Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol
Background/Aim: Currently, there are limited evidence-based protocols for improving upper extremity (UE) motor function after stroke. The Keys protocol, a distributed form of constraint-induced movement therapy (CIMT), delivers CIMT components in fewer hours per day over an extended period, fitting...
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MDPI AG
2025-01-01
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| author | Sarah dos Anjos Mary Bowman David Morris |
| author_facet | Sarah dos Anjos Mary Bowman David Morris |
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| description | Background/Aim: Currently, there are limited evidence-based protocols for improving upper extremity (UE) motor function after stroke. The Keys protocol, a distributed form of constraint-induced movement therapy (CIMT), delivers CIMT components in fewer hours per day over an extended period, fitting outpatient rehabilitation schedules and third-party payor models. This pilot study aimed to assess the effectiveness of the Keys protocol in enhancing UE capacity and performance poststroke. Methods: Ten adults with chronic stroke (>6 months) participated in an 8-week intervention. The protocol included 22 supervised training sessions (1.5 h each): 4 days/week for 4 weeks, 2 days/week for weeks 5–6, and 1 day/week for weeks 7–8. Participants wore a restraint mitt on the less-affected UE during waking hours and used an adapted transfer package. Outcome measures included the Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), Stroke Impact Scale (SIS), and Zung Depression Scale, assessed pre-treatment, mid-treatment (4 weeks), and posttreatment. Results: Significant improvements were observed in SIS Strength, ADLs/IADLs, Mobility, and Hand Function domains, exceeding MCID thresholds. Memory and Communication domains improved significantly at the 3-month follow-up. WMFT performance times improved, with fewer incomplete tasks. MAL scores for Amount of Use and Quality of Movement increased across all time points. Depressive symptoms significantly decreased posttreatment. Conclusions: The Keys protocol effectively improves UE use, motor function, mood, and quality of life, with the greatest gains observed mid-intervention. These findings support its feasibility and potential for outpatient stroke rehabilitation (ClinicalTrials.gov Registration: NCT05311384). |
| format | Article |
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| institution | Kabale University |
| issn | 2076-3425 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-9ddeafc552b44031b9f2a8f00aa131fa2025-01-24T13:25:56ZengMDPI AGBrain Sciences2076-34252025-01-011518710.3390/brainsci15010087Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment ProtocolSarah dos Anjos0Mary Bowman1David Morris2Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USADepartment of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USADepartment of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USABackground/Aim: Currently, there are limited evidence-based protocols for improving upper extremity (UE) motor function after stroke. The Keys protocol, a distributed form of constraint-induced movement therapy (CIMT), delivers CIMT components in fewer hours per day over an extended period, fitting outpatient rehabilitation schedules and third-party payor models. This pilot study aimed to assess the effectiveness of the Keys protocol in enhancing UE capacity and performance poststroke. Methods: Ten adults with chronic stroke (>6 months) participated in an 8-week intervention. The protocol included 22 supervised training sessions (1.5 h each): 4 days/week for 4 weeks, 2 days/week for weeks 5–6, and 1 day/week for weeks 7–8. Participants wore a restraint mitt on the less-affected UE during waking hours and used an adapted transfer package. Outcome measures included the Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), Stroke Impact Scale (SIS), and Zung Depression Scale, assessed pre-treatment, mid-treatment (4 weeks), and posttreatment. Results: Significant improvements were observed in SIS Strength, ADLs/IADLs, Mobility, and Hand Function domains, exceeding MCID thresholds. Memory and Communication domains improved significantly at the 3-month follow-up. WMFT performance times improved, with fewer incomplete tasks. MAL scores for Amount of Use and Quality of Movement increased across all time points. Depressive symptoms significantly decreased posttreatment. Conclusions: The Keys protocol effectively improves UE use, motor function, mood, and quality of life, with the greatest gains observed mid-intervention. These findings support its feasibility and potential for outpatient stroke rehabilitation (ClinicalTrials.gov Registration: NCT05311384).https://www.mdpi.com/2076-3425/15/1/87constraint-induced movement therapystrokerehabilitationupper extremity |
| spellingShingle | Sarah dos Anjos Mary Bowman David Morris Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol Brain Sciences constraint-induced movement therapy stroke rehabilitation upper extremity |
| title | Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol |
| title_full | Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol |
| title_fullStr | Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol |
| title_full_unstemmed | Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol |
| title_short | Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol |
| title_sort | effects of a distributed form of constraint induced movement therapy for clinical application the keys treatment protocol |
| topic | constraint-induced movement therapy stroke rehabilitation upper extremity |
| url | https://www.mdpi.com/2076-3425/15/1/87 |
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