Evidence - Principles of training R&M

Question 1

Johansoon & Westling, 1988

Answer 1

Muscle activity during a ball catching/ throwing task in normal population

• Prep hand grip movements and decreased grip force occur when movements are self initiated
• prep hand grip movements also absent when movements are in response to an imposed change in load with vision occluded
• Clinical Implications: Train both self imposed and externally impose, eyes opened and closed

Question 2

Jeannerod, 1984

Answer 2

• Normal population
• transport and Manipulation components interrelated
• Transport phase slower when object is close; duration of task and grip aperture are unchanged
• CLinical implications: train whole activity: both components together
• manipulate speed of transport phase by positioning objects at different distances

Question 3

Iberall et al, 1986

Answer 3

• Normal population
• different grasps depending on object is placed accurately in new location or shaken
• Clinical Implications: train specific tasks and include purpose

Question 4

Wing & Fraser, 1983

Answer 4

• Normal population
• thumb is invariant when grasping (doesn’t move from beginning position) - hand is opened/ closed by MCP/ IP movement
• Clinical Implications: Don’t allow thumb to move during activity training when providing fedback

Question 5

Kilbreath et al, 2006

Answer 5

• observational study at 5 min interval of object handling taks in Normal population
• 50% of time Bimanual tasks; 30% of time: Unimanual tasks; 20% time; none
• most often standing when performing R&M tasks
• Clinical implications: Train Non dominant hand, train Bimanual & unimanual tasks and in training

Question 6

Wu et al, 2000

Answer 6

• effect of presence and absence of objects on reaching performance in health and stroke subjects
• When objects were present, arm moved faster, smoother and more directly
• Clinical Implications: Train by giving patient on object to aim for

Question 7

Corbetta et al, 2015

Answer 7

• Systematic review comparing CIMT ith usual therapy
• Improvement in arm motor function
• No significant difference in disability or at follow up
• Clinical Implications: CIMT potentially effective treatment for arm motor function improvement

Question 8

Bang et al, 2015

Answer 8

• RCT examining difference between CIMT with/ without trunk restraint
• CIMT combined with trunk restraint showed greater improvement in strength, activity limitations and participation
• Clinical implications: consider using trunk restraint with CIMT