by Adam Ahlgren, Jeremy Durst, Susie Serbus, Todd Sirrine, & David Windandy
The purpose of this two-phase, sequential, mixed methods study was to obtain quantitative and qualitative information regarding the effects of two therapeutic interventions, constraint-induced movement therapy (CIMT) and modified constraint-induced movement therapy (mCIMT), on hand function. CIMT and mCIMT are forms of therapy that aim to overcome learned nonuse by retraining the affected extremity through forced use. CIMT uses neurorehabilitation and motor recovery techniques as the therapy invention, while constraining the non-affected upper extremity.
CIMT techniques use repetition with the affected extremity to improve motor recovery and functional performance in the affected extremity. A traditional CIMT program consists of two weeks of skilled therapy for five days a week, six hours a day, and involves use of a constraint at home for 90% of waking hours. A mCIMT involves four weeks of skilled therapy for five days a week, three hours a day, and involves the use of a constraint at home for the top 5-6 arm use hours of the day.
This study utilized a mixed methods approach in which both quantitative and qualitative data were gathered. The quantitative data were obtained through a quasi-experimental, nonequivalent, two-group pretest-posttest design, which did not involve randomization of the subjects into study groups. A descriptive, qualitative approach was used to obtain data regarding the participants' perceived changes in hand function and independence in performing ADLs pre- to post-intervention. Four subjects participated in the traditional CIMT program, and four participated in the modified CIMT program.
The quantitative data from the two experimental groups (CIMT and mCIMT) were analyzed using descriptive statistics. The averages of the pre- and post-intervention scores on the seven Wolf Motor Function Test (WMFT) subtests for the CIMT/mCIMT groups were calculated. The CIMT group displayed a decrease in the average time required to perform 4 of the 6 selected time-based subtests of the Wolf Motor Function Test. The participants in the CIMT program also displayed slight improvements in average grip strength. The mCIMT experimental group lowered their average time to complete 5 of the 6 selected time-based subtests of the Wolf Motor Function Test, and also displayed an average grip strength increase of nearly 10 kilograms.
After analyzing the qualitative data gathered through the participant journals and post-treatment focus group, seven general themes were identified. The seven themes identified were (1) a dramatic decrease of participation in areas of work and leisure; (2) an increase in use of the affected hand; (3) a more positive perception of themselves; (4) expectations being met during therapy; (5) an increase in social networking; (6) feelings of having a routine again; and (7) therapy can be "fun."
Interpretation of Results
The researchers concluded that both CIMT and mCIMT may be effective forms of treatment to improve hand function in individuals who have experienced a stroke. The subjects did express they were using their affected extremity more spontaneously, and had noticed an increase in the quality of movement, after participating in CIMT and mCIMT.
Directions for Future Research
The researchers recommend further studies be conducted focusing on hand function as an outcome to CIMT/mCIMT. In particular, randomized controlled trials with larger sample sizes should be performed that measure hand function as an outcome with CIMT. Future research should examine the effects of CIMT on hand function in further detail. Range of motion of all digits and electromyographic studies of the muscles in the hand after CIMT may also be good measurements of outcomes following this program.
The authors of this study would like to thank all of the participants in this study for their time, effort, and commitment. They would also like to acknowledge the IRB for allowing the opportunity to conduct the research. We wish to thank the supervising staff. This includes Dr. Donald Earley, OTD, MA, OTRL, for his time, dedication, and guidance in CIMT; Ellen Herlache, MA, OTRL, for guiding intervention sessions, and assisting with research protocols. Additionally, we would like to thank Jill Ewend, OTRL, CBIS, for her lab management, assistance with participants, and guidance. Furthermore, we would like to thank all of the participants for their time, dedication, and willingness to participate in this study.