Hicks Christine M, Kluding Patricia
Postprofessional DPT Program, Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS 66160, USA.
J Geriatr Phys Ther. 2008;31(3):113-9. doi: 10.1519/00139143-200831030-00007.
Constraint induced movement therapy (CIMT) has been found to be beneficial in upper extremity recovery of patients following a stroke. However, its feasibility in the home health setting has not been assessed. This prospective case study describes changes in upper extremity function with a modification of CIMT administered in the home health setting.
The participant was an 83-year-old man 6 months post-stroke with left sided hemiparesis resulting from a right ischemic stroke. The residual left-sided weakness was complicated by pre-existing left shoulder pain due to osteoarthritis. He had not been able to return to many of his household chores and hobbies following the stroke. The intervention consisted of 1 hour functional task practice sessions in the participant's home 3 days each week for 5 weeks. A restraint of the less-affected arm was used for 5 hours each day during the intervention period. Activities that required use of the left upper extremity alone and activities that required the use of both upper extremities were included. Primary outcome measures used before and after the intervention included the Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT).
Improvements were noted in both the MAL and WMFT following the intervention. The participant increased his ability to perform functional activities and household chores.
The supervised practice of functional tasks in the participant's home provides a clinically-relevant option for home-based physical therapy of the geriatric patient with stroke. This case study showed that the modified CIMT was feasible in the home setting for our participant. Further research on CIMT interventions in the home setting should include repeated baseline measurements and a larger number of subjects.
已发现强制性运动疗法（CIMT）对中风后患者的上肢恢复有益。然而，其在家庭健康环境中的可行性尚未得到评估。本前瞻性病例研究描述了在家庭健康环境中实施的改良CIMT对上肢功能的影响。
参与者是一名83岁男性，中风后6个月，因右侧缺血性中风导致左侧偏瘫。残留的左侧无力因先前存在的骨关节炎引起的左肩疼痛而复杂化。中风后，他无法恢复许多家务和爱好。干预措施包括每周3天，在参与者家中进行1小时的功能任务练习，共5周。在干预期内，每天对受影响较小的手臂进行5小时的约束。包括仅需使用左上肢的活动和需要使用双上肢的活动。干预前后使用的主要结局指标包括运动活动日志（MAL）和沃尔夫运动功能测试（WMFT）。
干预后，MAL和WMFT均有改善。参与者执行功能活动和家务的能力有所提高。
在参与者家中对功能任务进行监督练习，为中风老年患者的家庭物理治疗提供了一种临床相关的选择。本病例研究表明，改良的CIMT在我们参与者的家庭环境中是可行的。在家庭环境中对CIMT干预的进一步研究应包括重复的基线测量和更多的受试者。
