impairments and disabilities caused by the stroke and how to help the patient achieve optimal function again.

The goal of stroke rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life - physically, emotionally, and socially.

Rehabilitation is designed to meet each person's specific needs; therefore, each program is different. Some general treatment components for stroke rehabilitation programs include the following:

• treating the basic disease and preventing complications

• treating the disability and improving function

• providing adaptive tools and altering the environment

• teaching the patient and family and helping them adapt to lifestyle changes

It is important to focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence.

The success of stroke rehabilitation depends on many variables, including the following:

• cause, location, and severity of stroke

• type and degree of any impairments and disabilities from the stroke

• overall health of the patient
  family support

Always consult your physician for more information.