Modification of Constraint Induced Movement Therapy in the Home Health Setting for a Subject with Chronic Hemiparesis after Stroke

Abstract

Constraint induced movement therapy (CIMT) has been found to be beneficial in upper extremity recovery of patients following a stroke. However, its feasibility in the home health setting has not been assessed. This prospective case study describes changes in upper extremity function with a modification of CIMT administered in the home health setting. The participant was an 83-year-old man 6 months post-stroke with left sided hemiparesis resulting from a right ischemic stroke. The residual left-sided weakness was complicated by pre-existing left shoulder pain due to osteoarthritis. He had not been able to return to many of his household chores and hobbies following the stroke. The intervention consisted of 1 hour functional task practice sessions in the participant's home 3 days each week for 5 weeks. A restraint of the less-affected arm was used for 5 hours each day during the intervention period. Activities that required use of the left upper extremity alone and activities that required the use of both upper extremities were included. Primary outcome measures used before and after the intervention included the Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT). Improvements were noted in both the MAL and WMFT following the intervention. The participant increased his ability to perform functional activities and household chores. The supervised practice of functional tasks in the participant's home provides a clinically-relevant option for home-based physical therapy of the geriatric patient with stroke. This case study showed that the modified CIMT was feasible in the home setting for our participant. Further research on CIMT interventions in the home setting should include repeated baseline measurements and a larger number of subjects.