| Profoundly impaired motor dysfunction is a major consequence of stroke, functional training is the main method in clinical rehabilitation. Mainly neurodevelopment treatment (NDT) are rehabilitation traing techniques applying in clinic. These techniques have been showed that patients with hemiplegia were gotten beneficial from functional training in clinic, but patients can not finish activity of daily living in home environment. There was a difference in what the patients could do in clinic and what they did do at home.Each activity of daily living was less well performed in the home situation in 25%-45% cases.Most of neurodevelopment techniques were originated from clinical experiece, and not only lack whole of neurophysiological theory evidence but also lack of clinical experimental control research.Therefore it is too difficult to determine which one of NDT is most effective on stroke patients'functional recovery.Recently, Edward Taub developed a new neurorehabilitation technique termed Constraint-induced Movement Therapy (CIMT) which is applied behavioral psycholigical methods to neurorehabilition.By behavioral means of shaping,behavioral contract and restraining it successfully transfer motor ability trained in clinic to home and improve the motor function and activity of daily living in stroke patients.CIMT has been showed that it is the most effective rehabilitation technique, especially in improving motor function of chronic stroke patients with hemiparasis.A possible mechanism of CIMT is that behavioral factors of its might have an important role during treatment.By clinical research of CIMT on rehabilitaion in stroke patients with hemiplegia, this research is to observe rehabilitation effects of behavior factors of CIMT on upper extremity motor function, and to explore the relationship between behavior technique and motor function, and to provide the neurophysical mechanism of CIMT, and to provide the evidence and conditions of CIMT applied to rehabilitation in stroke patients.Is is valuable for clinic applyingt in rehabilitaion of stroke patients with hemiplegia.Method:50 chronic stroke patients with hemiplegia collected in CIMT laboratory (University of Alabama at Birmingham) from 2005 to 2006.Inclusion criteria:Clinical diagnosised as ischemic stroke and confirmed by CT or MRI; ages from 18 years old to 85 years old;at least 1 years after stroke with hemiplegia;shoulder flextion≥45°and abduction≥45°, elbow extension≥20°from a 90°flexed starting position, wrist extension≥20°, fingers extension of all MCP and IP(either PIP or DIP) joints≥10°, thumb extension or abduction of thumb≥10°; MAL score<2.5; other inclusion criteria from previous projects such as balance, cognitive skills, etc applied for.Exclusion criteria:Botox injections in the affected UE within 3 months of treatment;reocurrence of TIA,stroke,hemorrahagic,acute myocardial infarction,bone fracture,cosma,etc;serious mental disorders, serious cognitive disorders, dementia;receiving other rehabilitation treatment;patients and caregivers would not rely on this research.All cases were divided into 5 groups randomly by computer.10 cases in each group.Group1 (occupational therapy+behavioral technique) were treated with repetitive occupational therapy+behavior technique+restraining in clinic and home environment;group2 (shaping+ behavioral technique) were treated with shaping+behavior technique+restraining in clinic;group3 (CIMT) were treated with standard CIMT (shaping+behavioral technique+restraining in clinic and home environment); group4 (occupational therapy) were treated with occupational therapy;group5 (shaping) were treated with shaping+restraining in clinic+MAL post-treatment 1 month.All of groups were treated 3h/d, 5d/w, 2 weeks.Wolf motor function test (WMFT) was used to assess the motor function in stroke patients, functional abilility score (FA) was used to assess activity's ability and motor ability log (MAL) was used to assess the motor ability of patients at home.All groups were measured by WMFT and FA pre-and post-treatment.MAL were measured pre and post-treatment 1 day,post-treatment 6 months and 1 year.Gruop 1 (occupational therapy+behavioral technique), group3 (CIMT) and group 5(shaping) were measured by MAL post-treatment 1w, 2w, 3w and 4w.All data were analysized by SAS8.02 software bags.F test used to analysis measurement data, chi square test used to analysis enumeration data and repeated measures analysis of variance used to analysis comparison of MAL,WMFT and FA between and within groups.Result:①There were no significant difference in general of all groups (P>0.05), so all groups could be compared with each other.②Overall of MAL changes in all groups:there were significant improvement of MAL post-treatment compared with pre-treatmen(tP<0.01)in all groups.The best improvement of MAL is group3(CIMT), next is group1(occupational therapy+behavioral technique), group5 (shaping),group2 (shaping+restraining) and group4 (occupational therapy).MAL score has been showed significant improvement post-treatment 1 month especially post-treatment 4 weeks, next is post-treatment 1 day,6 months and 12 months.