This case study describes how to safely implement a modified Constraint Induced Movement Therapy (CIMT) protocol for a patient with cognitive impairments post-stroke. Assessments used are validated for the stroke population and highlight the significant improvement in motor function and self-care ability despite little improvement in cognition. This case study offers a promising starting point for evidence to support the use of modified CIMT for people following a stroke who present with cognitive impairments in inpatient rehabilitation.
Stroke is the leading cause of preventable disability in the United States, occurring once every forty seconds (Impact, 2016). About half of stroke survivors require assistance with basic everyday activities including dressing and toileting once discharged back to the community (Wolf, 2014). Forty-five percent of stroke survivors experience depression five years post incident (Wolf, 2014) due to the adverse effects on quality of life. Seventy percent of stroke survivors require assistance with activities such as grocery shopping and driving (Wolf, 2014) which greatly influence their ability to reintegrate into the community. Activities of daily living (ADLs) are severely impacted by impairments in motor function, but can additionally be impacted negatively by cognitive impairments due to difficulties with initiation, sequencing and problem solving.
Constraint-Induced Movement Therapy (CIMT) protocol emphasizes repetitive, massed practice interventions used to address motor control deficits in order to improve the use of a targeted limb and prevent “learned non-use” (Morris, Taub, & Mark, 2006). Those with cognitive impairments are typically excluded from such protocols; however, this case study describes how to safely implement a modified CIMT protocol within the context of inpatient rehabilitation during the acute phase of stroke recovery. Outcome measures used highlight the clinically significant improvement in motor function and self-care independence post-intervention despite little improvement in cognition. This case study offers a promising starting point for evidence to support the use of modified CIMT for people following a stroke who present with cognitive impairments in inpatient rehabilitation. In addition, this participant demonstrated that motor relearning after a stroke can take place, despite cognitive impairment. Proper safety protocols and interdisciplinary team involvement are key factors in successful implementation of modified CIMT in stroke patients with cognitive impairments.