| چکیده انگلیسی مقاله |
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. |
| نویسندگان مقاله |
نازیلا اکبرفهیمی | Nazila Akbarfahimi
Department of Occupatonal Therapy, University of Social Welfare and Rehabilitaton Sciences, Tehran, Iran
گروه کاردرمانی، دانشگاه علوم بهزیستی و توان بخشی، تهران، ایران
شیوا عابدی | Shiva Abedi
Department of Occupatonal Therapy, University of Social Welfare and Rehabilitaton Sciences, Tehran, Iran
گروه کاردرمانی، دانشگاه علوم بهزیستی و توان بخشی، تهران، ایران
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