Combined Effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis

Keywords: mCIMT, Hemiparesis, Telehealth

Abstract

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.   

 

  

Author Biography

Mary Ann Smith, University at St. Augustine Austin, Texas

Clinical Associate Professor

University of St. Augustine for Health Sciences

References

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.

http://www.biostathandbook.com/multiplecomparisons.html

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

Published
2020-06-30
How to Cite
Smith, M. A., & Tomita, M. R. (2020). Combined Effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis. International Journal of Telerehabilitation, 12(1), 51–62. https://doi.org/10.5195/ijt.2020.6300
Section
Research