|
|
Home Forced Use in an Outpatient Rehabilitation Program for Adults with Hemiplegia: A Pilot Study
Samuel R. Pierce
Department of Research, Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA, 19140. spierce{at}shrinenet.org
Kara G. Gallagher
Susan W. Schaumburg
Arthur M. Gershkoff
John P. Gaughan
Lori Shutter
The objective of this study was to examine the effectiveness of a program of traditional outpatient neurological rehabilitation that included home forced use. In total, 17 patients with chronic stroke and 1 patient with subacute stroke (mean time poststroke = 27.6 months) completed an individualized program consisting of seven 2-hour treatment sessions composed of 1 hour of occupational therapy and 1 hour of physical therapy. Therapy sessions were completed over a 2- to 3-week period and included instruction on the use of a restraining mitt at home during functional activities. The Wolf Motor Function Test (WMFT) was used to assess upper extremity impairment and function at baseline, midway through treatment, and posttreatment. Patients demonstrated statistically significant improvements (P < 0.05 corrected for multiple comparisons) in mean time for completion in 12 of 17 WMFT subtasks when comparing baseline to posttreatment. The preliminary results suggest that the forced-use component of constraint-induced therapy may be effective when applied within a traditional outpatient rehabilitation program. However, additional investigation is required to examine the effectiveness of using forced use within typical outpatient rehabilitation under more experimentally controlled conditions.
Key Words: Rehabilitation • Arm • Cerebrovascular
References
- 1. Taub E. Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine. In: Ince, LP, editor. Behavioral psychology in rehabilitation medicine: clinical applications. New York: Williams & Wilkins; 1980. p. 371-401.
- 2. Sterr A, Freivogel S, Schmalohr D. Neurobehavioral aspects of recovery: assessment of the learned nonuse phenomenon in hemiparetic adolescents. Arch Phys Med Rehabil 2002;83:1726-1731.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 3. Dromerick AW, Edwards DF, Hahn M. Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after stroke? Stroke 2000;31:2984-2988.[Abstract/Free Full Text]
- 4. Blanton S, Wolf SL. An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Phys Ther1999;79:711-713.
- 5. Taub E, Miller NE, Novack TA, Cook EW, Fleming WC, Nepomuceno CS, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehab 1993;74:347-354.[Web of Science][Medline]
[Order article via Infotrieve]
- 6. Miltner WHR, Bauder H, Sommer M, Dettmers C, Taub E. Effects of constraint-induced movement therapy on chronic stroke patients: a replication. Stroke1999;30:586-592.[Abstract/Free Full Text]
- 7. Page SJ, Levine P, Sisto S, Bond Q, Johnston MV. Stroke patients’ and therapists’ opinions of constraint-induced movement therapy. Clin Rehabil2002;16:55-60.[Abstract/Free Full Text]
- 8. Page SJ, Sisto S, Johnston MV, Levine P, Hughes M. Modified constraint induced therapy in subacute stroke: a case report. Arch Phys Med Rehabil2002;83:286-290.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 9. Page SJ, Sisto S, Johnston MV, Levine P. Modified constraint-induced therapy after subacute stroke: a preliminary study. Neurorehabil Neural Repair2002;16:290-295.[Abstract/Free Full Text]
- 10. Pierce SR, Daly K, Gallagher KG, Gershkoff AM, Schaumburg SW. Constraint-induced therapy for a child with hemiplegic cerebral palsy: a case report. Arch Phys Med Rehabil2002;83(10):1462-1463.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 11. Sterr A, Freivogel S, Voss A. Exploring a repetitive training regime for upper limb hemiparesis in an inpatient setting: a report on three case studies. Brain Inj2002;16:1093-1107.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 12. Morris DM, Uswatte G, Crago JE, Cook EW, Taub E. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil2001;82:750-755.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 13. Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke. Stroke 2001;32:1635-1639.[Abstract/Free Full Text]
- 14. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol1990;45(6):M192-M197.
