Masterclass - Stroke: Upper Limb Flashcards
State the 3 factors influencing goal directed movement and the 2 phases involved in goal-directed movement of the UL
Factors influencing goal directed movement:
1) Object position in space
2) Object characteristics
3) What you do with the object
2 Phases of goal-directed movement:
1) Transportation phase
2) Manipulation phase
State the basic patterns of upper limb impairment and how this may influence rehabilitation.
Inactivity of shoulder Abductors + flaccid RC -> Patients cant set scap or abduct shoulder
Distal muscles are often more affected than proximal muscles -> general ‘resting’ posture in a hemiparetic arm
Often coactivation of muscles and poor control of synergistic muscles -> Loss of intersegmental coordination (especially shoulder flexors + elbow extensors)
Describe the movements at each joint to reach for an object as well as the implications to normal movement (i.e. potential compensation strategies) due to a particular impairment
Shoulder elevation, supination, GH ER, wrist extension, finger pre-shaping (extension / conjoint rotation.
Compensation strategies: IR and lateral trunk flexion, holding breath / grimacing, and shoulder hiking.
Describe the principles behind repetitive task specific training and the evidence for it.
Repetitive task-specific training strengthens neural connections and enhances motor control through high repetitions. Evidence suggests it is effective in improving strength and arm and hand function post stroke, as show in a Cochrane review
Utilise devices/programs to increase repetitions and independence
- CIMT + mCIMT
- Robotics
- Assistive devices
Reps, reps, reps = improved neuroplasticity
Outline strategies for whole task-practice exercises for reaching and manipulation and the rationale for Constraint Induced Movement Therapy.
CIMT is intensive graded task specific use of only the affected limb (one-handed tasks). Tasks include cutting a piece of bread with a knife, pouring water into a glass, placing coins onto a piece of tape and pins into holes. The rationale is to force the patient to complete these tasks with the affected hand without compensating with the unaffected side.
Outline the inclusion criteria for CIMT therapy and provide an overview of CIMT training
Inclusion criteria:
- 10 deg of active wrist extension
- 10 deg of thumb abduction
- 10 deg or finger extension (all fingers)
- Minimal cognitive/perceptual deficits
CIMT Overview:
- 6 hours/day for 2 weeks
- Shaping (training for tasks that progressively increase in difficulty)
- Patients go home with forced use for 90% of the time
- During this time, patients are provided with a ‘transfer package’ to ensure effects are maintained
Outline the inclusion criteria for Mirror therapy and provide an overview of Mirror therapy training
Suitable for patients with flaccid hands. Providing a visual illusion of movement to promote motor recovery
Patient imagines that hand in mirror is the paretic hand. Provided feedback that the hand is actually functioning (patient performs task with non-paretic hand and attempt to replicate movement with their paretic hand)
Inclusion criteria
§ Cognition (attention, memory and concentration)
§ Vision (must see entire image in mirror)
§ Trunk control to sit unsupervised
§ Non-paretic limb must have normal pain free ROM
Performed in quiet room – try to do unsupervised
1x per day (10-30 mins) – 1 session or 2 smaller sessions
Start with simple movements (flexion/extension) then gradually increase complexity
Briefly discuss the pros and cons of using robotics, video games and mental practice in rehabilitation
Robotics: effective in enhancing motor strength but may vary in outcomes based on device quality. Variation among trials (intensity, duration, amount of training, type of treatment, participant characteristics, and measurements used)
Video games: engaging and motivating, useful for improving range and strength
Mental practice: enhances motor imagery and neural plasticity but may be less effective without physical movement
