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.
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Both the CIMT group and the usual-care group were studied over the year to see how quickly and effectively they could perform the tasks they had chosen.
The researchers used two different tests to monitor their progress: one to measure the patients' task speed and functional ability; the other to measure how well they could perform the tasks.
Although both groups improved over the year, the improvements were significantly more impressive in the CIMT group.
Compared with the usual-care group, the CIMT patients took 34% less time to complete a task and could perform the task 34% more efficiently.
The CIMT group also saw a 65% increase in the number of tasks they could successfully perform with their impaired arm compared with the usual-care group.
They also reported that they felt significantly less functional disability.
Improvements May Be Permanent
"One of the most convincing things about this trial is that it showed the durability of CIMT," Marler says. "The effects of a relatively short intervention could still be seen a year later. This is solid evidence that there is a benefit."
This benefit persisted even after the researchers adjusted for age, sex, and the level of disability in the impaired arm.
Because Wolf and his team are continuing to assess the study participants, the researchers are hopeful the benefits will continue two years or more.
CIMT is thought to work because it strengthens areas of the brain associated with muscle movement, either by making patients repeat a task over and over or by challenging them to problem-solve.
"The question of how it works hasn't yet been answered," Wolf says. "But brain scans indicate that there are real changes occurring in the brain."
"A lot of people who start physical therapy don't realize that exercise can solve a problem with the wiring in the brain," Marler says. "This trial would suggest that it can."
Future Looks Promising
Researchers are now evaluating whether CIMT might be even more effective if it's started earlier -- one to three months after a strokestroke -- or if it continues longer than two weeks.
One of Wolfe's colleagues has developed a modified CIMT program in which patients wear a mitt five hours a day for 10 weeks and undergo physical therapy once or twice a week. "It's proving to be effective as well," Wolf says.
Even though fewer than a third of stroke survivors may benefit from CIMT, Wolf expects the demand for the therapy to increase dramatically in light of the new research.
But there are hurdles to overcome.
Only about 10-12 medical centers in the U.S. now have competently trained CIMT therapists, Wolf says, although efforts are under way to develop a certification and standardization process.
Also, CIMT may not be covered by insurance. "Most of the subjects in our study had to pay for CIMT out-of-pocket," says Wolfe, who is pushing to expand coverage.