Ching-Yi Wu, Tien-Ni Wang, Yu-Ting Chen, Keh-Chung Lin, Yi-An Chen, Hsiang-Ting Li, Pei-Luen Tsai; Effects of Constraint-Induced Therapy Combined With Eye Patching on Functional Outcomes and Movement Kinematics in Poststroke Neglect. Am J Occup Ther 2013;67(2):236-245. doi: 10.5014/ajot.2013.006486.
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© 2019 American Occupational Therapy Association
OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk–arm kinematics in stroke patients with neglect syndrome.
METHOD. Twenty-four participants were recruited and randomly allocated to three intervention groups. All participants received intervention 2 hr/day, 5 days/wk, for 3 wk. Outcome measures included the Catherine Bergego Scale, eye movement, and trunk–arm kinematic analysis.
RESULTS. The CIT + EP and CIT groups demonstrated larger improvements in functional performance than the control group. The CIT group showed better performance with left fixation points than the CIT+EP group and shorter reaction time than the control group. The CIT + EP group improved more in preplanned control and leftward trunk shift than the other two groups.
CONCLUSION. CIT + EP and CIT were more effective interventions than conventional treatment of patients with neglect syndrome in daily functional performance.
A right-side cerebral stroke
Neglect syndrome as shown by results on two or more of four tests (double simultaneous stimulation test [Stone, Halligan, Wilson, Greenwood, & Marshall, 1991 ], line bisection test [Schenkenberg, Bradford, & Ajax, 1980 ], random shape cancellation test [Weintraub & Mesulam, 1988 ], and the random Chinese word cancellation test [Chen Sea, Henderson, & Cermak, 1993 ])
Ability to reach Brunnstrom’s Stage II or higher for the proximal and distal upper extremity (UE; Brunnstrom, 1970)
Considerable nonuse of the more affected UE (MAL amount of use score <2.5; Taub et al., 1993)
No excessive spasticity in the affected arm, including shoulder, elbow, wrist, and fingers (Modified Ashworth Scale score ≤2 in any joint; Bohannon & Smith, 1987)
No severe cognitive impairment by showing awareness and ability to respond to oral instructions (Folstein, Folstein, & McHugh, 1975)
No severe impairment of visual acuity after rectification
No participation in any experimental rehabilitation or drug studies during the study period.
Reaction time, which indicates the temporal efficiency for generation or planning of the motor action, is the interval from the start signal to movement onset (Brooks & Watts, 1988).
Movement time, representing temporal efficiency, refers to the total duration of the reaching movement (Wu, Lin, Chen, Chen, & Hong, 2007).
Total distance, representing spatial efficiency, refers to the path of the hand in three-dimensional space (Wu et al., 2007). Because of the varied task distance across participants, movement time and total distance were normalized by the direct distance between the hand at the start position and the target for each participant. The smaller normalized total distance shows the more direct movement path.
The PPV, reflecting the percentage of movement time used for the acceleration phase, characterizes the control strategy of reaching. A higher PPV value indicates less online error correction and more planned control of the reaching movement (Georgopoulos, 1986).
Trunk lateral shift shows the change in trunk movement in the horizontal plane between the start and the end position. A larger value represents more trunk left shift.
If the treatment goal is to improve functional performance in patients with neglect, either CIT + EP or CIT is appropriate.
CIT + EP may target enhancing preplanned motor control ability and induce more leftward trunk shifting than CIT.
CIT might be better than CIT + EP if therapists are attempting to improve leftward eye fixation and speed up movement initiation.
CBS might be a sensitive tool to evaluate treatment effects on functional performance among patients with neglect.
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