The Effect of Modified Constraint Induced Movement Therapy on Upper Extremity ‎Function In a Patient Suffering From Chronic Severe Acquired Brain Injury‌:‌‎ A Case ‎Study

Objective:  The primary objective of this case study was to investigate the effect of modified ‎constraint-induced movement therapy on upper extremity function in a patient with severe ‎acquired brain injury after 4 years. ‎ Material & method: A 33 years old women (F.Z), who had a severe acquired brain injury ‎‎(ABI) 4 years ago participated in the present study. The right hand was the dominant hand. ‎She was suffering from severe hypoxia due to suicide by hanging and had no history of ‎dislocation and fractures. This study was conducted in 2017. The informed consent letter ‎obtained from the participant. Inclusion criteria for the subject selection were presence of at ‎least 20◦ of active wrist extension, mini mental state examination score ≥ 23, and spasticity  ‎‎3 in the ashworth scale, and ability to maintenance balance in standing position ≥ 2 minute. ‎Modified constraint-induced movement therapy was performed for two weeks, five days a ‎week and three hours a day at Rofaideh Hospital. For the less affected upper limb, sling and ‎mitt were used at least six hours a day, so that movements and tasks of daily living were ‎restricted for the less affected hand. At the first, we used  traditional techniques to reduce ‎muscles tone (include of weight bearing on upper extremity, trunk rotation, scapular ‎protrusion, and reflex inhibition pattern), then some selected functional activities with shaping ‎techniques were used in therapy plan. Functional activities included of cleaning the table ‎surface with a towel, flipping the pages of the book, removing and taking the glass towards ‎the mouth, removing and moving a bottle, practicing and dropping out different objects, ‎moving forward with different objects to move them from one place to the next Another, ‎counting with your fingers, removing and reversing the card, and doing fine exercises and ‎manual manipulation using coins and beans. Assessments and data collection were done at 4 ‎times: before, 2nd, 4th, and 6th weeks with Fugl-Meyer assessment (FMA), functional ‎independence measure (FIM), motor activity log (MAL), and box and block test (BBT). ‎ Results:  The results indicate that improvement in motor functional status of upper extremity ‎in a chronic severe ABI patient can be achieved by using the modified constraint-induced ‎movement therapy intervention as an effective intervention. In this case study, the ‎intervention was designed in the intensive protocole of two weeks in 10 sessions of treatment. ‎According to FIM, improvement in four functional areas including motor function, balance, ‎sensation and range of motion was attained. The results showed, the patient’s score at ‎baseline (24) increased (56) in the FMA, this improvement was maintained at 4 weeks follow-‎up. Also dexterity of upper extremity was improved. In this regard, patient’s initial score of 5 ‎on the BBT improved to 7 at the second measurement, this improvement was increased to 12 ‎at 4 weeks follow-up. For the FIM, patient’s score improved from 19 to 31 at 2th week after ‎intervention, this improvement was increased to 36 and 38 at 2 and 4 weeks follow-up, ‎respectively. Also, the amount of movement score increased from 0 to 1.70 and quality of arm ‎use score increased from 0 to 1.66 at the final measurement. ‎ Conclusion: With respect to the findings of the case study, there is an evidence that modified ‎constraint-induced movement therapy could be an effective intervention for promoting of ‎upper extremity function in patients suffering from chronic severe ABI in a short time. ‎