"Forced use" helps patients with stroke regain function in their weak arm

doi:10.1136/bmj.333.7576.1013-b

BMJ 2006;333:1013 (11 November), doi:10.1136/bmj.333.7576.1013-b

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"Forced use" helps patients with stroke regain function in their weak arm

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Constraint induced therapy forces patients recoveringfrom stroke to use their weak arm and hand by placing an immobilisingmitt on the other one. When combined with intensive trainingof the paretic limb (constraint induced movement therapy), patientscan regain lost function up to nine months after a stroke, accordingto a randomised trial. Patients wore the mitt for most of theirwaking hours for two weeks and attended a training programmefor six hours each working day for the same two weeks, wherethey were encouraged to do frequent repetitions of simple movements.They made statistically and clinically relevant improvementsin functional ability, most of which was endured for at leasta year, compared with controls who had usual care.

Patients in this trial could already extendtheir wrists and fingers by at least 10° and stand up fromsitting, so the results may not apply to those with denser strokes,but the results are exciting, says an editorial (pp 2141-3),because they are the first to show a clear benefit from anyrehabilitation intervention three to nine months after a stroke.They suggest that meaningful gains can be made even after theend of the traditional "recovery period," giving motivated patientsmuch needed hope after a devastating event.