Constraint induced movement therapy in multiple sclerosis may be equally effective as in stroke

Abstract

Background: Constraint-induced movement therapy (CIMT) has been shown to be an effective treatment option for arm and hand paresis in patients with stroke and is recommended for the rehabilitation of the upper limb in these patients. However, little is known whether CIMT may also be effective in patients with multiple sclerosis (MS). In 2008, we introduced CIMT as a treatment option for routine care in our rehabilitation centre. In this observational study, we report our first experiences in MS patients and compare the results of those obtained in stroke patients. Patients and Methods: Eligible patients for CIMT are those admitted to inpatient rehabilitation in our department with moderate upper limb paresis irrespective of the underlying diagnosis at the discretion of the treating physiotherapist. Group therapy was administered five days a week for one hour each in a multidisciplinary team setting, with physiotherapists, occupational therapists and art therapists. The treatment consisted of training sessions encouraging the use of the affected hand and was adapted in respect to MS specific problems such as fatigue and/ or the involvement of both hands. Standardized measures of arm function (action research arm test, ARAT) and activities of daily living (Barthel index, BI) were performed before and after the 4 - 5 week rehabilitation program. Data were analysed from 18 MS patients (10 relapsing-remitting, 8 chronic progressive, 4 male, 14 female, mean age 53 +/- 9.3 years, EDSS mean 3.75 +/- 1.6) and compared to those of 21 stroke patients (8 male, 13 female, mean age 77.9 +/- 4.9 years). Results: In both groups median ARAT was significantly improved after treatment (MS from 43 to 54, p < 0.001; stroke from 38 to 50 p < 0.014). This improvement was more pronounced in the MS group compared to stroke patients (9.5 vs. 9.0 p = 0.583) but failed to reach statistically significance. Within the MS group, relapsing-remitting patients did not differ from those with chronic progressive MS. BI was not significantly changed in neither group, although small improvements were seen in both groups. Conclusion: These observational data suggest that CIMT may be equally effective in MS patients with affected upper limb function as in stroke patients, and encourage the use of CIMT also in this disease. The results of our study may be the rationale for conducting a randomized controlled study for the efficacy of CIMT in patients with MS.