Graduation Year

2017

Degree Type

Open Access Capstone

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

Abstract

Background: Despite increasing and strong evidence of modified constraint-induced therapy (mCIT) as an effective intervention approach for patients with chronic and subacute stroke in outpatient settings, it is still not widely used for the rehabilitation of patients with acute stroke who are typically admitted to inpatient rehabilitation hospitals.

Purpose: The purpose of this study is to implement an evidence-based approach using mCIT in the upper extremity rehabilitation of patients with acute stroke in an inpatient rehabilitation hospital and to demonstrate its feasibility and efficacy in increasing the motor recovery, and the amount and quality of arm use when compared to traditional occupational therapy intervention.

Theoretical Framework: The theoretical framework is based on behaviorist theory, and the model of human occupational (MOHO).

Methods. The study is a quasi-experimental, multiple baseline, randomized, pretest-posttest control-group design study, using a dose-matched control intervention, traditional rehabilitation (TR) for comparison with mCIT. A total of six participants admitted to an inpatient rehabilitation within two weeks of their first stroke and who met the eligibility criteria were randomly assigned to the two groups. The participants were assessed on outcome measures namely the Canadian Occupational Performance Measure, the Fugl-Meyer Assessment, the Wolf Motor Function Test, and the Motor Activity Log before and after intervention.

Results: Four of the 6 participants completed the study according to the study protocol. This study demonstrated significant improvement in motor recovery, improved arm function, more frequent and effective use of the affected arm, and clinically significant improvement in the participants’ perception of occupational performance and satisfaction with performance by both intervention approaches. It has also demonstrated greater improvement following intervention with mCIT compared with TR in all outcome measures studied except in the client’s perception of satisfaction with performance, with significantly greater change in affected arm motor recovery and the frequency of affected arm use.

Conclusions: The findings of this study demonstrate the feasibility and efficacy of mCIT in upper limb rehabilitation of patients with acute stroke in an inpatient rehabilitation hospital. This strengthens the case for the routine implementation of this evidence-based intervention approach that has been strongly demonstrated in patients with subacute and chronic stroke.

Faculty Mentor

Camille Skubik-Peplaski, PhD, OTR/L, BCP, FAOTA

Department Affiliation

Occupational Science and Occupational Therapy

Committee Member

Melba Custer, PhD, OT/L

Department Affiliation

Occupational Science and Occupational Therapy

IRB Approval Number (if applicable)

16-248

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