cMIT and Stroke Patients

The treatment approach is constraint-induced movement therapy as an early option for patients’ post-stroke. The kind of scoring to help determine a patient’s functional level is the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) (Auwal Abdullahi, 2014). To identify level of physical ability, this scoring system allows for assessment of balance, joint functioning, and motor functioning around 4 months after stroke. Patients will have initial pre-intervention motor function score taken (FMA) and then given the treatment modality.
It is important to continually assess motor function starting at the beginning of intervention, then in the middle and finally towards the end of intervention for a total of two weeks (Yue, Liu, Huai, Gao, & Zhang, 2017). Some barriers/obstacles are related to the type of therapy involved. Modified Constraint-Induced Movement Therapy (mCIMT) is a method used to improve a patient’s mobility and functionality in the often more affected upper extremity post stroke (Borch, Thrane, & Thornquist, 2015). Potential barriers revolve around the Mitt being left on for 90% of the day. Many patients take issue with having the Mitt on for so long. Additionally the intensive task-specific training that can last 6 hours a day for five days each week can lead to negative emotions and stress (Borch, Thrane, & Thornquist, 2015). Lastly, the therapy is resource intense and of high cost compared to other therapeutic protocols (Ju & Yoon, 2018).
Hesitancy of staff/family to use restraints can be alleviated by using the Mitt to promote least restricting restraint. Patients give consent to restrain hand, especially for 90% of the day. Such long duration of patient restraint involved education of family and staff along with patient consent. Safety comfort level must be assessed throughout the two-week period (Singh & Pradhan, 2013). Drivers for change to mCIMT are that it leads to be better health outcomes. Research shows faster, improved outcomes with mCIMT through increased independence of patient that equals to higher quality of life (Singh & Pradhan, 2013) (Borch, Thrane, & Thornquist, 2015).
References
Auwal Abdullahi, S. S. (2014). Standardizing the Protocols of Constraint Induced Movement Therapy in Patients within 4 Months Post-stroke: A Pilot Randomized Controlled trial. International Journal of Physical Medicine & Rehabilitation, 02(04). doi:10.4172/2329-9096.1000215
Borch, I. H., Thrane, G., & Thornquist, E. (2015). Modified constraint-induced movement therapy early after stroke: Participants’ experiences. European Journal of Physiotherapy, 17(4), 208-214. doi:10.3109/21679169.2015.1078843
Ju, Y., & Yoon, I. (2018). The effects of modified constraint-induced movement therapy and mirror therapy on upper extremity function and its influence on activities of daily living. Journal of Physical Therapy Science, 30(1), 77-81. doi:10.1589/jpts.30.77
Singh, P., & Pradhan, B. (2013). Study to assess the effectiveness of modified constraint-induced movement therapy in stroke subjects: A randomized controlled trial. Annals of Indian Academy of Neurology, 16(2), 180. doi:10.4103/0972-2327.112461
Yue, S., Liu, X., Huai, J., Gao, J., & Zhang, Y. (2017). Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials. Neural Regeneration Research, 12(9), 1443. doi:10.4103/1673-5374.215255