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Rehabilitation

Modified constraint induced therapy

06/01/2006

Question:

My son had a severe TBI in Dec 05. After coming out of a coma his right side was affected. However he could snap his finger w/ his right hand. In Feb 06 we placed him at TLC in Galveston, Tx for additional therapies including OT. Two and a half months later he now cannot touch his fingers together on his right hand. We started using a glove on his left hand to restrict that hand on May 10, 06. By May 12 he could again touch his fingers together but by May 15 he again lost this ability. Since then he has worn a sling to immobilze his left arm in conjunction w/ TIRR in Houston. But progress seems to be getting worse rather than better. His attitude does not lend to helping himself by using his right hand. What else can we do to help him restore his right side? Sorry this is so long of a question. Thanks for any help you can provide.

Answer:

Of course, it is difficult to determine exactly what your son's deficits are and, thus, what would be most appropriate for him over e-mail. TIRR is a good resource and it is good that you are consulting with them. Make sure that a pediatric physiatrist (a doctor who specializes in rehabilitation with kids) is running the show.

As far as therapies, modified constraint-induced therapy is possibly one option, as it requires therapy within existing managed care parameters, and has shown some promise in TBI (see Page et al., Brain Injury, 2003). However, if this approach is frustrating to him, you may want to try something less restrictive. ne possibility is electrical stimulation using something called the Bioness device (www.bionessinc.com). This device has folks practice functional activities and provides electrical stimulation while they are performing the activities.

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Response by:

Stephen J Page, PhD Stephen J Page, PhD
Director of Research, Associate Professor
Drake Center
University of Cincinnati