Combined Effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis
Telehealth use allows improved access to services and results in potential cost savings. The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy (mCIMT) program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity. Using a pre-experimental design with a 6-week intervention, 28 participants were assessed twice on use of upper extremity via subjective and objective measures. For the Motor Activity Log, the amount of use and quality of use were significant for Groups 1 and 2. Significant improvements were shown on the Wolf Motor Function Test (WMFT), the Fugl-Meyer UE, and the Functional Independence Measure (FIM) for both groups except for the strength subtest on the WMFT and the timed portion for Group 1. Percentages of attendance for telehealth and in-person sessions were also compared. Telehealth sessions had a higher attendance rate (84.5%) than in-person sessions (75.3%) (p=.004). The combined mCIMT program of telerehabilitation and in-person group sessions was effective in improving functional ability after a stroke.
Almhdawi, K., Mathiowetz, V., & Bass, D. (2014). Assessing abilities and capabilities: Motor planning and performance. In Radomski, M. V. & Trombly Latham, A. (Eds.), Occupational Therapy for Physical Dysfunction (7th ed., pp. 243-253) Philadelphia: Lippincott Williams & Wilkins.
American Occupational Therapy Association (2019). CMS reverses decision, denies telehealth therapy coverage in Medicare Advantage, Federal News and Legislative Updates. https://www.aota.org/Advocacy-Policy/Congressional-Affairs/Legislative-Issues-Update/2019/CMS-MA-Rule-Fails-To-Cover-Therapy-Telehealth.aspx
American Occupational Therapy Association. (2018). Telehealth in occupational therapy. American Journal of Occupational Therapy, 72(Suppl. 2). https://doi.org/10.5014/ajot.2018.72S219
Benjamini, Y. & Hochberg. Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, 57(1), 289-300. https://doi 289-300. doi.org/10.1111/j.2517-6161.1995.tb02031.x
Benjamini, Y. & Hochberg, Y. (2000). On the adaptive control of the false discovery rate in multiple testing within dependent statistics. Journal of Educational Behavior, Statistics, 25, 60-83. http://links.jstor.org/sici?sici=1076-9986%28200021%2925%3A1%3C60%3AOTACOT%3E2.0.CO%3B2-N
Benjamini, Y. & Yekutieli, D. (2001). The control of the false discovery rate in multiple testing under dependency. The Annals of Statistics, 29(4), 1165-1188. http:// www.jstor.org/stable/2674075
Bonifer, N. & Anderson, K. (2003). Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia. Physical Therapy, 83(4), 384–398, http://doi.org/10.1093/ptj/83.4.384
Bowman, M. H., Taub, E., Uswatte, G., Delgado, A., Bryson C., Morris, D.M., McKay, S., & Mark, V.W. (2006). A treatment for a chronic stroke patient with a plegic hand combining CI therapy with conventional rehabilitation procedures: Case report. NeuroRehabilitation, 21,167-176. doi: 10.3233/NRE-2006-21208
Brennan, D.M., Lum, P.S., Uswatte, G., Taub, E., Gilmore, B.M., & Barman, J. (2011, August 30-September 3). A telerehabilitation platform for home-based automated therapy of arm function [Conference session]. 33rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Boston, Massachusetts.
Chan, D., Chan, C., & Au, D. (2006). Motor relearning programme for stroke patients: A randomized controlled trial. Clinical Rehabilitation, 20,191-200. http://doi: 10.1191/0269215506cr930oa
El-Helow, M.R.., Zamzam, M.L., Fathalla, M.M., El-Badawy, M.A., El Nahhas, N., El-Nabil, L.M, Awad, M.R., & Von Wild, K. (2015). Efficacy of modified constraint-induced movement therapy in acute stroke. European Journal of Physical and Rehabilitation Medicine, 51(4), 371-379. https://www.ncbi.nlm.nih.gov/pubmed/25030204
Jacobs, K., Cason, J., & McCullough, A. (2015). The process for the formulation of the international telehealth position statement for occupational therapy. International Journal of Telerehabilitation, 7(1), 21-32. http://doi.org/10.5195/ijt.2015.6163.
