Restraint Therapy Improves Function for Stroke Patients

THURSDAY, March 2 (HealthDay News) -- A stroke-rehabilitation treatment that restrains a healthy arm can restore function to the damaged arm years after the brain attack, a new study shows.

The finding upsets the conventional belief that only immediate treatment can be effective for people who have strokes, said Gitendra Uswatte, an assistant professor of psychology and a member of the University of Alabama at Birmingham team reporting the findings.

The study was led by Edward Taub, a professor of psychology at the university, who pioneered the treatment that forces patients to use their stroke-weakened arm.

"The traditional wisdom has been that patients more than a year after a stroke have no capacity to regain function," Uswatte said. "This study challenges that."

The findings appear in the March 3 issue of Stroke.

The research has potentially important financial as well as medical implications, Uswatte said. "Today it is difficult for stroke patients to get reimbursement for treatment six to 12 months after a stroke," he said, noting that the new study might help change that.

The trial included 41 middle-aged people who had mild to moderate loss of function in one arm because of a stroke that occurred, on average, 4.5 years after the study began. Twenty of patients went through a general fitness program that included strength, balance and stamina training and relaxation exercises six hours a day for 10 consecutive weekdays.

The other 21 had their healthy arm constrained by a hand splint or sling about 90 percent of the time for two weeks and also had intensive training of the affected arm.

The people who got what is formally called constraint-induced movement therapy reported significant improvement in function of the affected arm. "They scored, on average, 1 on a scale of 1 to 4 before treatment and 3 after," Uswatte said. No significant change occurred in the other patient group.

And while the study focused only on arms, "we have done other studies showing that patients with mild to severe deficit of other limbs can benefit from the treatment," he said.

Constraint-induced movement therapy is offered by a number of institutions, but is not widely available "because of the barrier of insurance coverage," Uswatte said. "Clinics offer the treatment on a fee-for-service basis, so patients have to pay out of their own pocket."

Dr. Elizabeth Noser, an assistant professor of neurology at the University of Texas Medical School at Houston, agreed that such treatments can prove costly to patients. "You're talking about six hours of therapy a day for 10 to 12 days," she said. "That's expensive."

A clinic that will offer constraint therapy along with other treatments is being opened by the Houston medical center, in collaboration with HealthSouth Corp., she said.

The effectiveness of the therapy has been demonstrated on brain images, Noser said. "More brain cells are activated after constraint therapy," she said. Still, "health insurance companies say that not enough definitive trials have been done, so patients have to pay out of pocket," she added.

There's hope the results of a multi-center trial now under way, expected to be published in the next few months, will help change that stance, Uswatte said.

The Alabama study makes two major points, he said: "There is now hope for patients long after a stroke, and also an emphasis on transferring gains made in the laboratory into a clinical setting."