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Forcing stroke victims to use the weak arm makes it stronger in the long run

Updated:
KISSIMMEE, Florida (AP) _ It sounds cruel: binding a stroke victim's good arm to force use of the weak one.

But those who tried it for two weeks were better off in the long run, greatly improving their ability to do everyday tasks like answering the phone, doctors reported Saturday.

Attending an American Stroke Association conference, they presented the results of the first large study of the treatment, called constraint or ``forced-use'' therapy. It is especially promising because it involves no drugs or surgery and therefore is relatively free of risk.

``About 23 to 30 percent of the stroke population would appear to benefit from this kind of treatment,'' said Dr. Steven Wolf, a stroke rehabilitation specialist at Emory University in Atlanta who led the study.

More than 5 million Americans have suffered a stroke _ 700,000 occur each year _ and many are left with paralyzed or weak arms and legs.

Ordinary physical therapy helps rehabilitate them but only up to a point because of the brain damage a stroke causes. And if a stroke victim becomes reluctant to use an impaired limb, ``there's a learned suppression of movement'' that gradually makes the situation even worse, Wolf explained.

Doctors wondered whether forcing patients to use the weak arm might encourage the brain to rewire itself and send more signals to restore movement. Two small studies gave encouraging results, and Wolf's large nationwide study was launched.

He and researchers at seven other medical centers around the country randomly assigned 222 people who had suffered moderate strokes in the previous 3 to 9 months to get standard rehabilitation therapy or the forced-use treatment, either right away or a year later.

The forced-use group had their ``good'' arms immobilized with a splint-like mitt for two weeks while they received six hours of intense physical therapy a day on their weak arms.

The amount and quality of movement the participants had in their wrists, shoulders, arms and fingers were assessed before and after treatment began. To be sure they were getting an accurate picture, researchers videotaped participants' movements at times when they did not know they were being observed.

The result was that both groups improved with therapy but patients who had their strong arms constrained improved more and by every measure, Wolf said. They completed far more movement tests within the two minutes allowed for each task, he said.

Wolf would not give details because they are soon to be published in a major medical journal.

However, a videotape shown at the conference of a man at the start of the study showed him awkwardly trying to grasp a phone, repeatedly knocking it off the cradle as he struggled to wrap spastic fingers around the receiver. It took him a minute and 11 seconds.

Six weeks after the forced-use treatment, the man appears in a second video, more smoothly wrapping his hand around the device and pressing numbers to make a call.

Researchers are still analyzing whether those who got the treatment a year after their strokes improved as much as those who got it sooner. That's an important issue for insurance reasons, said Dr. Daniel Hanley, a Johns Hopkins University stroke expert who had no role in the study.

``Many don't get insurance if they don't start rehabilitation within 30 days'' of the stroke, he explained, ``and they're often cut off early if they're not improving.''

``The data looked encouraging,'' said Dr. Steven Warach, a stroke researcher at the National Institute of Neurological Disorders and Stroke, the federal agency that funded the study.

But specialists will be better able to analyze how good the treatment really may be once the details are published, he said.
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