title: Attempting to improve function and quality of life using the FTM Protocol: case report.
abstract: OBJECTIVE
  The Functional Tone Management (FTM) arm training program uses repetitive task practice, stretching, and electrical stimulation as patients with moderate upper extremity hemiparesis wear a dynamic hand orthosis to retrain grasp and release of objects. The case study quantitatively evaluates the extent to which FTM training improved function and quality of life in a patient who met criteria for which the device was intended.
  
  
  METHODS
  The participant, a 44-year-old male in the chronic stage of stroke recovery with moderate right upper extremity motor impairment, was trained for 10 days over a 2-week period by a licensed clinician with extensive experience in FTM training methods. Measurements were taken over 3 baseline visits, then immediately preintervention, postintervention, and at a 3-month follow-up. The outcome measures, following the International Classification of Functioning, Disability, and Health (ICF) Model, included the: Fugl-Meyer assessment (FMA) (upper extremity portion), UE range of motion (ROM), Modified Ashworth scale, Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Health related quality of life was measured using the Stroke Impact Scale (SIS).
  
  
  RESULTS
  The participant showed limited gains in upper extremity function immediately postintervention. Increases in AROM occurred in forearm supination and wrist flexion and extension, but no improvements were noted in finger ROM. A slight decrease in tone was found in forearm pronators (1 to 0) and wrist flexors (1+ to 1). WMFT values for the more affected upper extremity did not change immediately after training, but a 17% reduction in time occurred at follow-up, with improvements, most notably in the tasks of lifting a pencil and lifting a paper clip. No changes occurred in UE-FMA scores immediately following the intervention, however, a 17% improvement was measured at followup. A slight improvement in MAL scores was noted but not to a level of independent functional use of the impaired upper extremity. SIS scores improved in the domains of strength, communication, mobility, social participation, hand recovery, and overall physical component, while decreases were seen in the ADL/IADL, hand function, emotion, and cognitive domains.
  
  
  CONCLUSIONS
  The case study indicates that for this patient with chronic, moderate upper extremity impairment following stroke, a 2-week FTM training regimen resulted in modest changes occurring as a decrease in impairment, with functional improvement and improved quality of life. Further investigation of the innovative training program should be undertaken before the efficacy of its use can be ascertained amongst patients with limitations comparable to the participant.
authors.affiliation: Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA. andrew.butler@emory.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Butler
authors.forename: Sarah
authors.initials: S
authors.lastname: Blanton
authors.forename: Veronica
authors.initials: V
authors.lastname: Rowe
authors.forename: Steven
authors.initials: S
authors.lastname: Wolf
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology; D009989:Orthotic Devices; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation* / Q000628:therapy; D011788:Quality of Life; D020127:Recovery of Function; D020521:Stroke / Q000150:complications / Q000628:therapy; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology