Conventional therapy to improve upper limb function following stroke is often not effective. Only 5% of people who survive a stroke but have severe paralysis regain upper limb function. No conventional therapy is better than another, but intensity is important Learnt non-use has been identified as an important factor in poor recovery. Constraint Induced Therapy (CIT), proposes that constraint of the unaffected arm and hand, coupled with intensive training of the hemiplegic limb, leads to behavioural changes towards greater use of the hemiplegic limb, neuroplastic cortical changes and return of function]. The theory has been tested in large RCTs which have showed improvement in function maintained at 12 months post-treatment.
Despite this convincing evidence the treatment has not translated into clinical practice. One reason is the cost of intensive (minimum 4 hours/day for 10 days) one-to-one treatment. Healthcare professionals consider the resources required to be a prohibitive barrier. A second barrier to adoption is concern about the comfort and safety of constraining the unaffected limb especially in the home environment. Professor Jane Burridge and the clinical lead at Farnham Hospital (Alison Burns) therefore designed and tested a low-cost, comfortable hand constraint that allowed gross movement such as holding a walking stick, but restricted manual tasks. Burns and Burridge then examined whether clinical benefit would be gained if the C-MIT was used in conjunction with a 2-week home-based exercise programme without intensive one-to-one therapy. In an A-B-A trial they found improvement in upper limb function during the intervention phase after correcting for background recovery, but patients reported lack of motivation to wear the C-MIT and comply with the exercise programme.
A team at the University of Southampton (led by Yardley) have developed a system (‘LifeGuide’) with the potential to address the motivational barriers to home-based CIT. The LifeGuide is a set of software resources that allows researchers and clinicians to create and modify programmes of personalised online support for therapy, without the need for costly dedicated programming. With core funding from the ESRC as part of the National Centre for e-Social Science, the pioneering LifeGuide programme commenced in May 2008 and has already been used to successfully develop a range of self-care and other health-related web-based interventions funded by the MRC, NIHR and EC and currently being trialled. Several of these were successfully designed to be engaging and accessible to people with no previous computer/internet experience, including older people.
The aim is to use LifeGuide to develop a web supported CIT system (‘LifeCIT’) for upper limb stroke rehabilitation, and carry out a pilot RCT across 6 NHS Trusts to test the efficacy of the intervention.
For more information see the Clinical trials website
For more information see the Life guide website