The protocol described in this case report complies with standards of the Declaration of Helsinki and was approved by the Institutional Review Boards of participating institutions (IRB #16039-H29 and STU00203728) and met the Health Insurance Portability and Accountability Act (HIPAA) requirements for disclosure of protected health information. Written informed consent for participation was obtained from the patient's legal guardian.
The participant was a 42-year-old female who sustained a TBI from being struck by a motor vehicle at age 12. At study entry, she was 29.5 years post injury, dependent on caregivers for most ADL/instrumental activities of daily living (IADLs), used a manual wheelchair for mobility, resided in a group home setting, and required assistance from caregivers to help her make decisions. She attended an adult workshop where she would perform general fitness/mobility activities along with interacting with peers socially, and had done so for several years. As a result of her injury, she had abnormal tone, weakness and dysmetria/ataxia leading to decreased motor control and coordination of the right upper limb. She has avoided using her right (dominant) arm, which has led to learned nonuse of the right arm and overuse of the left arm. Furthermore, she had cognitive, short-term memory, and perceptual deficits. Right visual processing deficits made it difficult for her to read and distinguish color. Her mini mental state exam (MMSE) score at baseline was 15 out of 30. Due to these impairments, she did not spontaneously use her right upper limb functionally. Over the years since her injury, interventions including traditional physical and occupational therapy (functional mobility training, upper limb task practice, aquatic therapy provided by licensed therapists) have been implemented with limited success to increase the use of her right upper limb.