CONSTRAINT-INDUCED MOVEMENT THERAPY IN PATIENTS WITH CONGENITAL HEMIPARESIS DUE TO STROKE

Objectives: Constraint-induced movement therapy (CIMT) is an established method in rehabilitation of adults with acquired stroke and has been shown to be effective in patients with congenital hemiparesis. However, in all published studies so far, the variety of brain lesions leading to spastic hemiparesis have not been taken into account. This study considers homogenity of lesions and reorganisation patterns when evaluating the effects of CIMT in patients with congenital hemiparesis. Methods: 11 patients (mean age: 15.3 years, range: 10–30) with infarction of the arteria cerebri media due to congenital stroke and contralateral cortico-spinal reorganisation underwent a 12-day training period in an in-patient setting. Restraint of the non-paretic hand was ensured by a glove that was worn daily (8:00 a.m. –7:00 p.m.). Shaping exercises were developed by specifically skilled physiotherapists according to the patients' functional goals. To measure the effect of CIMT before and after treatment, the Wolf Motor Function Test (WMFT) as a tool for function and activity was used. Results: We found significant improvement in the WMFT measuring the time of performance as well as the quality after treatment (WMFT-time pre: 2.04±0.77 (mean±SD), WMFT-time post: 1.89±0.91, p=0.036; WMFT-quality pre: 3.33±0.80, WMFT-quality post: 3.78±0.87, p=0.003). Conclusion: Our results revealed a distinct benefit of motor performance in the paretic extremity after CIMT in patients with congenital hemiparesis due to infarction of the arteria cerebri media. The homogenity of lesions and reorganization patterns may be a precondition to identify prognostic factors for therapy outcome and therefore may help to optimize therapy strategies.