The Effect of Constraint-Induced Movement Therapy(CIMT) With Cognitive-Perceptual Training on Upper Extremity Function of Stroke Patients With Mild Cognitive Impairment

경도 인지손상을 가진 뇌졸중 환자의 상지 기능에 미치는 강제유도운동치료(CIMT)와 인지-지각 훈련의 병행 효과

  • Kim, Hun-Ju (Department of Occupational Therapy, Dongju College) ;
  • Shin, Joong-Il (Department of Occupational Therapy, Choonhae College of Health Science) ;
  • Kam, Kyung-Yoon (Department of Occupational Therapy Graduate School, FIRST research group, Institute of Aged Life Redesign, U-Healthcare Research Center, Inje University)
  • 김훈주 (동주대학 작업치료과) ;
  • 신중일 (춘해보건대학 작업치료과) ;
  • 감경윤 (인제대학교 의생명공학대학 작업치료학과, FIRST연구사업단, 고령자라이프리디자인 연구소, 유비쿼터스-헬스케어 연구소)
  • Received : 2011.10.06
  • Accepted : 2011.12.13
  • Published : 2011.12.31


The purpose of this study is to examine effects of constraint-induced movement therapy(CIMT) and/or cognitive-perceptual training(CPT) on the change of hand function in cerebrovascular accident(CVA) patients and to evaluate the change in the amount and quality of use of the affected upper extremity in performing daily living tasks. The subjects of study were 10 patients who had been under rehabilitation for more than three months after CVA onset. They were all determined as mild cognition impairment according to NCSE or MVPT test. For CIMT group, to restrict the movement of the unaffected hand the subjects had been worn modified resting arm-splint in daytime for 4 weeks. For CIMT+CPT group, the subjects were performed CPT with CIMT and control group had been under conventional occupational therapy for the same period. CIMT+CPT group showed significant improvement in simulated feeding, lifting large light objects, and lifting large heavy objects of Jebsen-Taylor Hand Function Test. CIMT group also showed significant improvement compared with control group. The mean changes of the amount of use(AOU) of the affected arm had a statistically significant difference among groups (p<.05). While CIMT+CPT group had the biggest change in the quality of movement(QOM) of upper extremity of the affected side, CTL group showed the smallest change. Both CIMT and CIMT+CPT groups had statistically significant difference in the change in the quality of movement in upper extremity of affected side with CTL group(p<.05), but there was not significant difference between CIMT group and CIMT+CPT group. CIMT performed to the patients of stroke, with mild impairment in cognitive perceptual abilities showed the improvement in hand movement and AOU and QOM of upper extremity in the affected side and the combination of CIMT with CPT showed synergic effects.


CIMT;cognitive-perceptual training;stroke;Motor Activity Log


  1. Kwakkel G, Wagenaar RC, Kollen BJ, & Lankhorst GJ. Predicting disability in stroke-A critical review of the literature. Age Ageing, 25(6):479-489, 1996.
  2. Taub E, Uswatte G. Constraint-induced movement therapy and massed practice. Stroke, 31:983-991, 2000.
  3. Taub E, Uswatte G, & Pidikiti R. Constraint-induced movement therapy: A new family of techniques with broad application to physical rehabilitation-a clinical review. J Rehabil Res Dev, 36(3):237-251, 1999.
  4. Page SJ, Sisto SA, Levine P, Johnston MV, & Hughers M. Modified constraint induced therapy: a randomized feasibility and efficacy study. J Rehabil Res Dev, 38(5):583-590, 2001.
  5. Page SJ, Sisto S, Johnston MV, Levine P, & Hughes M. Modified constraint induced movement therapy in subacute stroke: a case report. Arch Phys Med Rehabil, 83(2):286-290, 2002.
  6. Page SJ, Sisto S, Levine P, & McGrath RE. Efficacy of modified constraint induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Arch Phys Med Rehabil, 85(1):14-18, 2004.
  7. Classen J, Liepert J, Wise SP, Hallett M, & Cohen LG. Rapid plasticity of human cortical movement representation induced by practice. J Neurophysiol, 79(2):1117-1123, 1998.
  8. Wittenberg GF, Chen R, Ishii K, Bushara KO, Eckloff S, Taub E, et al. Constraint-induced movement therapy in stroke: Magnetic stimulation motor maps and cerebral activation. Neurorehabil Neural Repair, 17(1):48-57, 2003.
  9. Paik NJ. Neuromodulation and brain plasticity. Brain Neurorehabil, 1(1): 12-19, 2008.
  10. Kim YH. Mechanism of neurolasticity after brain injury and neurorehabilitation. Brain NeuroRehabil. 1(1): 6-11, 2008.
  11. Perfetti C. La rieducazione motoria dell'emiplegico (The motor rehabilitation of hemiplegia). Milano: Ghedini. 1979.
  12. Siev E, Freishtat B, & Zoitan B. Perceptual and cognition dysfunction in the adult stroke patient: a manual for evaluation and treatment. New Jersey: Slack Inc. 1986.
  13. Han TR, Kim JH, Seong DH, Chun MH. The Correlation of the Mini-Mental State Examination (MMSE) and functional outcome in the stroke patients. Kor Acad Rehabil Med, 16:118-122, 1992.
  14. Baik JY. The effect of transfer of training approach on cognitive function and functional recovery of stroke patients with cerebral infarction and intracerebral hemorrhage. J Kor Acad Occup Ther, 9(1):11-24, 2001.
  15. Wolf SL, Winstein CJ, Miller JP, Thompson PA, Taub E, Uswatte G, et al. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomized trial. Lancet Neurol, 7(1):33-40, 2008.
  16. Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, & Howard LA. An objective and standardized test of hand function. Arch Phys Med Rehabil, 50(6):311-319, 1969.
  17. Uswatte G, Taub E, Morris D, Vignolo M, & McCulloch K. Reliability and validity of the upper-extremity motor activity log-14 for measuring real-world arm use. Stroke, 36(11):2493-2496, 2005.
  18. Feys HM, De Weerdt WJ, Selz BE, Cox Steck GA, Spichiger R, Vereeck LE, et al. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke, 29(4):785-792, 1998.
  19. Kim JR, Jung MY, Lee JS & Yoo EY. Comparison of Effect Between Constraint-induced Movement Therapy (CIMT) and Forced Used (FU) Therapy for Hemiplegic Stroke Patients. J Kor Acad Occup Ther, 16(2):1-13, 2008.
  20. Nys GM, van Zandvoort MJ, de Kort PL, van der Worp HB, Jansen BP, Algra A, et al. The prognostic value of domain-specific cognitive abilities in acute first-ever stroke. Neurology, 64(5):821-827, 2005.
  21. Page SJ, Levine P, & Leonard A. Mental practice in chronic stroke: results of a randomized, placebocontrolled trial. Stroke, 38(4):1293-1297, 2007.
  22. Broeks JG, Lankhorst GJ, Rumping K, & Prevo AJ. The long term outcome of arm function after stroke: Results of a follow-up study. Disabil Rehabil, 21(8):357-364, 1999.
  23. Miltner WH, Bauder H, Sommer M, Dettmers C, & Taub E. Effect of constraint-induced movement therapy on patient with chronic motor deficits after stroke. Stroke, 30(3):586-592, 1999.