Constraint Induced Movement Therapy Based Telerehabilitation Practices in Stroke Patients

Abstract

Functional disorders in the upper extremity after stroke greatly affect the daily lives of patients. There are many approaches that target functional recovery in the upper extremity after stroke. Technology-based approaches such as virtual reality, robotic rehabilitation and telerehabilitation, especially neurodevelopmental approaches such as Bobath, Constraint Induced Movement Therapy (CIMT), Proprioceptive Neuromuscular Facilitation (PNF), are among these approaches. When we examine the literature, the method with the highest level of evidence among these approaches is CIMT.
Although CIMT is a method with high evidence value and known to have very high clinical outcomes, the most important question that comes to mind with the Covid-19 pandemic entering our lives and face-to-face physiotherapy applications becoming risky has been whether we can apply this approach in a way to achieve the same effective results as telerehabilitation. It is seen that researchers asked this question before the pandemic and started some studies, albeit at the level of pilot studies. The aim of this review is to examine the basic principles of CIMT and telerehabilitation and to present the combination of these two applications by reviewing the literature.

Keywords

• Stroke
• Upper Extremity
• Telerehabilitation
• Modified-Constraint Induced Movement Therapy.

İnme Hastalarında Kısıtlayıcı Zorunlu Hareket Tedavisi Temelli Telerehabilitasyon Uygulamaları

Abstract

İnme sonrası üst ekstremitede meydana gelen fonksiyonel bozukluklar hastaların günlük yaşamlarını büyük oranda etkilemektedir. İnme sonrası üst ekstremitede fonksiyonel geri dönüşü hedefleyen pek çok yaklaşım bulunmaktadır. Bobath, Kısıtlayıcı Zorunlu Hareket Tedavisi (KZHT), Proprioseptif Nöromusküler Fasilitasyon (PNF) gibi nörogelişimsel yaklaşımlar başta olmak üzere, sanal gerçeklik, robotik rehabiliasyon ve telerehabilitasyon gibi teknoloji temelli yaklaşımlar bu yaklaşımların başında gelmektedir. Literatürü incelediğimizde bu yaklaşımlar arasında kanıt düzeyi en yüksek yöntem KZHT’dir.
KZHT kanıt değeri yüksek, klinik çıktıları çok fazla olduğu bilinen bir yöntem olsa da Covid-19 pandemisinin yaşamlarımıza girmesi ve yüz yüze fizyoterapi uygulamalarının riskli hale gelmesi ile akla gelen en önemli soru bu yaklaşımın telerehabilitasyon yolu ile aynı etkin sonuçlar elde edecek şekilde uygulayıp uygulayamayacağımız olmuştur. Araştırmacıların pandemi öncesinde de bu soruyu sordukları ve pilot çalışmalar seviyesinde olsa da bazı çalışmaları başlattıkları görülmektedir. Bu derlemenin amacı KZHT’nin ve telerehabilitasyonun temel prensiplerini incelemek ve bu iki uygulamanın kombinasyonu ile ilgili literatür incelemesi yaparak sunmaktır.

Keywords

• İnme
• Üst ekstremite
• Telerehabilitasyon
• Modifiye-Kısıtlayıcı Zorunlu Hareket Tedavisi

