New Therapy for Partial Paralysis
In some stroke survivors with partial paralysis on one side, intensive physical therapy that restrains their good arm and hand may lead to lasting improvements in the paralyzed one.
Nov. 1, 2006 -- In some stroke survivors with partial paralysis on one side,
short-term, intensive physical therapy that restrains their good arm and hand
may lead to lasting improvements in the paralyzed one, a new study shows.
In the study, patients who underwent the new therapy took a third less time
to complete a task and could perform the task 34% more efficiently than those
treated with the usual care.
"This study offers a completely new hope that's never been there before,
that following through with a difficult regimen of physical therapy will
actually lead to significant improvements in physical function, happiness, and
quality of life," says John Marler, MD, associate director of clinical
trials at the National Institute of Neurological Disorders and Stroke (NINDS),
which co-funded the study.
The study results appear in the Nov. 1 issue of The Journal of the
American Medical Association.
Stephen L. Wolf, PhD, of the Emory University School of Medicine in Atlanta,
and colleagues studied 222 survivors of first-time, mild-to-moderate
In order to participate in the study, the patients had to successfully
complete a simple test: resting their impaired forearm on a table with their
hand extended over the edge and raising their wrist and fingers in a
"waving goodbye" gesture.
Only 5%-30% of stroke survivors are able to complete this test, Wolfe tells
Patients Worked Hard
Three to nine months after their strokes, 106 of the patients were assigned
to receive constraint-induced movement therapy (CIMT).
The other 116 received usual or customary care, which included physical and
occupational therapy, orthotics, day treatment programs, etc.
All the subjects were followed for a year.
During the two-week CIMT intervention, patients wore a mitt over their good
hand during waking hours. They also met every day with a physical therapist to
practice physical tasks for up to six hours with their impaired hand.
"They chose 30 real-world tasks that were most meaningful to them,"
Wolf says. "These included adaptive tasks such as eating, washing, bathing,
grooming, and opening doors. They also included tasks such as writing, drawing,
and -- for those who like gardening -- using a shovel to lift potting soil into
To keep patients from getting frustrated, each task was broken down into its
component parts. "So each patient was literally relearning the sequence of
events that go into completing a task and reformulating a motor plan to do it
correctly," Wolf says.