- 15. Foreman MD. Reliability and validity of mental status questionnaires in elderly hospitalized patients. Nurs Res 1987;36(4):216-220.[Web of Science][Medline]
[Order article via Infotrieve]
- 16. Davies PM. Steps to follow: a guide to the treatment of adult hemiplegia. Berlin, Germany: Springer-Verlag; 1985.
- 17. Armitage P, Berry G. Statistical methods in medical research. 3rd ed. Cambridge, MA: Blackwell Science; 1994.
- 18. Conover WJ, Iman RL. Rank transformations as a bridge between parametric and nonparametric statistics. Am Statistician1981;35:124-129.[CrossRef][Web of Science]
- 19. Harter HL. Expected values of normal order statistics. Biometrika1961;48:151-165.[Free Full Text]
- 20. Winer BJ, Brown DR, Michels KM. Statistical principles in experimental design. 3rd ed. New York: McGraw-Hill; 1991.
- 21. Wolf SL, Lecraw DE, Barton L, Jann BB. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exper Neurol1989;104:125-132.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 22. Whyte J, Hart T. It’s more than a black box; it’s a Russian doll: defining rehabilitation treatments. Am J Phys Med Rehabil2003;82:639-652.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 23. Taub E, Uswatte G. Constraint-induced movement therapy and massed practice. Stroke2000;31:986-988.[Web of Science][Medline]
[Order article via Infotrieve]
- 24. Page SJ, Sisto S, Levine P. Modified constraint induced therapy in chronic stroke. Am J Phys Med Rehabil 2002;81:870-875.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 25. Blanton S, Wolf SL. An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Phys Ther1999;79(9):711-713.
- 26. Liepert J, Bauder H, Wolfgang HR, Miltner WH, Taub E, Weiller C. Treatment-induced cortical reorganization after stroke in humans. Stroke2000;31:1210-1216.[Abstract/Free Full Text]
- 27. Levy CE, Nichols DS, Schmalbrock PM, Keller P, Chakeres DW. Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraintinduced movement therapy. Am J Phys Med Rehabil 2001;82:4-12.
Neurorehabilitation and Neural Repair, Vol. 17, No. 4,
214-219 (2003)
DOI: 10.1177/0888439003259424
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
S. J Page, P. Levine, A. Leonard, J. P Szaflarski, and B. M Kissela
Modified Constraint-Induced Therapy in Chronic Stroke: Results of a Single-Blinded Randomized Controlled Trial
Physical Therapy,
March 1, 2008;
88(3):
333 - 340.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Burns, J. Burridge, and R. Pickering
Does the use of a constraint mitten to encourage use of the hemiplegic upper limb improve arm function in adults with subacute stroke?
Clinical Rehabilitation,
October 1, 2007;
21(10):
895 - 904.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. T. Kaplon, M. G. Prettyman, C. L. Kushi, and C. J. Winstein
Six hours in the laboratory: a quantification of practice time during constraint-induced therapy (CIT)
Clinical Rehabilitation,
October 1, 2007;
21(10):
950 - 958.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. L. Wolf, C. J. Winstein, J. P. Miller, S. Blanton, P. C. Clark, and D. Nichols-Larsen
Looking in the Rear View Mirror When Conversing With Back Seat Drivers: The EXCITE Trial Revisited
Neurorehabil Neural Repair,
October 1, 2007;
21(5):
379 - 387.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. L Wolf
Revisiting Constraint-Induced Movement Therapy: Are We Too Smitten With the Mitten? Is All Nonuse "Learned"? and Other Quandaries
Physical Therapy,
September 1, 2007;
87(9):
1212 - 1223.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. L. Wolf, C. J. Winstein, J. P. Miller, E. Taub, G. Uswatte, D. Morris, C. Giuliani, K. E. Light, D. Nichols-Larsen, and for the EXCITE Investigators
Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.
JAMA,
November 1, 2006;
296(17):
2095 - 2104.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Brogardh and B. H Sjolund
Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use
Clinical Rehabilitation,
March 1, 2006;
20(3):
218 - 227.
[Abstract]
[PDF]
|
|
|
|
|
