Combined effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis.

Mary Ann Smith,Machiko R Tomita

doi:10.5195/ijt.2020.6300

Abstract

Telehealth use allows improved access to services and results in potential cost savings. The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy (mCIMT) program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity. Using a pre-experimental design with a 6-week intervention, 28 participants were assessed twice on use of upper extremity via subjective and objective measures. For the Motor Activity Log, the amount of use and quality of use were significant for Groups 1 and 2. Significant improvements were shown on the Wolf Motor Function Test (WMFT), the Fugl-Meyer UE, and the Functional Independence Measure (FIM) for both groups except for the strength subtest on the WMFT and the timed portion for Group 1. Percentages of attendance for telehealth and in-person sessions were also compared. Telehealth sessions had a higher attendance rate (84.5%) than in-person sessions (75.3%) (p=.004). The combined mCIMT program of telerehabilitation and in-person group sessions was effective in improving functional ability after a stroke.

Highlights

Telehealth use allows improved access to services and results in potential cost savings
The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity
The study conducted by Yu et al (2017) regarding the effect of modified Constrained Induced Movement Therapy (mCIMT) on subcortical cerebral infarction only required the participants to wear a mitt on their unaffected arm for 30% of their waking hours, whereas the studies by Nijand et al (2012), El-Helow et al (2015), and Smania et al (2012) mandated that their participants wear the constraining mitt for a minimum of 3 hours, 6 hours, and 12 hours a day, respectively

Summary

Introduction

Telehealth use allows improved access to services and results in potential cost savings. The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy (mCIMT) program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity. Research exploring the effects of deafferentation in primates led to the discovery of the phenomenon of “learned non-use,” in which an individual avoids the use of the affected limb due to pain, aversion, or repeated failure from previous attempts (Taub et al, 1994). This leads to the predominant use of the unaffected limb as a compensatory technique to overcome the lack of mobility in the affected upper limb (Nijland et al, 2013). Length of time of constraint, and length of mCIMT program resulted in improved tolerance and increased compliance with many participants (El-Helow et al, 2015; Yu et al, 2017)

Objectives

Methods

Results

Discussion

Conclusion