Profoundly impaired motor dysfunction is a major consequence of stroke. As a result, a large number of the more than 700,000 people in America sustaining a stroke each year have limitations in motor ability and compromised quality of life. Therapeutic interventions designed to enhance motor function and promote independent use of an impaired upper extremity following stroke are quite limited. There is a need to translate unique behavioral techniques shown to have impact on plasticity in the nervous system into practical, evidence-based, therapeutic interventions, especially at a time when the duration and number of treatments have been retracted. One such technique, derived from basic research with animals and human subjects has produced results that can substantially reduce the incapacitating deficits of many patients with chronic stroke and can increase their independence. The techniques, termed Constraint-Induced (CI) Movement Therapy or Forced Use, involve motor restriction of the less affected upper extremity for two weeks. Over this time, repetitive use of the more affected upper extremity is promoted for many hours a day. This treatment produces long-lasting improvements in real world extremity use among patients who are more than 1 year post-stroke and who have an ability to initiate some extension in wrist and digit joints. This intervention has never been studied across facilities systematically, nor has it been applied to sub-acute patients. Pilot work from 6 sites indicates that CI therapy may be as effective for sub-acute patients, 3-6 months post-stroke, as it is for more chronic patients. This prospective, 5-year, randomized national clinical trial, including 2-year follow-up will use a crossover design. Sub-acute patients with stroke with at least minimal ability to extend at wrist and digits (N=240) will be randomly assigned to receive CI therapy or the customary care normally available to them; 40 patients will be tested at each of 6 sites. One year after intake, control patients will be crossed over to receive CI therapy. All patients will be stratified into equal numbers of higher and lower functioning patients, categorized by movement criteria. Primary outcome measures are a laboratory motor function test and amount of extremity use in the real world setting. Changes in psychosocial functioning will also be measured.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD037606-03
Application #
6521185
Study Section
Special Emphasis Panel (ZHD1-DRG-A (SW))
Program Officer
Ansel, Beth
Project Start
2000-04-01
Project End
2005-03-31
Budget Start
2002-04-01
Budget End
2003-03-31
Support Year
3
Fiscal Year
2002
Total Cost
$1,449,453
Indirect Cost
Name
Emory University
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
042250712
City
Atlanta
State
GA
Country
United States
Zip Code
30322
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Lang, Kimberly C; Thompson, Paul A; Wolf, Steven L (2013) The EXCITE Trial: reacquiring upper-extremity task performance with early versus late delivery of constraint therapy. Neurorehabil Neural Repair 27:654-63
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Wolf, Steven L; Thompson, Paul A; Estes, Emily et al. (2012) The EXCITE Trial: analysis of ""noncompleted"" Wolf Motor Function Test items. Neurorehabil Neural Repair 26:178-87
Woodbury, Michelle; Velozo, Craig A; Thompson, Paul A et al. (2010) Measurement structure of the Wolf Motor Function Test: implications for motor control theory. Neurorehabil Neural Repair 24:791-801
Wolf, Steven L; Thompson, Paul A; Winstein, Carolee J et al. (2010) The EXCITE stroke trial: comparing early and delayed constraint-induced movement therapy. Stroke 41:2309-15
Schweighofer, Nicolas; Han, Cheol E; Wolf, Steven L et al. (2009) A functional threshold for long-term use of hand and arm function can be determined: predictions from a computational model and supporting data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial. Phys Ther 89:1327-36
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Bogard, Kimberly; Wolf, Steven; Zhang, Qin et al. (2009) Can the Wolf Motor Function Test be streamlined? Neurorehabil Neural Repair 23:422-8

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