Therapeutic efficacy of modified Constraint Induced Movement Therapy on patients with gait dysfunction in the stroke population: A randomized clinical trial

Abstract

Background: Post-stroke complications often include gait dysfunction due to impaired motor control, balance, and mobility, significantly affecting patients’ independence and quality of life. Constraint-induced movement therapy (CIMT), a motor rehabilitation technique, is often used to restore impaired limb motor function after and reduce learned nonuse. Building upon the success of CIMT in upper extremity rehabilitation for stroke patients, modified CIMT (mCIMT) has been introduced for lower extremity training in stroke patients. However, there is still not enough strong evidence to prove how effective mCIMT is for lower extremity rehabilitation, and more research is needed. Objectives: To evaluate the therapeutic efficacy of modified Constraint Induced Movement Therapy (mCIMT) for the lower extremity in patients with gait dysfunction in the stroke population. Methodology: A single-blind randomized clinical trial was conducted at CRP, Savar, Bangladesh, involving 42 stroke patients (22 in the experimental group and 20 in the control group). The experimental group received mCIMT with conventional physiotherapy, while the control group received only conventional therapy. The outcome measures were evaluated by the ten-meter walk test, timed up and go test, single limb stance test and functional ambulation category. Results: After the 16 sessions of intervention, significant improvements were observed in the experimental group. Between-group analysis: the Timed Up and Go test and the 10-meter walk test showed statistically significant improvements in the experimental group (p = 0.038 and p = 0.029). On the other hand, the between-group analysis, the single limb stance test for the affected limb and unaffected limb, the p-value was 0.124 and 0.001. Lastly, between-group analysis: the functional ambulation category showed statistically not significant improvements in the experimental group (p = 0.172). Discussion: The findings suggest that modified Constraint-Induced Movement Therapy (mCIMT) helps stroke patients improve their walking ability more than conventional physiotherapy alone. Patients who received mCIMT showed better balance, faster walking, and to encouraged to use their weaker leg, helping to reduce the habit of avoiding it (known as "learned non-use"). Because mCIMT uses simple exercises and doesn’t require expensive equipment, it can be a useful and practical treatment method, especially in resource-limited settings like Bangladesh. Keywords: stroke, gait dysfunction, modified constraint-induced movement therapy.