Effectiveness of Modified Constraint-Induced Movement Therapy in Restoring Fine Motor Function of the Upper Limb in MCA Post-Stroke Patients: A Prospective Case Study

Abstract

Introduction: A cerebral vascular accident, or stroke, occurs when brain cells suddenly die due to insufficient blood flow. A stroke affecting the middle cerebral artery (MCA) commonly results in the loss of upper limb function, significantly impacting everyday activities. Modified Constraint-Induced Movement Therapy (mCIMT) is a stroke rehabilitation method that restricts the unaffected arm, encourages repeated task practice, and utilizes behavioral techniques to boost neuroplasticity, aiding in recovery. This case report investigates the effectiveness of mCIMT in restoring fine motor function of the upper limb in a 70-year-old male patient with right-sided hemiparesis following an MCA stroke.

Methods: The patient, with a history of diabetes, hypertension, ischemic heart disease, recent COVID-19 symptoms, and a prior left-sided cerebral vascular accident (CVA), demonstrated grade 2 spasticity and a score of 44 on the Fugl-Meyer Assessment for the upper limb. The patient also exhibited some degree of wrist and finger movement, specifically 25 degrees of wrist extension and 10 degrees of finger flexion. His performance on the Wolf Motor Function Test (WMFT) revealed severe functional deficits: tasks took 100-120 seconds to complete, with Functional Ability Scale (FAS) scores ranging from 1 to 2.5. Over 10 weeks, the patient underwent mCIMT at a tertiary care hospital, involving 45-minute sessions four times a week, and wore a restrictive mitten on the unaffected arm for at least three hours daily at home.

Results: Post-treatment evaluations revealed significant improvements. The Fugl-Meyer Assessment score increased from 44 to 58, indicating enhanced motor function and coordination. In the WMFT, the average completion time for timed tasks decreased from 100-120 seconds to 70-90 seconds per task, and the FAS scores improved from 1-2.5 to 3-4. The total time for completing 15 timed tasks was reduced from approximately 1500-1800 seconds to 1050-1350 seconds, and the total FAS score for 17 tasks increased from around 25-42 to 51-68.

Conclusion: The mCIMT intervention led to considerable improvements in fine motor function and overall upper limb performance in this MCA post-stroke patient. The therapy resulted in faster task completion, improved movement quality, and enhanced independence in daily activities. These findings underscore the efficacy of mCIMT in rehabilitating upper limb function and highlight its potential as a valuable intervention for stroke patients with MCA involvement.