Analysis and Training of Reaching and Manipulation for Health Conditions

Question 1

What interventions exist to improve reaching and manipulation?

Answer 1

• Constraint induced movement
• Repetitive task-specific training (incl. part practice)
• Mechanically assisted training
• Additional interventions such as:
  o Mental practice
  o Mirror therapy
  o Bilateral training
  o EMG feedback
  o Electrical stimulation

Question 2

What is constraint induced movement therapy (CIMT)?

Answer 2

A way to set up the environment during training to prevent adaptive strategies. CIMT is effective at improving arm impairments and decreasing trunk movement in reaching

Question 3

What is the clinical significance of robotics?

Answer 3

Robotics is equivalent to intensive physio (both having 24hrs of training over 12 weeks yielding not significantly different results). This is useful as robotics can be used in clinical practice to facilitate intensive training without a therapist. Unfortunately, robotics are not routinely available in Australia

Question 4

What is the Graded Repetitive Arm Supplementary Program (GRASP)?

Answer 4

Aims to improve reaching and manipulation. This has been shown to be effective by a study in 2009, where participants who supplemented standard rehab with GRASP had better arm and hand function than a control group who only had standard rehab, and these benefits were maintained 5 months later

Question 5

What has research shown about task-specific repetitive training?

Answer 5

• Better to train reach to grasp as one task (as soon as possible)
• Ensure hand begins to open early in transport phase
• Use objects in training
• Use objects of different dimensions and properties to progress training
• Use objects with different precision requirements
• Use objects with different frictional qualities
• Use objects which require bimanual reach and grasp
• Include purpose of task in instructions (not just grasp)
• Include tasks which require manipulation of objects
• Include instructions to transport objects in different directions

Question 6

What should we consider when choosing activities to train?

Answer 6

FUNCTION/GOAL ORIENTED: develop functional movements, SMART goal
PERSON-CENTRED: What can’t the patient do that they want/need to do? What could you be doing better?
UNDERLYING IMPAIRMENTS: What is the prime concern? What else needs to be addressed once this is under control?