References

1. 1. Sudlow, C. L. M., & Warlow, C. P. (1996). Comparing stroke incidence worldwide: what makes studies comparable?. Stroke, 27(3), 550-558.
2. 2. World Health Organization. (2000). The world health report 2000: health systems: improving performance. World Health Organization.
3. 3. Broeks, G. J., Lankhorst, G. J., Rumping, K., Prevo, A. J. H. (1999). The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil, 21(8), 357-364.
4. 4. Kwakkel, G., Kollen, B. J., Wagenaar, R. C. (1999). Therapy impact on functional recovery in stroke rehabilitation: a critical review of the literature. Physiotherapy, 85(7), 377-391.5.
5. 5. Henderson, A., Korner-Bitensky, N., Levin, M. (2007). Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery. Top Stroke Rehabil, 14(2), 52-61.
6. 6. Juenger, H., Linder-Lucht, M., Walther, M., Berweck, S., Mall, V., Staudt, M. (2007). Cortical neuromodulation by constraint-induced movement therapy in congenital hemiparesis: an FMRI study. Neuropediatrics, 38(03), 130-136.
7. 7. Könönen, M., Tarkka, I. M., Niskanen, E., Pihlajamäki, M., Mervaala, E., Pitkänen, K., & Vanninen, R. (2012). Functional MRI and motor behavioral changes obtained with constraint‐induced movement therapy in chronic stroke. Eur J Neurol, 19(4), 578-586.
8. 8. Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702.

