Specialist Upper Limb Evaluation and Treatment intervention Clinic
Upper limb (UL) impairment affects 85% of all Stroke patients ( Rodgers et al 2003). 50 % of patients with UL impairment still have significant functional limb problems 4 years later ( Brocks et al 1999). Stroke patients feel insufficient attention is paid to the UL management (Wade et al 1997) and the lower limb (LL) has priority over upper limb rehabilitation (Lincoln et al 1998).
Constraint- Induced movement (CI) therapy consists of a family of therapies that induce persons with stroke to greatly increase the use of the more affected UL for many hours of the day over a 2-3 week period. CI therapy studies have indicated that it substantially increases the use of the more affected UL in the everyday life situation ( Taub et al 1999,1993).
Two different but linked mechanisms are considered responsible for increased use of the more affected UL in the life situation post stroke:
· Overcoming learned nonuse
· Inducing use-dependent cortical re-organization
Objective of the Clinic
A Specialized unit that facilitates as best as possible the:
· Prevention and treatment of shoulder pain
· Facilitates decreased neurological impairment
· Optimization of functional recovery
Based on the use of specialized treatment approaches and validated outcome measures.
Specific Outcomes of Interest
Primary measure the clinic strives for: Improved motor and functional recovery
Secondary measures and service development: Research into:
· Programmes of care
· Quantity of care
· Cost of clinical outcomes
· Economic impact
Assessment
The relevant team will conduct an extensive initial assessment. Which will include the use of standardized Outcome Measures namely:
Wolf Motor Function
MAS/UL
Fugl Meyer
Cybex testing
Hand Dynamometry
Modified Ashworth Scale
General assessment will include a measure of active and passive range of motion, general muscle strength, and pain for both upper extremities.
Programme Design
Stage 1: Assessment at Clinic
Stage 2: Medical Aid motivations for therapy
Stage 3: Trial with therapist in recommended treatment programme
Stage 4: 6 weeks programme intervention
Stage 5: Follow up re- assessment s at 6 weeks, 12 weeks and 6 months.
Programme Recommendations
Features include:
- Management of Shoulder pain
- Group strengthening programmes; this will include three levels of client severity/ ability
- Group task specific training programmes
- NMES
- Saeboflex training programmes
- Constraint induced training programmes
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The main purpose is to assist stroke survivors with performing repetitive functional exercises with their involved arm/hand. Stroke survivors most appropriate for this programme include individuals who are unable to open their hands due to spasticity (i.e. increased muscle tone).
