Ted Stevenson

A Modified Constraint-Induced Movement Therapy Regimen for Individuals with Upper Extremity Hemiplegia

Background. The Constraint-Induced Movement Therapy approach has been identified as a promising method to address deficits in upper limb function experienced by some stroke survivors. There is some question regarding whether the intervention administered in the research setting could be translated into clinical practice. Purpose. This paper describes the modified version of Constraint-Induced Movement Therapy developed at St. Boniface General Hospital, Winnipeg, Canada. Method. This modified regimen involves practice of upper limb tasks for four hours per day for 10 weekdays over two weeks, concurrent with participants attempting to wear a restraint mitten on the less involved hand for 90% of their waking hours. Results. The primary outcome measure was the Canadian Occupational Performance Measure. Two case reports illustrate how the regimen is administered. Implications. The need for further research of this regimen in terms of the selection of participants, the measurement tools, and the effectiveness is discussed.

Threshold Berg Balance Scale Scores for Gait-Aid Use in Elderly Subjects: A Secondary Analysis

PURPOSE To determine the threshold Berg Balance Scale (BBS) scores that discriminate among levels of gait-aid use in elderly subjects. METHODS A secondary analysis of data combined from two projects was performed. Both projects determined BBS performance, self-selected gait speed, and gait-aid use in samples of community-dwelling, independently ambulant individuals older than 65 years of age. Receiver operating characteristic curves were used to identify BBS scores that optimized identification of individuals with different levels of ambulation. RESULTS Previously determined associations between BBS score and various indicators of ambulatory ability were reproduced with the combined data set. Threshold BBS scores were identified for ability to walk without an aid (≥49/56) and ability to walk without a four-wheeled walker (≥43/56). The percent agreement values for the identified threshold scores ranged from 51% to 87%. CONCLUSIONS Although some threshold BBS scores could be determined, the accuracies of the scores render them of limited use for guiding gait-aid prescription in individual clients.