Which is More Effective– Sling or Voluntary Constraint Induced Movement Therapy?

 A randomized, prospective, single-centre, blinded observer rated study was conducted by Maciej Krawczyk etal of the IInd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland and the Department of Neurology of the Medical University of Warsaw, Poland.
The objective of the study was to determine whether a combination of constraint-induced movement therapy (CIMT) and physiotherapy for stroke patients using different constraint regimens ( voluntary versus sling  constraint) reduces or changes  motor deficits, the amount of functional use of the arm and also whether the effects of treatment continue after a 12 month period.
 Forty-seven stroke patients were randomly divided into intensive physiotherapy treatments focused on regaining arm functions.
The test ocurred in the Neurorehabilitation Unit of IInd Department of Neurology at the Institute of Psychiatry and Neurology in Warsaw.
 Patients were randomly allocated to either regimen.
 Massed practice with the paretic arm was conducted for 5 hours per day for 15  days. The sling-constraint group had their arm immobilized in a hemi-sling during the therapy process. Also, individual,  physiotherapy sessions lasting one hour were conducted in both groups.
The results showed that there  was no significant difference between groups after therapy for the sling group or for the voluntary-constraint group. All treated patients retained mean gains after 12 months follow-up.
The conclusion drawn was that the voluntary activity constraint in the intact arm is equivalent to sling, standard constraint during massed practice of the paretic arm.
Alternatively, the HANDTUTOR has been an effective device to be used together with CIMT. It, together with its sister devices, the ARMTUTOR, LEGTUTOR and 3DTUTOR, aims to increase the amount of use and quality of movement of the weaker arm or limb by following a structured treatment program.
The treatment program works by  ‘rewiring’  the brain. This means that a larger part of the brain becomes active when producing movement of the weaker arm. This program is underpinned by several research studies which have proven benefits, particularly for stroke patients and CP patients.
The program involves a number of components. In particular the use of repetitive training practice or repetitive impairment practice. This involves the child or adult doing intensive customized repetitive isolated exercises with the weaker arm  using the ARMTUTOR and the hand using the HANDTUTOR.  The exercise practice is customized by the physical and occupational therapists to the patient’s movement ability. The dedicated rehabilitation software provides information on the patient’s performance and corrects the patient in the form of biofeedback when they are not doing the movement correctly. This means that the training practice is customized to the patient’s movement ability regarding  their functional ability. The patient can also begin to understand how he is progressing. This allows the patient and PT to  do more intensive and motivating exercise practice.  Research has proven that such intensive and repetitive use of the weaker arm over this short period leads to increased use of the weaker arm as well as improved quality of movement. The TUTORS have been used effectively together with CIMT training and therapy and most recently at the Rusk Rehabilitation Hospital children’s summer camp.
The TUTORS are currently being used in leading hospitals and clinics in the U.S. and Europe and are fully certified by the FDA and CE. The TUTOR system can also be used in the patient’s home through telerehabilitation.
See WWW.MEDITOUCH.CO.IL for more information
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