“It’s not what you’ve got; it’s what you use that makes a difference” according to motivational speaker Zig Ziglar. This point is important for stroke patients because most impact measurements focus on impairment, not potential. But recent research out of California shows that chronic phase stroke patients can use more and different movements than current therapy approaches recognize. Incorporating constraint therapy after stroke can help patients even in the chronic phase.
We tend to think of walking as simple movements in a line. Something that takes us from point A to point B. But walking is a complex activity involving three types of motion related to three different planes. One plane divides the body into the left and right side and controls forward and backward motions. Sit-ups and curls are examples of such activities. Another plane divides the body’s back and front and controls side to side motion. Leaning left or right and jumping jacks are such activities. A third plane cuts the body into top and bottom at the hips and involves rotational motion at the hips. Swinging a golf club is an example of this. Every step a person takes uses all three types of motions.
Traditionally, constraint-induced movement therapy uses a constraint mitt to limit a patient’s use of their stronger hand or arm during sessions. The idea is to force the patient to intensively use and learn to perform tasks with their weaker arm. Constraint-induced movement therapy has proven useful for patients with arm or hand problems but has not been tested for those with mobility problems until now. This study was able to use the concept of constraining movement for walking activities by using a device to make a treadmill narrower. This device limits the area where a patient can walk and forces a patient to use more back and forth motions while walking.
Researchers tested eight chronic phase stroke patients’ walking form on a treadmill at a comfortable speed for brief periods without constraint. Then they tested them again with the constraining device installed on the treadmill. They found that patients were able to adjust to the constraint and that their walking pattern characteristics actually improved. The practical, clinical takeaway is that constraint-induced movement therapy may help patients improve their walking form. But the more exciting implication of the study is that even post-acute stroke patients can learn to move in useful new ways that conventional therapy seldom practices or measures. Hopefully, researchers will tap this exciting potential as they come up with new ideas and approaches!
Limitations of the study include the small sample size and the fact that unconstrained walking was always tested first. Therefore, further research is needed. This technology is still in its testing phases, so is not offered as part of a regular program yet. However, we will keep you updated on new studies that come out on this topic and let you know when this type of therapy is widely available.
The first author of this study was Clarisa Martinez, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.