Effects of sling and voluntary constraint during constraint-induced movement therapy for the arm after stroke: a randomized, prospective, single-centre, blinded observer rated study
Clinical Rehabilitation,  Clinical Article

Krawczyk M et al. – Voluntary activity constraint in the intact arm is equivalent to sling, standard constraint during massed practice of paretic arm.

Methods
  • Patients were randomly allocated to: the sling–constraint group (n = 24) or to the voluntary–constraint group (n = 23).
  • Massed practice with the paretic arm (5 hours/day for 15 consecutive working days).
  • Sling–constraint group had their arm immobilized in a hemi–sling during therapy.
  • In addition, individual, 1–hour physiotherapy sessions were conducted in both groups.
  • Rivermead Motor Assessment (RMA) Arm scale, (0–15), Motor Activity Log – Quality of Movement (MAL–QOM) (0–5 for 30 daily tasks).

Results
  • There was no significant difference between groups after therapy (MAL–QOM mean change for sling group 0.78, SD = 0.46 and for voluntary–constraint group 0.84, SD = 0.48; P = 0.687).
  • All treated patients retained mean gains in real–world arm use (MAL–QOM) mean scores after 12 months follow–up compared with posttreatment values but there was no significant difference between groups (comparison of estimated mean change of MAL–QOM stated 0.23. 95% confidence interval = –0.04–0.50).

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