Evaluation of therapies of modified constraint-induced movement therapy, constraint-induced movement therapy and Bobath in the improvement of motor function in upper extremities in patients with apoplexy hemiparalysis

Objective To compare effect of three therapies( modified constraint-induced movement therapy (mCIMT), constraint-induced movement therapy (CIMT) and Bobath therapies)on the recovery of motor function in upper-extremities of patients with apoplexy hemiparalysis. Methods Fifty-seven patients with apoplexy hemiparalysis were randomly divided into CIMT treatment group ( n = 19), mCIMT group (n = 19) and Bobath group (n = 19). Patients in Bobath group exercised 2 h/d, 5 d/week for 6 weeks. CIMT group and mCIMT group had restriction of movement at the unimpaired upper extremity by placing it in a sling a whole day for training using impaired extremity. Patients in CIMT treatment group exercised 6 h/d,5 days a week for 2 weeks in a row; mCIMT treatment group exercised for 1 h/d, 3 days a week, and also exercised in daily life at least 2 hours every day, for ten consecutive weeks. The patients in all three groups were assessed for upper-extremities motor function using FMA of Fugl-Meyer, for recovery of upperextremities motor speed using STEF and for recovery of daily ability at respective time-points of pre-treatment and the second week, sixth week and tenth week of post-treatment. Results In 3 assessments in the 3 groups there was no obvious change before treatment, while the FMA score was 45. 2 ± 5.1 (F = 1. 107 ,P =0. 382), BI score was 63. 1 ± 10. 3 ( F = 0. 930, P = 0. 401 ), STEF score was 63.4 ± 8.6 ( F = 1. 843, P =0. 168). At the second week, sixth week and tenth week of the treatment, the difference of assessment in the three groups was significant. The improvement in CIMT group was better after 2 weeks treatment compared with Bobath and mCIMT group, while the Bobath group showed better results than mCIMT group did after 6 weeks treatment. After 10 weeks treatment, the FMA, STEF in mCIMT and CIMT groups were improved better than Bobath group, while the BI score in mCIMT group was better than that in Bobath and CIMT group. Conclusions The mCIMT and CIMT therapy are better in improving the upper limb function in stroke patients compared with Bobath, while the mCIMT therapy is more effective in improving the abilities of daily life in stroke patients compared with the other two treatments. Key words: Stroke;  Hemiplegia;  Exercise therapy;  Activities of daily living;  Treatment outcome