The purpose of this study was to explore the effects of two interventions, Constraint Induced Movement Therapy (CIMT) and modified Constrain Induced Movement Therapy (mCIMT), on proprioception among persons with hemiparesis post-cardiovascular accident (CVA). The goal of this research project was to build on previously-conducted research to determine if CIMT and mCIMT improves proprioceptive functioning in the affected extremity of clients who have experienced a CVA. CIMT is an approach to rehabilitation that addresses lowered upper extremity function through use of a constraint on the unaffected side to elicit movement from the affected side (Porter, 2004).
A mixed methods approach, consisting of qualitative and quantitative methodology, was used. The quantitative portion of the study involved use of a quasi-experimental, nonequivalent, two-group pretest-posttest design (as described in Portney & Watkins, 2008). This approach allowed the researchers to examine the effects of CIMT and mCIMT on proprioception. Subjects were not randomly assigned to groups, and a control group was not used. Rather, treatment groups were determined via participants' preference (CIMT vs. mCIMT protocol), as well as participants' individual capabilities and therapeutic tolerance for the requirements of each protocol. The qualitative portion of this study included review of data collected from journals kept by the participants throughout therapy, and a post-treatment focus group.
The total sample size for the research study included eight participants (four in the CIMT program and four in the mCIMT program). Each group was required to complete sixty hours of therapy. The CIMT group participated in therapy for six hours a day, five days a week, for two weeks. The mCIMT group participated in therapy for three hours a day, five days a week, for four weeks. All participants also completed home activities involving constraint use between therapy sessions. A researcher-designed Proprioceptive Assessment Tool was administered pre- and post-intervention.
Out of the four participants in the CIMT program, improvements in proprioception were seen in one participant. In the mCIMT protocol, improvements in proprioception were seen in all four participants. Thus, the results of the researcher-designed Proprioceptive Assessment tool suggest that CIMT/mCIMT could be an effective treatment method for individuals post-CVA who are experiencing deficits in proprioception skills.
Seven themes were developed from the data analysis of the qualitative portion of this study. The data was gained from the focus group from the CIMT and mCIMT programs following treatment. The focus questions revolved around thoughts and feelings of the participants before, during and after the program. The identified themes were: change of lifestyle; positive hand use improvement; determination; expectation; outgoing; "It's like having a job again"; and enjoyment.
Interpretation of Results
After reviewing the quantitative data from the researcher-designed Proprioceptive Assessment Tool , it appears that many of the participants showed improvements in proprioceptive functioning from pre- to post- intervention. This study shows that CIMT/mCIMT may have an effect on proprioceptive deficits. However, more research is needed to further explore the area of proprioception and its remediation through the use of CIMT/mCIMT.
Recommendations for Future Research
A larger sample size is recommended for future studies on CIMT/mCIMT and its effects on proprioception. This larger sample size should include more participants who have more significant proprioceptive deficits. Another recommendation is to develop a more comprehensive assessment battery for proprioception. Having a stronger assessment battery would allow a better evaluation of the effectiveness of CIMT/mCIMT in the treatment in of proprioceptive deficits.
We would like to thank the participants for their dedication to this program while the study was conducted. We would also like to thank Ellen Herlache MA, OTRL, Dr. Donald Earley OTD, MA, OTRL, and lab assistant, Jill Ewend OTRL, CBIS for their help and guidance throughout the research and implementation of the study.