All ETDs from UAB

Advisory Committee Chair

Edward Taub

Advisory Committee Members

Gitenrdra Uswatte

David M Morris

Victor W Mark

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Education


Constraint Induced Movement (CI) therapy has been demonstrated to be an efficacious rehabilitation therapy for upper extremity (UE) hemiparesis after stroke. Despite this, CI therapy is not widely used in neurorehabilitation in the United States. One barrier to its acceptance is the perception of its difficulty among therapists and patients. However, this opinion has been influenced by two published surveys in which responses were obtained from therapists with no direct exposure of CI Therapy. Patients’ perception that a treatment is difficult to undergo has an important role in determining whether it will be provided clinically. Besides the perception of difficulty, the dissemination of a therapy is also influenced by patient satisfaction with treatment outcomes. The present study assessed the perception of the difficulty of CI therapy of participants with chronic stroke who had actually undergone CI Therapy. A determination was also made of whether there is any change in this perception from the pre- to post-treatment phase. We further examined how CI therapy outcome correlates with participants’ satisfaction with therapy and its perceived difficulty. The participants’ perception of difficulty of CI therapy and their satisfaction with this treatment was assessed by a Patient Opinion Survey (POS). The use of their hemiparetic arm in real life situations was assessed by the Motor Activity Log (MAL) and its use in the treatment setting was measured by the Wolf Motor Function Test (WMFT). The participants showed large improvements in the motor ability of their hemiparetic extremity after the treatment. We found that participants with chronic stroke perceived CI therapy to be of only moderate difficulty before the beginning of treatment; the average rating of difficulty was 4.4 on a 7 point scale. After therapy, there was a significant decrease in this perception (mean = 3.74). We also found that participants were highly satisfied with CI therapy after its completion; the average rating of satisfaction was 6.3 out of 7 points. There was also a significant positive relationship between the gains in use of the more affected arm in real life situations and the patient satisfaction. The gains in quality of movement (QOM) explained a significant proportion of the variance in overall satisfaction, R2 = 0.36, p = .002. However, there was no significant correlation between overall satisfaction and the magnitude of gain resulting from CI therapy in use of the more affected arm in the treatment setting.

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