Effectiveness of a distributed practice model utilizing combit protocol on tone and function of hemiplegic upper limb -A randomized comparison trial

Hemiplegia following stroke leads to impairments in tone and motor function of the affected upper limb. Recently, Constraint-induced Movement Therapy (CIMT) and Bimanual Training (BIT) has been proved to have a positive effect on upper limb function. But these approaches have limitations in the clinical application of transfer of function. A hybrid model of therapy combining the effects of CIMT and Bimanual training needs to be studied. Combined Modified Constraint-induced Movement Therapy along with Bimanual Intensive Training (COMBiT) a form of distributed practice model needs to be compared with a standard Practice Hand Arm Bi Manual Training (HABIT) model to determine its effectiveness.

To study the effects of training utilizing a distributed practice model with three weeks of mCIMT followed by one week of BIT over a standard 4-week HABIT program on tone and function of Hemiplegic upper limb.

Thirty patients were randomly allocated into two groups, Group A-COMBiT Group and Group B-HABIT Group with 15 patients in each group. Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Frenchay Arm Test (FAT), Grip Strength (GS), Nine Hole Peg Test (NHPT), and Finger Tapping Rate (FTR) were measured as Pre-test and post-test scores.

With-in group comparisons showed significant reductions in spasticity in both groups. Significant improvements in function were noted in FMA, FIM, FAT, GS, NHPT and FTR. COMBiT had significant improvement on MAS, FIM, FAT, GS, NHPT and FTR.

From the findings of this study, it can be concluded that COMBiT, a distributed practice program can be more useful in reducing spasticity and improving Upper limb function when compared with a structured program like HABIT.