March 29, 2017

Constraint Therapy is Good and Bad

Constraint therapy involves 1 or more hours of therapy that focuses exclusively on the hemiplegic hand plus wearing a mitt on the sound hand for 3+ hours at home each day to force the hemiplegic hand to work.  Constraint therapy is good because it challenged long held beliefs that clients cannot recover function for years after a stroke.

Constraint therapy is bad because it is appropriate for a limited pool of clients.  1) Stroke survivors must already be able to extend (straighten) their fingers 10 degrees and their wrist 20 degrees.
2) It is good for men who have women to take care of them.  Husbands may not be willing to help with chores at home while wives constrain their sound hand all day.

Current research offers an alternative.  Hayner found guiding both hands to work while making lunch, eating, and cleaning up helped stroke survivors improve as much as subjects whose hand was constrained during the same activity (1).  Sterr also found that stroke survivors who were helped to use their hemiplegic hand for 90 or 180 minutes improved as much as subjects who received constraint therapy for the same amount of time (2).  These and other studies have shown that any practice which is intense can produce recovery.  

1. Hayner K, Gibson G, Giles G. Comparison of constraint-induced therapy and bilateral treatment
    of equal intensity in people with chronic upper-extremity dysfunction after cardiovascular    
    accident.  American Journal of Occupational Therapy. 2010;64(4):528-539.
2.  Sterr A, Oneill D, Dean P, Herron K.  CI therapy is beneficial to patients with chronic low-
     functioning hemiparesis after stroke. Front. Neurol. 2014;5:

March 4, 2017

Hand Use Able-bodied Adults Take for Granted


When my hand was flaccid I had to put objects in my mouth or squeeze them between my thighs to hold objects still.  This made me aware of the dozens of times each day I used to reach out to hold an object still so the other hand could manipulate it.  Here is an example of what I mean.  It is aggravating to get out cereal, a bowl, and a spoon, but not be able to open the milk.  My hand can now hold the milk container still so it does not spin around when I remove the cap, but first I have to reach for the handle. 

Using my hemiplegic right arm to reach for and hold a lint trap so my sound left hand can clean the lint trap sounds like a deceptively easy skill.  If shoulder muscles struggle to lift the arm, high muscle tone can cascade down the arm and make hand muscles tighten.  It is difficult to open a tight hand.  I am grateful that my OTs, NeuroMove, and Saeboflex helped me regain  this simple skill.  Being able to reach out and open my hemiplegic hand to hold objects helps me do 26 ADL tasks