9. 9. Johansson, T., Wild, C. (2011). Telerehabilitation in stroke care–a systematic review. J Telemed Telecare, 17(1), 1-6.
10. 10. Taub, E., Miller, N. E., Novack, T. A., Cook, E. W., Fleming, W. C., Nepomuceno, C. S., et all. (1993). Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil, 74(4), 347-354.
11. 11. Hüseyinoğlu, B.E., (2010) İnmeli hastalarda üst ekstremite iyileşmesi üzerine Kısıtlayıcı-Zorunlu Hareket Tedavisi ve Bobath Tedavi yaklasımının etkileri. (Doktora Tezi). İstanbul Üniversitesi, İSTANBUL.
12. 12. Munk, H., (1909) Über die functionen von Hirn und Rückenmark: Gesammelte mitteilungen. Hirschwald.
13. 13. Ogden, R., & Franz, S. I. (1917). On cerebral motor control: The recovery from experimentally produced hemiplegia. Psychobiology, 1(1), 33.
14. 14. Knapp, H. D., Taub, E., Berman, A. J. (1963). Movements in monkeys with deafferented forelimbs. Exp Neurol, 7(4), 305-315.
15. 15. Taub, E. (1980). Somatosensory deafferetation research with monkeys: implications for rehabilitation medicine. Behavioral psychology in rehabilitation medicine: Clinical application.
16. 16. Fritz, S. L., Butts, R. J., Wolf, S. L. (2012). Constraint-induced movement therapy: from history to plasticity. Expert Rev Neurother, 12(2), 191-198.
17. 17. Kwakkel, G., Veerbeek, J. M., van Wegen, E. E., Wolf, S. L. (2015). Constraint-induced movement therapy after stroke. Lancet Neurol, 14(2), 224-234.
18. 18. Taub, E., & Uswatte, G. (2000). Constraint-induced movement therapy and massed practice. Stroke, 31(4), 983-991.
19. 19. Morris, D. M., Taub, E., Mark, V. W. (2006). Constraint-induced movement therapy: characterizing the intervention protocol. Eura Medicophys, 42(3), 257.
20. 20. Page, S. J., Sisto, S., Johnston, M. V., Levine, P., Hughes, M. (2002). Modified constraint-induced therapy in subacute stroke: a case report. Arch Phys Med Rehabil, 83(2), 286-290.
21. 21. Page, S. J., Boe, S., Levine, P. (2013). What are the “ingredients” of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations. Restor Neurol Neurosci, 31(3), 299-309.
22. 22. Morris, D. M., & Taub, E. (2001). Constraint-induced therapy approach to restoring function after neurological injury. Top Stroke Rehabil, 8(3), 16-30.
23. 23. Page, S. J., Sisto, S., Levine, P., Johnston, M. V., & Hughes, M. (2001). Modified constraint induced therapy: a randomized feasibility and efficacy study. J Rehabil Res Dev, 38(5), 583-590.
24. 24. Blanton, S., Wolf, S. L. (1999). An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Phys Ther, 79(9), 847-853.
25. 25. Page, S. J., Levine, P., Sisto, S., Bond, Q., Johnston, M. V. (2002). Stroke patients' and therapists' opinions of constraint-induced movement therapy. Clin Rehabil, 16(1), 55-60.
26. 26. Shi, Y. X., Tian, J. H., Yang, K. H., Zhao, Y. (2011). Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: a systematic review and meta-analysis. Arch Phys Med Rehabil, 92(6), 972-982.
27. 27. Sirtori, V., Corbetta, D., Moja, L., & Gatti, R. (2009). Constraint‐induced movement therapy for upper extremities in stroke patients. Cochrane Database Syst Rev, 7(4).
28. 28. Brennan, D. M., Mawson, S., Brownsell, S. (2009). Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation, and self management. Stud Health Technol Inform, 2009(145), 231-248.
29. 29. Russell, T. G. (2009). Telerehabilitation: a coming of age. J Physiother, 55(1), 5-6.
30. 30. Ricker, J. H., Rosenthal, M., Garay, E., DeLuca, J., Germain, A., Abraham-Fuchs, K., et all. (2002). Telerehabilitation needs: a survey of persons with acquired brain injury. J Head Trauma Rehabil, 17(3), 242-250.
31. 31. Torsney, K. (2003). Advantages and disadvantages of telerehabilitation for persons with neurological disabilities. NeuroRehabilitation, 18(2), 183-185.
32. 32. Jin, W., Chen, J., Shi, F., Yang, W., Zhang, Y., Liu, Y., ... & Ren, C. (2015). Home-based tele-supervising rehabilitation for brain infarction patients (HTRBIP): study protocol for a randomized controlled trial. Trials, 16(1), 1-8.
33. 33. Chatto, C. A., York, P. T., Slade, C. P., & Hasson, S. M. (2018). Use of a telehealth system to enhance a home exercise program for a person with Parkinson disease: a case report. Journal of Neurologic Physical Therapy, 42(1), 22-29.
34. 34. van Beek, J. J. W., van Wegen, E. E. H., Rietberg, M. B., Nyffeler, T., Bohlhalter, S., Kamm, C. P., ... & Vanbellingen, T. (2020). Feasibility of a home-based tablet app for dexterity training in multiple sclerosis: Usability study. JMIR mHealth and uHealth, 8(6), e18204.
35. 35. Pickett, T. C., Davis, S. B., Fritz, S. L., Malcolm, M. P., Ketterson, T. U., Light, K. E., et all. (2007). Telehealth and Constraint-Induced Movement Therapy (CIMT) An Intensive Case Study Approach. Clin Gerontol, 31(1), 5-20.
36. 36. Uswatte, G., Taub, E., Lum, P., Brennan, D., Barman, J., Gilmone, B., ... & Mark, V. W. (2013). Poster 45 Telerehabilitation Versus Outpatient Delivery of Constraint-Induced Movement therapy: Update on a Randomized Controlled Trial. Arch Phys Med Rehabil, 94(10), 27-28.
37. 37. Smith, M. A., & Tomita, M. R. (2020). Combined effects of telehealth and modified constraint-induced movement therapy for individuals with chronic hemiparesis. Int J Telerehabil, 12(1), 51.
38. 38. Page, S. J., & Levine, P. (2007). Modified constraint-induced therapy extension: using remote technologies to improve function. Arch Phys Med Rehabil, 88(7), 922-927.
39. 39. Handelzalts, S., Ballardini, G., Avraham, C., Pagano, M., Casadio, M., & Nisky, I. (2021). Integrating tactile feedback technologies into home-based telerehabilitation: opportunities and challenges in light of COVID-19 pandemic. Frontiers in Neurorobotics, 15, 4.
40. 40. Bersano, A., Kraemer, M., Touzé, E., Weber, R., Alamowitch, S., Sibon, I., & Pantoni, L. (2020). Stroke care during the COVID‐19 pandemic: experience from three large European countries. Eur J Neurol, 27(9), 1794- 1800.