IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 2, Issue 6 (Nov. – Dec. 2013), PP 39-44 www.iosrjournals.org www.iosrjournals.org 39 | Page Effect Of Distributed Model Of Constraint Induced Movement Therapy For Subacute Stroke Patients Muthuukaruppan Muthiah 1* , Vikram Mohan 2 , Moses Arun Kumar 3 1, School of Physiotherapy, Faculty of Allied Health Professions, AIMST University, Semeling, Kedah, Malaysia. 2, Department of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia. 3, College of Physiotherapy, Meenakshi University, Virugambakkam, Chennai, India. Abstract Background: Constraint-induced movement therapy (CIMT) has proved to increase the amount and quality of function of an affected upper extremity after stroke by overcoming learned non-use to bring about functional reorganization of the primary motor cortex. The objective of the study was to examine the effects of distributed model of CIMT in improving upper extremity (UE) functions in subacute stroke and to study the importance of constraint in improving the upper extremity function. Methods: Sixteen subjects with subacute stroke were recruited based on the inclusion and exclusion criteria. Subjects were assigned to the experimental (constraint) group and the control (non-constraint) group using random sampling method. Subjects in the constraint & the non-constraint group were provided therapy for 3 hours with repetitive functional task practice. The subjects in the constraint group wore the constraint for 5hrs/day on their less affected UE which included 2 hrs at home and 3 hrs during repetitive functional task practice for 20days. The non-constraint group did not wear the constraint. Three UE subscales of the motor assessment scale were used to measure the activity level of the more affected arm pretest & posttest. Results: The results expressed that the constraint group significantly improved with P = 0.008 (P<0.01) than the non-constraint group, which emphasizes that distributed model of constraint induced movement therapy could facilitate the UE function after stroke in subacute patients. Conclusion: The constraint group significantly improved than the non-constraint group, which emphasizes that distributed model of CIMT could improve the upper extremity function after stroke in subacute patients Keywords: Constraint induced movement therapy, upper extremity function, subacute stroke and repetitive functional task practice I. Introduction Upper extremity (UE) dysfunction among stroke population reduces patient’s independence and has an impact on activities of daily living and quality of life. 1 Muscle weakness and loss of dexterity are important factors for the reduced upper extremity function in stroke patients. 2 Activities such as grasping, holding, and manipulating objects are daily functions of upper extremity, lacking in 55% to 75% of patients with 3 to 6 months following stroke. 3 Hence, strategies to improve upper extremity function among stroke population are necessitated to ameliorate motor recovery as motor recovery will decelerate in subacute (>3 months) and chronic (>1 year) stroke phases. 4,5 Traditional neurophysiological approaches developed by Bobath, Brunstrom, Rood & Kabat for enhancing recovery in stroke rehabilitation, lack to date scientific evidence. 6,7 Research in facilitating neuroplasticity led to the development of new movement therapy protocols inducing crucial neural and motor recovery. Movement therapy protocols like the task specific training, CIMT, and mental imagery have convincing evidence for their role in neural reorganization and associated motor and functional recovery. 8,9,10 Movement therapy protocols based on motor learning principles are capable of facilitating neural reorganization post stroke. 11,12 Motor learning refers to permanent changes in behavior that occurs due to practice & experience. 13 Movement therapy protocols target deficits in the neuromuscular system and use repetition or an experience for improving skilled motor activity. 14 Repetitive practice for reaching to a glass of water improves the elbow extension, causes structural and functional changes in the motor cortex and cerebellum. Such changes are indicative of motor recovery, which is permanent. 15 Changes are not found with simple exercises, such as performing elbow flexion extension without any goal. 16 These findings aided in developing upper extremity rehabilitation protocols for stroke with increasing exercise duration and intensity 17,18,19 focusing on task-specific training. 20