Potential predictors of motor and functional outcomes after distributed constraint-induced therapy for patients with stroke.

摘要

BACKGROUND: Selection of patients who are most and least likely to benefit from constraint-induced therapy (CIT) for the upper extremity is uncertain. OBJECTIVE: This study investigated demographic and clinical characteristics that may predict outcomes for a distributed form of CIT. METHODS: A group of 57 patients were treated with distributed CIT, and 7 potential predictors were identified, including age, sex, side of stroke, time since stroke, spasticity, neurologic status, and movement performance of the distal part of the upper extremity. Treatment outcome was assessed in terms of motor performance, perceived functional ability of the affected hand, and functional performance of daily activities, measured by Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and Functional Independence Measure (FIM), respectively. RESULTS: Motor ability of the distal part of the upper extremity and time since stroke were significantly predictive of outcomes on the FMA (adjusted R(2) = 0.18, P = .002) and the MAL subtest quality of movement (adjusted R( 2) = 0.43, P < .0001). Motor ability and age were significant predictors of amount of use measured by the MAL (adjusted R(2) = 0.20, P = .001). None of the variables exhibited a predictive relationship with the FIM. CONCLUSIONS: The best predictor for motor outcomes after distributed CIT was greater motor ability of the distal part of the upper extremity, which is consistent with the presence of residual motor pathways that may respond to training. The FMA may be of value in stratifying patients for their likelihood to benefit from distributed CIT protocols.