Characterizing the intervention protocol for early modified Constraint Induced Movement Therapy in the EXPLICIT-stroke trial

On behalf of the EXPLICIT-stroke consortium. A complete list of the EXPLICIT-stroke consortium is provided at the end. The EXPLICIT mCIMT intervention protocol Chapter 6 98 6 ABSTRACT Constraint-induced movement therapy (CIMT) is a commonly used rehabilitation intervention to improve upper limb recovery after stroke. CIMT was originally developed for patients with a chronic upper limb paresis. Although there are indications that exercise interventions should start as early as possible after stroke, only a few randomized controlled trials have been published on either CIMT or modified forms of CIMT (mCIMT) during the acute phase after stroke. The implementation of (m)CIMT in published studies is very heterogeneous in terms of content, timing, and intensity of therapy. Moreover, mCIMT studies often fail to provide a detailed description of the protocol applied. The purpose of the present article is therefore to describe the essential elements of the mCIMT protocol as developed for the EXplaining PLastICITy after stroke (EXPLICIT-stroke) study. The EXPLICIT-stroke mCIMT protocol emphasizes restoring body functions, whilst preventing the development of compensatory movement strategies. More specifically, the intervention aims to improve active wrist and finger extension, which are assumed to be key factors for upper limb recovery. The intervention starts within 2 weeks after stroke onset. The protocol retains 2 of the 3 key elements of the original CIMT protocol, i.e. repetitive training and the constraining element. Repetitive task training is applied for 1 hour per working day, and the patients wear a mitt for at least 3 hours per day for 3 consecutive weeks.