330: Working With The "Excluded" Patient: A Case Study Using Modified CIMT After Stroke With Briana Elson, MS, OTR/L, BCPR, CBIS

What do you do when the most evidence-based intervention you have is also the one your patient is "not allowed" to receive? Constraint-induced movement therapy has decades of research behind it, yet its exclusion criteria — especially around cognitive impairment — rule out a huge share of the stroke survivors clinicians actually see. In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, talk with neuro OT Briana Elson, MS, OTR/L, BCPR, CBIS, about her decision to try modified CIMT with an 86-year-old stroke patient who had significant cognitive impairment and underlying dementia — a textbook exclusion — and why his profile, a left-handed man whose affected side was his dominant hand, made forced use feel natural and salient rather than confusing. Briana walks through how she built the protocol around safety and supervision in inpatient rehab: getting a physician order for the constraint mitt, educating and enlisting his wife, keeping a consistent daily schedule, breaking the three-to-six hours into non-consecutive blocks, and removing the mitt before late-day sundowning. She shares the outcomes that surprised even her skeptics — meeting the minimal detectable change on the Box and Block Test and a standardized motor scale within roughly thirteen days, plus real gains in grooming and feeding independence — alongside the honest caveats, including that his cognition never improved and that real-world delivery never looks as clean as the published article. It's a practical, encouraging conversation about reading the research, respecting its limits, and giving more patients a shot at an intervention they're usually told they can't have.