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PubMed2003

Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia.

BACKGROUND AND PURPOSE: Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. CASE DESCRIPTION: The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. METHODS: The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. OUTCOMES: Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. DISCUSSION: This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.

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PubMed2003

Mobility and muscle strength contralateral to hemiplegia from stroke: benefit from self-training with family support.

OBJECTIVE: To determine whether patient exercise with the support of family members maximizes mobility and improves muscle strength in the nonparetic lower limb after stroke. DESIGN: Comparison of improvement at 2 wk between conventional exercise sessions and a program also including the participation of family members. Subjects were 60 patients rendered nonambulatory by severe hemiparesis from their first stroke. Of these, 42 had family members participating in their therapy. Lower limb strength was measured on the nonparetic side using an isokinetic machine. Mobility status was assessed using the Rivermead Mobility Index. Patients were evaluated at the first inpatient gym session and again at 1 and 2 wk. RESULTS: At the first evaluation, lower limb strength and the Rivermead Mobility Index score did not differ between the two groups. Reevaluations were conducted at 1 and 2 wk after the first evaluation. Patients' strength and mobility improved more when family members participated. CONCLUSION: Family participation is an important contributor to stroke rehabilitation.

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