scholarly journals An Application of Upper-Extremity Constraint-Induced Movement Therapy in a Patient With Subacute Stroke

1999 ◽  
Vol 79 (9) ◽  
pp. 847-853 ◽  
Author(s):  
Sarah Blanton ◽  
Steven L Wolf
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Internal Capsule ◽  
Movement Therapy ◽  
Self Report ◽  
Full Potential ◽  
Posterior Limb ◽  
Constraint Induced Movement Therapy ◽  
Subacute Stroke

Abstract Background and Purpose. The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a “learned nonuse phenomenon.” Case Description. The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). Outcomes. For the Wolf Motor FunctionTest, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both “how well” and “how much” the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. Discussion. Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.

scholarly journals Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia

2003 ◽  
Vol 83 (4) ◽  
pp. 384-398 ◽  
Author(s):  
Nancy (McNamara) Bonifer ◽  
Kristin M Anderson
Keyword(s):  
Case Report ◽  
Motor Activity ◽  
Upper Extremity ◽  
Motor Function ◽  
Movement Therapy ◽  
Motor Deficits ◽  
Intensive Training ◽  
Constraint Induced Movement Therapy ◽  
Task Practice

Abstract 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.

scholarly journals Participant Perception of Recovery as Criterion to Establish Importance of Improvement for Constraint-Induced Movement Therapy Outcome Measures: A Preliminary Study

2007 ◽  
Vol 87 (2) ◽  
pp. 170-178 ◽  
Author(s):  
Stacy L Fritz ◽  
Steven Z George ◽  
Steven L Wolf ◽  
Kathye E Light
Keyword(s):  
Outcome Measures ◽  
Regression Models ◽  
Negative Likelihood Ratio ◽  
Movement Therapy ◽  
Self Report ◽  
Change Scores ◽  
Constraint Induced Movement Therapy ◽  
Starting Point ◽  
Cutoff Scores

Background and PurposeChanges in function following constraint-induced movement therapy (CIMT) are characterized primarily by improvements in performance; however, the importance of these outcome measures to the participant may be unclear. The primary purpose of this study was to determine whether either change scores or raw follow-up scores for the Motor Activity Log amount scale (MALa) and the Wolf Motor Function Test (WMFT) predicted participants’ self-reports of recovery of upper-extremity function at 4 to 6 months after starting CIMT.Subjects and MethodsThis study was a secondary analysis of a cohort of subjects (N=46) who participated in CIMT trials. Subjects completed measures at baseline and 4 to 6 months later. Hierarchical regression models determined whether change scores or raw follow-up scores of CIMT outcome measures were predictive of perceived recovery. Receiver operating characteristic (ROC) curves determined cutoff scores for measures that significantly contributed to participants’ reports of perceived recovery.ResultsThe regression models indicated that raw follow-up MALa scores (β=0.80, P=.024) and WMFT scores (β=−0.37, P=.03) contributed to perceived recovery. Proposed cutoff scores for the MALa scores were less than 1.15 (negative likelihood ratio [LR]=0.17) for predicting less than 50% recovery and greater than 2.50 (positive LR=2.75) for predicting 50% or greater recovery. Proposed cutoff scores for follow-up WMFT scores were greater than 34.0 seconds (negative LR=0.24) for predicting less than 50% recovery and less than 11.0 seconds (positive LR=5.96) for predicting 50% or greater recovery.Discussion and ConclusionRaw follow-up scores for the MALa and WMFT were better predictors of self-report of recovery in comparison with change scores. These data also serve as a starting point for developing cutoff scores that accurately predict self-report of recovery.

scholarly journals Can the Wolf Motor Function Test be Streamlined?

2009 ◽  
Vol 23 (5) ◽  
pp. 422-428 ◽  
Author(s):  
Kimberly Bogard ◽  
Steven Wolf ◽  
Qin Zhang ◽  
Paul Thompson ◽  
David Morris ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Movement Therapy ◽  
Change Score ◽  
Functional Level ◽  
Regression Methods ◽  
Constraint Induced Movement Therapy ◽  
Gender Concordance ◽  
Function Test ◽  
Wolf Motor Function Test

Background. To assess upper extremity (UE) capabilities following stroke, the Wolf Motor Function Test (WMFT) measures time to complete 15 UE tasks and 2 strength tasks, but takes 30 to 45 minutes for the clinician to complete. Objective. In an effort to streamline the WMFT, this study evaluated the association between the magnitude of improvement on any timed task of the WMFT and the change score on all other tasks among participants in the Extremity Constraint Induced Therapy Evaluation (EXCITE) trial. Methods. This association was evaluated using regression methods according to chronicity and controlling for key covariates (functional level, gender, concordance) for log mean WMFT scores. Results. After controlling for covariates, 6 tasks (hand to table [front], hand to box [front], reach and retrieve, lift can, lift pencil, and fold towel) influenced the overall WMFT score for survivors meeting EXCITE criteria and treated within 3 to 9 months poststroke. Six different tasks (extend elbow weight, hand to box [front], lift can, lift pencil, turn key in lock, and fold towel) influenced the overall WMFT score for those receiving constraint-induced movement therapy (CIMT) 1 year later. The importance of certain tasks relative to others may best represent overall UE function, but this streamlining enables the clinician to prioritize these tasks in the evaluation. Conclusions. The delineation of those tasks depends on the time poststroke from enrollment to CIMT. This study demonstrates that the WMFT can be streamlined from 17 to 6 tasks.

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