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Functional Improvement Using Observational Movement Analysis and Task Specific Training for an Individual with Chronic Severe Upper Extremity Hemiparesis

Ling, Shawna S. DPT, CSCS1; Fisher, Beth E. PhD, PT2

Journal of Neurologic Physical Therapy: June 2004 - Volume 28 - Issue 2 - p 91–99
doi: 10.1097/01.NPT.0000281189.79135.ae
Research Article

Post-stroke upper extremity (UE) intervention studies have focused on individuals with mild/moderate UE deficits following acute stroke. Fewer studies have described interventions for individuals with chronic stroke and severe UE deficits. This report details an examination and intervention for a patient 4. 5 years post middle cerebral artery stroke with severe left UE deficits (UE Fugl-Meyer motor score: 18/66). Observational movement analysis was used to both identify compensatory movement patterns that appeared to augment UE deficits and also to determine task specific interventions. The patient's goal was to use a community laundromat, which required that he ambulate 300 feet and negotiate one curb while carrying a laundry basket. Initially, the patient could hold the basket with the left UE for only 57 seconds. Eight one-hour treatments focused on modifying the patient's ineffective movement strategy to reach forward, grasp, and hold the basket while ambulating. Scapular and trunk deviations decreased and the patient walked for more than 5 minutes holding the basket. Upper extremity Fugl-Meyer motor score was unchanged. This report identifies the benefit of observational movement analysis in combination with task specific training to optimize hemiparetic UE use, despite ongoing impairments.

1Adjunct Clinical Faculty, Department of Biokinesiology and Physical Therapy, University of Southern California (sling@mail.randrinc.com)

2Research Assistant Professor, Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA

© 2004 Neurology Section, APTA