Feasibility of the modified constraint-induced movement therapy in patients with median and ulnar nerve injuries: a single-subject A-B-A design Article

Abstract Objective: The present study aimed to determine feasibility and efficacy of the modified constraintinduced movement therapy on upper limb function in patients with median and ulnar nerve injuries. Design: Single subject, A1-B-A2 design. Setting: Occupational therapy outpatient clinic. Subjects: A convenience sample including three patients with median and ulnar nerve injuries. Interventions: Modified constraint-induced movement therapy as follows: an intensive practice with affected hand for one hour daily, five days per week, for four weeks while the healthy hand was immobilised using a splint during waking hours. Main measures: Semmes-weinstein monofilaments, Box and block test, and Disabilities of the arm, shoulder, and hand questionnaire. A blinded assessor administered the assessments in a random order across sessions, six times for the baseline phase (A1), four times for the intervention phase (B), and four times for the withdrawal phase (A2). Results: Touch perception did not occur after the intervention phase at the pulp of the index and little fingers. Manual dexterity and motor ability significantly improved (Box and block change scores exceeded the minimal detectable change of 5.5 blocks), as well performance in activities of daily living during real life (Disabilities of the arm, shoulder, and hand questionnaire change scores exceeded the clinically important change value of 20.9 points). These improvements maintained and even enhanced during the withdrawal phase. Conclusions: Modified constraint-induced movement therapy is a feasible and useful adjunct to rehabilitation of the patients with median and ulnar nerve injuries that warrants further research

Efficacy of combined virtual reality with constraint-induced movement therapy on upper limb function of children with hemiparetic cerebral palsy

Introduction: Hemiparetic cerebral palsy refers to an impairment caused by non-progressive damages to premature brain which is more sever in one side of the body than the other side. The aim of the present study was to determine the effects of combining constraint-induced movement therapy (CIMT) with virtual reality (VR) on upper limb functioning of children with hemiparetic cerebral palsy. Materials and Methods: In a single blind randomized, controlled trial, 16 children with hemiparetic cerebral palsy, who were selected through a simple random sampling method in Ahvaz city, were divided into 4 groups of CIMT, VR, CIMT+VR, and controls. Subjects in experimental groups participated in one-and-half-hour therapeutic sessions which were held every other day during a four-week period. Measures were conducted pre, post and 3-month after the treatment period using Pediatrics Motor Activity Log and Bruininks-Oseretsky Test of Motor proficiency (BOTMP). Sample randomization and statistical analysis of data through analysis of variance with repeated measures were conducted via SPSS-16 software in which alpha level was set at 0.05. Results: Data analysis for measurement tools was indicative of significant difference of combined group compared to VR, CIMT, and control groups (P < 0.01) (mean amounts of BOTMP, speed and dexterity changed from 0.15 ± 0.08 to 1.89 ± 0.33 in post-test). Data analysis for follow-up session revealed the retention of results for 4 groups (P = 0.32). Conclusion: Incorporating VR and CIMT may improve upper limb functioning of children with hemiparetic cerebral palsy through combining the advantages of both protocols and implementing them in an integrated program. Keywords: Constraint-induced movement therapy, Virtual reality, Upper limb function, Hemiparetic cerebral pals