Affiliations: [a] Department of Psychology, School of Social and Behavioral Sciences, University of Alabama at Birmingham, AL, USA | [b] Department of Physical Therapy, School of Health Related Professions, University of Alabama at Birmingham, AL, USA | [c] Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, AL, USA | [x] Department of Psychology, School of Social & Behavioral Sciences, University of Alabama at Birmingham, AL, USA | [y] Department of Physical Therapy, School of Health Related Professions, University of Alabama at Birmingham, AL, USA
Correspondence:
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Address for correspondence: Mary H. Bowman, OTR/L, CI Therapy Research Group, CPM 712, 1530 3rd Ave. S., Birmingham, AL 35294-0018, USA. Tel.: +1 205 975 2177; Fax: +1 205 975 9791; E-mail: mbowman@uab.edu
Abstract: Constraint-Induced Movement therapy (CI therapy) is a recognized rehabilitation approach for persons having stroke with mild to moderately severe motor upper extremity deficits. To date, no rehabilitation treatment protocol has been proven effective that addresses both motor performance and spontaneous upper extremity use in the life situation for chronic stroke participants having severe upper extremity impairment with no active finger extension or thumb abduction. This case report describes treatment of a chronic stroke participant with a plegic hand using a CI therapy protocol that combines CI therapy with selected occupational and physical therapy techniques. Treatment consisted of six sessions of adaptive equipment and upper extremity orthotics training followed by a three-week, six-hour daily intervention of CI therapy plus neurodevelopmental treatment. Outcome measures included the Motor Activity Log for very low functioning patients (Grade 5 MAL), upper extremity portion of the Fugl-Meyer Motor Assessment, Graded Wolf Motor Function Test – for very low functioning patients (gWMFT- Grade 5), and Modified Ashworth Scale. The participant showed improvement on each outcome measure with the largest improvement on the Grade 5 MAL. In follow-up, the participant had good retention of his gains in motor performance and use of his more affected arm for real world activities after 3 months; after a one-week brush-up at 3 months, and at one year post-treatment.
Keywords: CI therapy, stroke, occupational therapy, physical therapy, plegic hand
