Evidence Based Practice - Upper Limb Rehabilitation

Question 1

What is repetitive task specific training and why?

Answer 1

Completing many repetitive movements of part or whole task practice which are important o the patient

Targets learning-dependent neuroplasticity

Question 2

What is bimanual training and why?

Answer 2

Symmetrical or alternating use of the bilateral upper limb to complete a task

Allows for transfer of the learned motor program in the cortex from the practised limb to the hemiparetic limb

Question 3

What is constraint-induced movement therapy?

Answer 3

The constraint of the unaffected upper limb for 90% of waking hours - combined with mass practice of tasks with affected upper limb

Aims to prevent learned non-use and reduce the reduction of the size of cortical representation

Question 4

What is neuromuscular electrical stimulation?

Answer 4

Promotes functional tasks with or without activation by the patient

Applies low dose electrical stimulation to the peripheral motor nerves to improve motor performance and cortical excitability

Question 5

What is mirror therapy?

Answer 5

Form of visual imagery - mirror is placed in the sagittal plane

Supplies visual feedback to the brain by tricking it into thinking the affected limb is moving in the same way and the unaffected limb - resulting in the rewiring of the prefrontal cortex

Question 6

What is computerised training and how does it work?

Answer 6

Computer-based interactive, immersive, multisensory stimulation environment

Works to activate and engage bilateral neural motor areas as a result of motor execution and imagery of that task

Question 7

What UL therapies have the largest evidence base?

Answer 7

• Repetitive practice
• Task-specific and context-specific practice
• Bimanual training in the acute phase

Some evidence for:

• CIMT
• Computerised training
• NMES
• Mirror therapy
• mental practice