Modified constraint-induced therapy extension: using remote technologies to improve function.

OBJECTIVE To determine efficacy of a modified constraint-induced therapy extension (mCITE) protocol, in which persons with stroke participated in therapy sessions via the Internet. DESIGN Pre-post, single-blinded case series. SETTING Outpatient clinic. PARTICIPANTS Four people with stroke who experienced stroke more than 1 year prior to study entry exhibiting upper-limb hemiparesis and nonuse. INTERVENTION Subjects participated in online, 30-minute therapy sessions, 3 times a week for 10 weeks using personal computer-based cameras and free network meeting software. During the same period, subjects' less affected hands and wrists were restrained every weekday for 5 hours. Patients completed online logs to document restraint use and activities practiced at home. MAIN OUTCOME MEASURES The Motor Activity Log (MAL) and Wolf Motor Function Test (WMFT). We also used a structured interview to ask patients about their satisfaction with the protocol. RESULTS After intervention, subjects exhibited marked improvements in more affected arm use (+2.7, +2.06, +1.7, +2,83, respectively), quality of movement (+2.1, +2.1, +2.03, +1.9, respectively), as measured by the MAL, and speed increases while performing WMFT tasks. Subjects' mCITE satisfaction and adherence were high, and motor changes translated to ability to perform valued activities. CONCLUSIONS A home-based, modified constraint-induced movement therapy program is feasible and appears to increase more affected arm use and function using commercially available, inexpensive technologies.

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