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Constraint-induced movement therapy for the lower extremities in multiple sclerosis: case series with 4-year
Victor W Mark1, Edward Taub, Gitendra Uswatte
1Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL 35294-7330, USA. vwmark@uab.edu
Objective:
To evaluate in a preliminary manner the feasibility, safety, and efficacy of Constraint-Induced Movement therapy (CIMT) of persons with impaired lower extremity use from multiple sclerosis (MS).
Design:
Clinical trial with periodic follow-up for up to 4 years.
Setting:
University-based rehabilitation research laboratory.
Participants:
A referred sample of ambulatory adults with chronic MS (N=4) with at least moderate loss of lower extremity use (average item score ≤6.5/10 on the functional performance measure of the Lower Extremity Motor Activity Log [LE-MAL]).
Interventions:
CIMT was administered for 52.5 hours over 3 consecutive weeks (15 consecutive weekdays) to each patient.
Main Outcome Measures:
The primary outcome was the LE-MAL score at posttreatment. Secondary outcomes were posttreatment scores on laboratory assessments of maximal lower extremity movement ability.
Results:
All the patients improved substantially at posttreatment on the LE-MAL, with smaller improvements on the laboratory motor measures. Scores on the LE-MAL continued to improve for 6 months afterward. By 1 year, patients remained on average at posttreatment levels. At 4 years, half of the patients remained above pretreatment levels. There were no adverse events, and fatigue ratings were not significantly changed by the end of treatment.
Conclusions:
This initial trial of lower extremity CIMT for MS indicates that the treatment can be safely administered, is well tolerated, and produces substantially improved real-world lower extremity use for as long as 4 years afterward. Further trials are needed to determine the consistency of these findings.