Kim, H., Her, J., Ko, J., Park, D., Woo, J., You, Y., & Choi, Y. (2012). Reliability, concurrent validity, and responsiveness of the Fugl-Meyer Assessment (FMA) for hemiplegic patients. Journal of Physical Therapy Science, 24, 893-898. http://doi.org/10.1589/jpts.24.893
Kwakkel, G., Veerbeek, J. M., van Wegen, E. E., & Wolf, S. L. (2015). Constraint induced movement therapy after stroke. Lancet Neurology, 14(2), 224-234. http://doi:10.1016/s1474-4422(14)70160-7
Linder, S. M., Rosenfeldt, A. B., Bay, R. C., Sahu, K., Wolf, S. L., & Alberts, J. L. (2015). Improving quality of life and depression after stroke through telerehabilitation. American Journal of Occupational Therapy, 69(2), 1-10 http://doi:6902290020p1–6902290020p10. doi:10.5014/ajot.2015.01449
Lum, P.S., Taub, E., Schwandt, D., Postman, M., Hardin, P., & Uswatte, G. (2004). Automated constraint-induced therapy extension (autoCITE) for movement deficits after stroke. Journal of Rehabilitation Research and Development, 41(3A), 249-258. http://doi.org/10.1682/jrrd.2003.06.0092
McCue, M., Fairman, A., & Pramuka, M. (2010). Enhancing quality of life through telerehabilitation. Physical Medicine and Rehabilitation Clinics of North America, 21(1), 195-205. http://doi: 10.1016/j.pmr2009.07.005
McDonald, J.H. (2014). Handbook of Biological Statistics (3rd ed.). Sparky House Publishing, Baltimore, Maryland. This web page contains the content of pages 254-260 in the printed version.
Morris, D., Uswatte, G., Crago, J., Cook, E., & Taub, E. (2001). The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Archives of Physical Medicine and Rehabilitation, 82, 750-755. http://doi.org/10.1053/apmr.2001.23183
Nijland, R., van Wegen, E., van der Krogt, H., Bakker, C., Buma, F., Klomp, A., van Kordelaar J., & Kwakkel, G. (2013). Characterizing the protocol for early modified constraint-induced movement therapy in the EXPLICIT-stroke trial. Physiotherapy Research International, 18(1), 1-15. http://doi:10.1002/pri.1521
Nijland R., van Wegen E., Verbunt, J., van Wijk, R., van Kordelaar, J., & Kwakkel, G. (2010). A comparison of two validated tests for upper limb function after stroke: The Wolf Motor Function Test and the Action Research Arm Test. Journal of Rehabilitation Medicine, 42(7), 694-696. http://doi: 10.2340/16501977-0560
Nilsen, D., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G., (2015). Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: An evidence-based review. American Journal of Occupational Therapy, 69, 180031-180039. http://doi:10.5014/ajot.2015.011965.
Ottenbacher, K., Hsu, Y., Granger, C., & Fiedler, R. (1996). The reliability of the functional independence measure: A quantitative review. Archives of Physical Medical Rehabilitation, 77, 1226-1230. http://doi:10.1016/s0003-9993(96)90184-7
Page, S. J., Sisto, S., Levine, P., & McGrath, R. E. (2004). Efficacy of modified constraint-induced movement therapy in chronic stroke: A single-blinded randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 85(1), 14-18. http://dx.doi.org/10.1016/S0003-9993(03)00481-7
Page, S.J., & Levine, P. (2007). Modified constraint-induced therapy extension: Using remote technologies to improve function. Archives of Physical Medicine and Rehabilitation, 88(7), 922-927. http://doi:10.1016/j.apmr.2007.03.03
Page, S. J., Levine, P., Leonard, A., Szaflarski, J. P., & Kissela, B. M. (2008). Modified constraint-induced therapy in chronic stroke: Results of a single-blinded randomized controlled trial. Physical Therapy, 88(3), 333-340. http://doi:10.2522/ptj.20060029
Ploughman, M. & Corbett, D. (2004). Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 85, 1417-1423. doi: 10.1016/j.apmr.2004.01.018
Sabari, J. S., Capasso, N., & Feld-Glazman, R. (2014). Optimizing motor planning and performance in clients with neurological disorders. In Radomski, M. V. & Trombly Latham, A. (Eds.), Occupational therapy for physical dysfunction (7th ed., pp. 620-628) Philadelphia: Lippincott Williams & Wilkins.
