The EXCITE trial was the lead article in last week's JAMA. It looks at a 2 week program of contstraint induced movement therapy vs. usual care in patients suffering a cva within the previous 3-9 months. Pt's in the treatment arm wore a restraining mitt on the less-affected hand and engaged in tasks/behaviors with the hemiplegic hand. This group was compared to a control group with usual care. Measures of performance time and motor function ability all showed clinically relevant improvements that persisted out to 1 year.
Commentary By Rob Staudinger, M.D. Program Director, NYU Neurology Residency, Associate Chief of Neurology at the Veterans Affairs NYHHS.
Stroke is the leading cause of disability in the US. Currently used rehabilitation treatments generally are based on empirical approaches rather than validated therapies. The EXCITE (Extremity Constraint Induced Therapy Evaluation) trial is interesting in several ways. It is the first multisite randomized study to demonstrate the efficacy of a rehabilitative intervention. It included patients who had the first stroke in the previous 3-9 months and therefore suggests that more recovery after a stroke is possible than we currently teach. The study included only patients with limited disability and it remains to be seen if this approach, based on the concept of neuronal plasticity, holds promise for more severely affected patients.