Stroke: Big Gains With Hand Splinting
Training Weaker Arm for 2 Weeks Reaped Benefits for 2 Years in Stroke Survivors
March 2, 2006 -- A new study shows long-term benefits from short-term therapy for stroke survivors.
The study, published online in Stroke, included 41 people with mild to moderate movement problems due to stroke. An average of four years had passed since their strokes.
Stroke damage can be stronger on one side of the body than the other. For two weeks, 21 participants wore a hand splint/sling for 90% of their waking hours on whichever arm worked better after their stroke.
The goal was to force the other arm to handle tasks of daily life. That approach is called "constraint-induced movement therapy."
Such therapy has shown improvements in past studies. But Edward Taub, PhD, of the University of Alabama at Birmingham, and colleagues gave their two-year test a twist.
Taub's team didn't just track the patients who wore the slings. They also studied 20 stroke survivors who followed a program of physical fitness, cognitive exercises, and relaxation techniques.
Both programs were brief and intense. The constraint group wore their slings for six hours a day for two weeks. The comparison group had a similar schedule for their slingless program.
After treatment, participants in the constraint group got four weekly phone calls from physical therapists about any barriers they had in using their more-impaired arm. They were also encouraged to practice using their more-impaired arm for 30 minutes daily, following a personalized list of tasks, such as stacking Styrofoam cups.
Participants wearing the slings showed "large to very large" improvements in their ability to use their arm that had been more affected by stroke in daily life, the researchers write. "The changes persisted over the two years tested."
The comparison group showed "no significant changes" in their ability to use their arm that had been more affected by stroke, write Taub and colleagues.
Results were based on participants' ratings of their improvement and on videotapes of the participants doing activities that used their stroke-affected arm. The videos were judged by trained observers who didn't know which patients had worn the slings.
Retraining the Brain
Constraint-induced therapy might help the brain learn to use the stroke-damaged arm, the researchers write.
Several years had passed since the participants' strokes, the researchers note. "The prevailing view has been that the amount of motor recovery present at one year after stroke is the level at which patients will remain," they write.
Their study defies that notion by showing movement improvement years after stroke.
"The traditional view that chronic stroke patients are refractory [resistant] to treatment needs to be reconsidered," write Taub and colleagues.
Recently, another team of researchers found similar results in a study comparing
to standard stroke therapy.