Donald Earley, Ellen Herlache, Dana R. Skelton; Use of Occupations and Activities in a Modified Constraint-Induced Movement Therapy Program: A Musician’s Triumphs Over Chronic Hemiparesis From Stroke. Am J Occup Ther 2010;64(5):735-744. doi: 10.5014/ajot.2010.08073.
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OBJECTIVE. This case report addresses the use of therapeutic occupations and activities within a modified constraint-induced movement therapy (mCIMT) approach for a 52-yr-old female violinist 4 yr after ischemic stroke.
METHOD. Analysis of occupational performance was completed before and after intervention using a modified version of the Fugl-Meyer Sensorimotor Evaluation, the Motor Functioning Assessment, the Arm Improvement and Movement Checklist, and information obtained from a client journal maintained throughout treatment. The mCIMT protocol included use of constraint of the affected arm, with emphasis placed on participation in meaningful occupations and activities.
RESULTS. Improved function in the affected extremity was noted at the conclusion of mCIMT. After completion of therapy, the client reported a return to playing violin.
DISCUSSION. The findings from this case report suggest that use of meaningful occupations and activities integrated into a mCIMT protocol may be effective in addressing skills deficits for clients with upper-extremity chronic hemiparesis.
Home program; constraint worn during daily activities for 5-6 hr
Craft activity; making scrapbook of meaningful violin experiences. Promoted self-expression, client-centeredness, and in-hand manipulation for affected extremity.
Use of the Baltimore Therapeutic Equipment; simulation of violin playing by implementing the primary movements needed to play the violin
Simulated playing the violin, which related to a dominant role in her life
Opening jars; incorporated ulnar–radial deviation needed in violin playing, strengthening of intrinsic–extrinsic musculature, and also related to leisure activity of cooking which client enjoyed doing for comrades in orchestra.
Prepares the client for occupational performance
Used in preparation for purposeful and occupation-based activities (AOTA, 2008).
Therapeutic stretching in all anatomical planes of motion
Progressive resistive exercises
Weight bearing and joint compression to affected extremity.
I played a program on my violin at a senior center today and just had to tell you how I felt. Before my stroke 4 years ago, I never had to worry about how I was holding my bow—it was always natural. I was about halfway through my program and all of the sudden I noticed that my bow hold was perfect, I wasn’t correcting it all the time, and my bow was nice and straight going across my violin. Not to mention, no scratching noises. Everything was just fluid. Only a few people noticed my big smile during the song. But it was enough that I know it felt good again. Nice strong bow strokes and confident playing. It’s been so long since that’s happened. (E. W., personal communication, July 2007)
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