This article describes a case report of the occupational therapy management of a 53-year-old woman diagnosed with primary shoulder adhesive capsulitis. The occupation-based interventions are described through the framework of occupation-as-means. Compensatory occupation, preparatory methods, and purposeful activities are demonstrated as being critical to minimizing connective tissue deformation associated with this condition. This case report indicates that occupation-based intervention should be initiated as soon as a diagnosis is identified to prevent the downward spiral of forced disuse associated with the affected upper extremity. As illustrated by the case report, occupation-based treatment that was provided in a timely manner immediately decreased pain, improved range and quality of motion, and enhanced occupational performance.
OBJECTIVE. This case report addresses the use of therapeutic occupations and activities within a modified constraint-induced movement therapy (mCIMT) approach for a 52-yr-old female violinist 4 yr after ischemic stroke.
METHOD. Analysis of occupational performance was completed before and after intervention using a modified version of the Fugl-Meyer Sensorimotor Evaluation, the Motor Functioning Assessment, the Arm Improvement and Movement Checklist, and information obtained from a client journal maintained throughout treatment. The mCIMT protocol included use of constraint of the affected arm, with emphasis placed on participation in meaningful occupations and activities.
RESULTS. Improved function in the affected extremity was noted at the conclusion of mCIMT. After completion of therapy, the client reported a return to playing violin.
DISCUSSION. The findings from this case report suggest that use of meaningful occupations and activities integrated into a mCIMT protocol may be effective in addressing skills deficits for clients with upper-extremity chronic hemiparesis.
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