Feasibility of the modified constraint-induced movement therapy in patients with median and ulnar nerve injuries: a single-subject A-B-A design

Abstract

Objective:

The present study aimed to determine feasibility and efficacy of the modified constraint-induced movement therapy on upper limb function in patients with median and ulnar nerve injuries.

Design:

Single subject, A1-B-A2 design.

Setting:

Occupational therapy outpatient clinic.

Subjects:

A convenience sample including three patients with median and ulnar nerve injuries.

Interventions:

Modified constraint-induced movement therapy as follows: an intensive practice with affected hand for one hour daily, five days per week, for four weeks while the healthy hand was immobilised using a splint during waking hours.

Main measures:

Semmes-weinstein monofilaments, Box and block test, and Disabilities of the arm, shoulder, and hand questionnaire. A blinded assessor administered the assessments in a random order across sessions, six times for the baseline phase (A1), four times for the intervention phase (B), and four times for the withdrawal phase (A2).

Results:

Touch perception did not occur after the intervention phase at the pulp of the index and little fingers. Manual dexterity and motor ability significantly improved (Box and block change scores exceeded the minimal detectable change of 5.5 blocks), as well performance in activities of daily living during real life (Disabilities of the arm, shoulder, and hand questionnaire change scores exceeded the clinically important change value of 20.9 points). These improvements maintained and even enhanced during the withdrawal phase.

Conclusions:

Modified constraint-induced movement therapy is a feasible and useful adjunct to rehabilitation of the patients with median and ulnar nerve injuries that warrants further research.