Smania, N., Gandolfi, M., Paolucci, S., Ianes, P., Recchia, S., Giovanzana, C.,…Farina, S. (2012). Reduced-intensity modified constraint-induced movement therapy versus conventional therapy for upper extremity rehabilitation after stroke: A multicenter trial. Neurorehabilitation Neural Repair, 26(9),1035-45. http://doi:10.1177/1545968312446003
Shi, Y.X., Tian, J.H., Yang, K.H., & Zhao, Y. (2011). Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 92(6), 972-982. http://doi.org/10.1016/j.apmr.2010.12.036
Statistics How To. (2020, May 5). Retrieved May 8, 2020, from https://www.statisticshowto.com/
Taub, E., Crago, J. E., Burgio, L. D., Groomes, T. E., Cook, E. W., Deluca, S. C., & Miller, N. E. (1994). An operant approach to rehabilitation medicine: Overcoming learned nonuse by shaping. Journal of the Experimental Analysis of Behavior, 61(2), 281-293. http://doi:10.1901/jeab.1994.61-281
Taub, E., Uswatte, G., & Pidikiti, R. (1999). Constraint-induced movement therapy: A new family of techniques with broad application to physical rehabilitation-A clinical review. Journal of Rehabilitation Research and Development, 38(3), 237-251. https://www.ncbi.nlm.nih.gov/pubmed/10659807
Taub, E., Lum, P.S., Hardin, P., Mark, V.W., & Uswatte, G. (2005). AutoCITE: Automated delivery of CI therapy with reduced effort by therapists. Stroke, 36(6), 1301-1304. doi: 10.1161/01.STR.0000166043.27545.e8
Taub, E. (2012). The behavior-analytic origins of constraint-induced movement therapy: An example of behavioral neurorehabilitation. Behavior Analyst, 35(2), 155-178. http://doi:10.1007/bf03392276
Tomita, M.R., Mann, W.C., Fraas, L.. & Stanton, K. (2004). Factors associated with assistive device use among home-based frail elders. Journal of Applied Gerontology, 23(2), 141-155. https://doi.org/10.1177%2F0733464804265606
Treger, I., Aidinof, L., Lehrer, H., & Kalickman, L. (2012). Modified constraint-induced movement therapy improved upper limb function in subacute poststroke patients: A small-scale clinical trial. Topics in Stroke Rehabilitation, 19(4), 287-303. http://doi.org/10.1310/tsr1904-287
Uniform Data System for Medical Rehabilitation (2014). The FIM instrument: Its background, structure, and usefulness. https://www.udsmr.org/
Uswatte, G., Taub, E., Morris, D., Light, K., & Thompson, P. A. (2006). The motor activity log-28 assessing daily use of the hemiparetic arm after stroke. Enterprises Incorporated. http://doi: 10.1212/01.wnl.0000238164.90657.c2
Van der Lee, J., Beckerman, H., Knol, D.L., de Vet, HCW, & Bouter, L.M. (2004). Clinometric properties of the Motor Activity Log for the assessment of arm use in hemiparetic patients. Stroke. 35, 1–5. http://doi.org/10.1161/01.STR.0000126900.24964.7e
Wen, B., Ma, L., & Weng, C. (2014). The impact of constraint induced movement therapy on brain activation in chronic stroke patients with upper extremity paralysis: An fMRI study. Wiley Online Library, 24(3), 270-275. http://doi: 10.1002/ima.22103
Wolf, S., Catlin, P., Ellis, M., Archer, A., Morgan, B., & Piacentino, A. (2001). Assessing wolf motor function test as outcome measure for research in patients after stroke. Stroke, 32(7), 1635-1639. https://doi.org/10.1161/01.STR.32.7.1635
Wolf, S. L. (2007). Revisiting constraint-induced movement therapy: Are we too smitten with the mitten? Is all nonuse “Learned”? and other quandaries, Physical Therapy, 87(9), 1212–1223. https://doi.org/10.2522/ptj.20060355
Wolf, S. L., Winstein, C., Miller, P., Thompson, P., Taub, E., Uswatte, G., Morris, D., Blanton, S., Nichols-Larsen, D., & Clark, P. (2008). Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: The EXCITE randomized trial. ScienceDirect, 7(1), 33-40. https://doi.org/10.1016/S1474-4422(07)70294-6
Wu, C., Chen, C, Tsai, W., Lin, K., & Chou, S. (2007). A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: Changes in motor impairment, daily functioning, and quality of life. Archives of Physical Medicine and Rehabilitation, 88, 273-278. https://doi.org/10.1016/j.apmr.2006.11.021
Wu, C., Chen, C., Tang, S., Lin, K., & Huang, Y. (2007). Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 88, 964-970. https://doi:10.1016/j.apmr.2007.05.012
Yu, C., Wang, W., Zhang, Y., Wang, Y., Hou, W., Liu, S., Gao, C., Want, C., Mo, L., & Wu, J. (2017). The effects of modified constraint-induced movement therapy in acute subcortical cerebral infarction. Frontiers in Human Neuroscience, 11, 265. http://doi:10.3389/fnhum.2017.00265
Copyright (c) 2020 Mary Ann Smith; Machikio R.Tomita
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.