③MAL changes post-treatment 1 day:MAL score were improved post- treatment compared to those of pre-treatment in all groups (P<0.01), especially in group 3 (CIMT) presented significantly.It showed that different functional training were effective to improve motor function in stroke patients with hemiplegia, and of all, MAL improvement in group 3 (CIMT) showed most significantly.④MAL changes in group1(occupational therapy+behavioral technique),group3 (CIMT) and group5 (shaping) post-treatment 1 months:Compared to pre-treatment, MAL score were significantly improved in group1(occupational therapy+behavioral technique) and group3 (CIMT) (P<0.01), and group5 (shaping) did not show significance of MAL improvement (P﹥0.05). It demonstrated that CIMT and occupational therapy+behavioral technique could maintain the efficacy of treatment until post-treatment 1 months, but shaping could not maintain it.⑤MAL changes post-treatment 6 months:There were signicantly improvement of MAL post-treatment 6 months in group1 (occupational therapy+behavioral technique) and group3 (CIMT) compared to those in group2 (shaping+restraining),group4 (occupational therapy) and group5 (shaping) (P<0.01) which have showed that shaping and occupational therapy+behavioral technique could still improve the motor ability in stroke patients with hemiplegia until post-treatment 6 months;MAL score were decreased post-treatment 6 months in group2 (shaping+restraining),group4 (occupational therapy) and group5 (shaping), but MAL score in group5 (shaping) were a little higher than those of group2 (shaping+restraining) and group4 (occupational therapy) which seemed following of MAL behavioral technique every week post-treatment 1 months might play a role in improving funtion in stroke patients.⑥MAL changes post-treatment 1 year: there were showed significant improvement of MAL in group3 (CIMT) compared to those in group1,group2,group4 and group5 which showed CIMT could maintain the motor ability's improvement in stroke patients with hemiplegia until post-treatment 1 year.Above all, CIMT could maintain the motor ability's improvement in stroke patients with hemiplegia until post-treatment 1 year;occupational therapy+ behavioral technique could maintain the motor ability's improvement in stroke patients with hemiplegia post-treatment 6 months;shaping+1 month's MAL assessment(one of behavioral techniques) was a little superior to shaping or occupational therapy but could not maitain the efficacy of treatment after treatment 6 months.⑦There were no significant improvement of WMFT and FA in all groups pre- and post-treatment (P >0.05) that showed 2-week short-time functional training could not improve motor function of stroke patients with hemiplegia.Conclusion:①CIMT can significantly improve the motor ability in stroke patients and maintain the efficacy of treatment until post-treatment 1 year.The possible mechanism is:1) shaping,behavioral technique and restraining could play an important role in improving the motor function, especially behavioral technique might be the most important in it. 2) shaping and behavioral technique applied together may significantly improve the motor function ability of affected extremity. 3) only restraining might improve motor function but not significantly.This result will provide a new treatment trail in improving motor ability of upper extremity in chronic stroke patients with hemiplegia.②If applied with behavioral technique together, repetitive occupational therapy can significantly improve ability of motor function in stroke patients with hemiplegia and maintain it until post-treatment 6 months.③Short-time training can not significantly improve motor function.CIMT and occupational therapy can not improve motor function of stroke patients.④It concluded that rehabilitation of function in stroke patients can not rely on single training technique and also can not transfer motor function obtained in clinic to home environment.Therefore, training technique should be applied with behavioral techniques in order to significantly increase recovery of hemiplegia patients. Traditional rehabilitation considered that there were impossible to recover motor ability for stroke patients after 1 year. The results from this research which showed that CIMT could significantly improve the efficacy of motor ability in chronic stroke patients overturn the previous traditional rehabilitation thought and bring new hopes of rehabilitation to stroke patients. Behavioral technique of CIMT may much important role on maintaining efficacy of rehabilitation, especially when applied in neurorehabilitation could significantly improve motor ability and activity of daily living in stroke patients. This opinion would pave a new function rehabilitation road and renew traditional opinion which considered only function training can improve motor function.It is very significantly applied value for directing clinic rehabilitaion training in stroke patients with hemiplegia.
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