Day Strength Dexterity Activity Pen / Paper Shaping 9-9.30am Pegs Buttons Brush teeth Etch Sketch Card turning 9.30-10am Putty Exercises Bingo balls Brush hair Colouring Connect 4
10-10.30am |
Slide sheet |
Mascara |
Window / wall |
|
|
|
cleaning |
Tracing
Cutting Playdough
10.30-11am |
Arm exercises |
iPad / phone |
|
|
game |
11-11.30am
Grasp / release tasks
Frustration game
Sensory work Word search Cone stack
Typing task |
Maze |
Wire bead |
|
|
board |
11.30am-12pm Ball throw / catch
Thread shoe lace
Send a text |
Board writing |
Spoon hand |
|
|
to mouth |
Above : Example timetable
and included cognitive impairment , uncontrolled pain , issues with mood , spasticity , mechanical limitations , compliance , or those requiring a mobility aid . This list is not exhaustive .
Due to potential issues with compliance , it was felt that mCIMT in the community would be best adhered to with shorter duration , for example five days over a few weeks . This also allows for the fact that in the community resources are less readily available and often shared with other clinicians / clients .
Additionally , there are other responsibilities / factors that may influence engagement that perhaps would not be as present in an inpatient setting , such as running of a household , family demands , appointments or distractions .
Devising an activity timetable
For the pilot programme , I worked with a 58-year-old client , who had had a haemorrhagic stroke . They had right sided weakness , were mobile with a walking stick , and reduced upper limb range of movement ( scapular , glenohumeral joint , wrist extension ), globally reduced digit extension and poor intrinsic activity for selective movements .
They had learned non-use of their right arm ; doing most tasks with their left hand and with assistance from family .
The client had completed inpatient CIMT . They had not maintained their range of movement since discharge , due to reduced compliance . They were educated on mCIMT and its application in the community .
We completed a contract and consent form and jointly we were able to highlight appropriate tasks to address the following domains – coordination , gross motor , fine motor , dexterity , accuracy and speed .
We devised an activity timetable , which was agreed before we started the programme . The duration was agreed as two weeks of daily mCIMT , three hours in the morning mCIMT tasks were set up in a bedroom upstairs , where there was access to an appropriate wall , desk and all necessary items . Function-based mCIMT tasks were completed on the table top upstairs or in the kitchen , as required . An example timetable is outlined in the table above .
Goals and outcomes
In terms of outcome measures , I opted to include the Motor Activity Log ( MAL ) as this was felt to be useful for instilling behavioural changes throughout the mCIMT programme , as it helps to raise awareness into use of the affected limb and whether this is increasing ( and if not , why not ), helping the clinician to tailor the programme midway through .
I also chose to use patient rated scores from the Canadian Occupational Performance Measure ( COPM ), on performance , satisfaction and importance of their upper limb level .
This was an existing outcome measure our service already uses and so was seen as appropriate to include .
For the constraint , a mitt is ideally an oven glove or resting splint on the unaffected hand . This needs to ensure that elbow extension is maintained for saving / balance reactions and to not restrict ROM / arm swing .
48 OTnews June 2023