Modified constraint-induced therapy in subacute stroke: A case report

Objective: To determine the efficacy of a modified constraint-induced therapy (CIT) protocol administered to a patient with subacute stroke. Design: Multiple-baseline, before-after trial. Setting: Subacute outpatient clinic. Patient: A 68-year-old woman who had a left anterior cerebral artery infarct 5 months before study entry and who exhibited learned nonuse of the affected upper limb. Intervention: Thirty minutes of structured physical therapy and 30 minutes of occupational therapy 3 times a week for 10 weeks, each session emphasizing affected arm use. During the same period, her unaffected arm and hand were restrained 5d/wk during 5 hours initially identified as a time of frequent use. Main Outcome Measures: The Fugl-Meyer Assessment of Motor Recovery (FMA), Action Research Arm Test (ARA), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL). Results: The patient exhibited substantial improvements on the FMA and ARA. She also improved on the WMFT in her ability to perform tasks and in the time taken to complete the tasks. Amount and quality of arm use also improved, as measured by the MAL. Conclusions: Modified CIT may be an efficacious method of improving function and use of the affected arms of patients with learned nonuse.