|In Most Comprehensive Study Yet, Two-Week Regimen
Helps Stroke Survivors Regain Arm Control
In the largest, most comprehensive study of its kind to date,
researchers supported by the National Institutes of Health (NIH)
showed clinical improvements out to one year when stroke survivors
who had lost function in one arm were given a unique, two-week
Steven Wolf, Ph.D., Professor of Rehabilitation Medicine at Emory
University, led a multi-center team that tested the effects of
constraint-induced movement therapy (CIMT) in 222 patients. The
study, which is featured in the November 1, 2006 issue of The
Journal of the American Medical Association,* was
funded by the National Institute of Child Health and Human Development
(NICHD) and the National Institute of Neurological Disorders and
“This study provides the strongest evidence to date that constraint
induced movement therapy can help stroke patients regain lost arm
function,” said NIH Director Elias A. Zerhouni, M.D. “This is welcome
news for stroke patients and those who care about them.”
Each year, more than 700,000 Americans are hospitalized for stroke,
an interruption of blood flow in the brain. Up to 85 percent of
survivors have weakness on one side of their body.
CIMT involves training the weakened hand and arm through repetitive
exercises, while restraining the unaffected hand and arm with a
mitt like a boxing glove. The theory behind the hand restraint
is that it forces the wearer to use the affected hand and arm.
“We now have an intervention that is beneficial for between 5
and 30 percent of the stroke population. CIMT should be considered
as a valuable form of rehabilitation, and opens the door to further
explorations,” said Dr. Wolf.
Known as the EXCITE trial, for Extremity Constraint Induced Therapy
Evaluation, Dr. Wolf’s study involved people who had weakness in
one arm caused by a stroke within the prior three to nine months.
About half of the trial participants received customary care, ranging
from no treatment to standard physical therapy, while the other
half received CIMT.
Study participants were asked to wear the restraint every day,
and come in for training every weekday for several hours, for a
period of two weeks. They were evaluated immediately after treatment,
and again four, eight, and 12 months later, through a series of
tasks designed to measure arm dexterity, and a set of questions
about how well and how often they used the impaired arm in daily
Compared to the group that received only customary care, the group
that received CIMT showed improved function of the stroke-affected
arm in timed tasks and in self-reported daily use at all time points.
At the earliest time points, some participants were unable to perform
certain tasks at all, but those who received CIMT were more likely
to regain the ability to perform those tasks by the end of the
year-long study period.
Previous neuroimaging studies have revealed that CIMT stimulates
increased activity in the part of the brain that controls the rehabilitated
arm. “The work of Dr. Wolf and his colleagues shows that it’s possible
to harness this remarkable plasticity in the brain to significantly
improve the lives of patients,” said John Marler, M.D., Associate
Director of Clinical Trials at NINDS.
Beth Ansel, Ph.D., a project director of the National Center for
Medical Rehabilitation Research, the NICHD division that funded
the study, said its results represent an important milestone after
many years of research. “These studies began as basic research
with laboratory animals, progressed to studies with patients, and
now are poised to change patient care,” she said.
The NICHD sponsors research on development, before and after
birth; maternal, child, and family health; reproductive biology
and population issues; and medical rehabilitation. For more information,
visit the Web site at http://www.nichd.nih.gov/.
The NINDS http://www.ninds.nih.gov is
a component of the NIH within the Department of Health and Human
Services and is the nation's primary supporter of biomedical
research on the brain and nervous system.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.