Abstract
Study Design
This was a pre post test design.
Introduction
Retraining the brain is one approach to remediate movement dysfunction resulting from
task specific focal hand dystonia (FHDTSP).
Purpose
Document change in task specific performance (TSP) for patients with FHDTSP after 8 weeks of comprehensive home training (fitness activities, task practice,
learning based memory and sensorimotor training).
Methods
Thirteen subjects were admitted and evaluated at baseline, immediately and 6 months
post treatment for task specific performance, functional independence, sensory discrimination,
fine motor speed and strength. In Phase I, 10 subjects were randomly assigned to home
training alone or supervised practice prior to initiating the home training. In phase
II, 2 subjects crossed over and 3 new subjects were added (18 hands). The intent to
treat model was followed. Outcomes were summarized by median, effect size, and proportion
improving with nonparametric analysis for significance.
Results
Immediately post-intervention, TSP, sensory discrimination, and fine motor speed improved
60-80% (p<0.00l respectively). Functional independence and strength improved by 50%.
Eleven subjects (16 hands) were re-evaluated at 6 months; all but one subject reported
a return to work. Task-specific performance was scored 84-90%. Supervised practice
was associated with greater compliance and greater gains in performance.
Conclusions
Progressive task practice plus learning based memory and sensorimotor training can
improve TSP in patients with FHDTSP. Compliance with home training is enhanced when initiated with supervised practice.
Level of Evidence
4.
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JHT Read for Credit
Quiz: Article # 128
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
- #1.The primary difference between groups was that the
- a.“Home + Group” was given a more complete set of initial instructions
- b.“Home Group” was given a more complete set of initial instructions
- c.“Home + Group” received on-going supervised instructions in therapy sessions whereas the “Home Group” received no additional supervision after the initial instruction session
- d.“Home + Group” had frequent unsupervised individual practice sessions during therapy visits whereas the “Home Group” did all their practicing at home
- a.
- #2.BrainFit refers to the
- a.software that was installed on the subjects' home computers
- b.software the investigators used in the initial screening process to select subjects
- c.instrument used by the investigators to measure the head size of each subject in order to insure that the cranial harness fit properly
- d.outcome measuring instrument
- a.
- #3.During evaluation sessions the
- a.trained investigators evaluated the subjects' performance in real time as the task was being performed
- b.trained investigators conducted interviews with the subjects immediately following the task
- c.final product (e.g. a writing sample) was recorded by a still digital camera for subsequent analysis
- d.subjects' performance was videotaped for subsequent analysis
- a.
- #4.The home program included ____ forms of intervention
- a.3
- b.4
- c.5
- d.6
- a.
- #5.According to the authors, the primary objective of therapy for FHd TSP should be
- a.sensory retraining
- b.retraining the brain
- c.fine motor retraining
- d.coordination retraining
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: March 16, 2009
Identification
Copyright
© 2009 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
