Constraint-Induced Movement Therapy in multiple sclerosis: Safety and three-dimensional kinematic analysis of upper limb activity. A randomized single-blind pilot study

Article type: Research Article

Authors: de Sire, Alessandro^{a; b; *} | Bigoni, Matteo^c | Priano, Lorenzo^{c; d} | Baudo, Silvia^c | Solaro, Claudio^a | Mauro, Alessandro^{c; d}

Affiliations: [a] Rehabilitation Unit, “Mons. L. Novarese” Hospital, Moncrivello, Vercelli, Italy | [b] Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy | [c] Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation S. Giuseppe Hospital, Piancavallo, Verbania, Italy | [d] Department of Neurosciences, University of Turin, Turin, Italy

Correspondence: [*] Address for correspondence: Alessandro de Sire, MD, Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Viale Piazza D’Armi 1, 28100, Novara, Italy. Tel.: +39 03213734800; E-mail: [email protected].

Abstract: BACKGROUND:There are few evidences on safety of Constraint-Induced Movement Therapy (CIMT), as well as its effects in neurological conditions, including multiple sclerosis (MS). OBJECTIVE:To evaluate safety and effectiveness of a 2-week CIMT protocol on upper limb activity of progressive MS patients through a three-dimensional (3D) kinematic analysis. METHODS:In this randomized single-blind pilot study, we randomly allocated patients affected by progressive MS reporting a reduced use of one upper limb into two different groups: CIMT group (less affected limb blocked by a splint) and control group (undergoing bi-manual treatment). Primary outcome was CIMT safety. Furthermore, we assessed CIMT effects through clinical outcomes (hand grip strength, HGS, and 9 Hole Peg Test, 9HPT) and 3D kinematic analysis (normalized jerk, number of movement units, going phase duration, mean velocity, endpoint error). All evaluations were performed at baseline (T0) and after 2 weeks of treatment (T1) for both arms in both groups. RESULTS:Ten MS patients, mean aged 51.0±7.7 years, were randomly allocated in the 2 groups. After treatment, no differences were found in the blocked arm. Furthermore, CIMT group showed significant improvements in clinical and kinematic parameters. CONCLUSIONS:CIMT might be considered a safe and effective technique in MS patients.

Keywords: Multiple sclerosis, rehabilitation, upper extremity, muscle strength, physical therapy modalities, constraint-induced movement therapy, kinematics

DOI: 10.3233/NRE-192762

Journal: NeuroRehabilitation, vol. 45, no. 2, pp. 247-254, 2019