Summary
The goal of this clinical trial is to learn how a partially self-supervised constraint-induced movement therapy (sCIMT) program in adults with arm and hand weakness will work after stroke. This study will look at whether the program can help people improve the use of their arm and hand after a stroke while requiring less time with a therapist. The main questions it aims to answer are:
* Does the sCIMT program help people use their affected arm and hand better - after a stroke?
* Do participants feel that the sCIMT program is useful, easy to follow, and a good fit for their recovery needs?
* Does taking part in the sCIMT program improve participants' quality of life and daily well-being?
Participants will:
* Take part in a therapy program 5x/week for 2 weeks. The program is designed to help improve the use of the arm and hand affected by stroke.
* Wear a mitt on the stronger hand during certain practice activities to encourage use of the weaker hand.
* Complete surveys and tests before and after the program to measure arm and hand use, experiences with the program, and quality of life.
Eligibility Criteria
Age Range: 18 years to 85 years
Inclusion Criteria:
* Sustained a first-time ischemic or hemorrhagic stroke ≥2 weeks prior to study enrollment
* Age ≥18 and ≤85
* Moderate UE hemiparesis as defined by a score ≥13 and ≤47 on the modified UE section of the Fugl-Meyer Assessment (60-point scale with no reflex testing)
* Ability to actively extend impaired wrist ≥10 degrees
* UE strength and active range of motion within functional limits on the non-hemiparetic side
* Ability to follow two-step commands (visual or verbal) as determined by the clinical investigator
* Nonuse of the more impaired UE as evidenced by an average score ≤2.5 on the Motor Activity Log Amount of Use Scale.
Exclusion Criteria:
* Excessive pain in the affected shoulder, arm, or hand as measured by a score ≥6 on a 10-point visual analogue scale
* Unable to passively reach neutral position for wrist extension and forearm supination
* Excessive spasticity in the affected wrist or finger flexors/extensors and elbow flexors, as defined as a score of \>2 on the Modified Ashworth Scale (MAS)
* Inability to actively participate in regular therapy sessions (e.g., due to medical complexity, insufficient endurance, transportation, etc.) as determined by participant or by clinical judgement of the evaluating therapist
* Receiving occupational therapy services for the hemiparetic UE during the two-week intervention window (including after pre-assessment and before post-assessment)
* Received focal anti-spasticity drug injection (e.g., Botox) to any muscles of the impaired UE within the past 1 month (or plan to at some point during study enrollment)
* Comorbid diagnosis in addition to stroke (e.g., dementia, peripheral neuropathy) that in the opinion of the investigator could impact study results
* Presence of moderate to severe unilateral spatial neglect as indicated by clinical observation or failure on a standardized screening tool (e.g., Line Bisection Test or Bells Test).