Modified Constraint-Induced Therapy for the Lower Extremity in Elderly Persons With Chronic Stroke: Single-Subject Experimental Design Study

Background: Studies have demonstrated improvements in arm motor function after constraint-induced (Cl) therapy. Few studies of Cl therapy for lower extremity conditions have been done. Our purpose was to evaluate the effect of modified Cl therapy for the lower extremity in terms of motor control in elderly persons with chronic stroke. Method: A single-subject experimental AB design was used, with 3 months of follow-up. The A phase consisted of a baseline period of 2 weeks with 6 measurements, and the B phase was a 4-week intervention with 8 measurements. Two men and 1 woman were included. The intervention consisted of intensive rehabilitation of the affected leg for 2 hours each weekday. A whole-leg orthosis was used to immobilize the nonaffected leg. The following tests were conducted: a step test for dynamic balance, Fugl-Meyer assessment for lower-extremity motor function, the Timed Up and Go test for mobility, and the 6-minute and 10-meter walk tests for walking ability. Statistical significance was analyzed by using Shewhart charts with a 2 standard deviation band method. Results: A positive change was observed in 14 of 18 variables. Significant improvements existed in 7 of the 14 positively changed variables. Positive changes remained in 13 of 14 variables at the 3-month follow-up evaluation. Conclusion: Modified Cl therapy may result in positive changes in balance and motor function in elderly persons with chronic stroke.