Evidence-Based Upper Limb Retraining

Evidence-Based Upper Limb Retraining after Stroke

Is there evidence to support the routine use of functional electrical stimulation (FES) after stroke to reduce shoulder subluxation and elicit muscle recovery?

Evidence-Based Upper Limb Retraining after Stroke

Is there evidence to support the use of prolonged low-load stretches or splints for the prevention of muscle contracture after stroke?

Evidence-Based Upper Limb Retraining after Stroke

What evidence is there for eliciting muscle activity in paralysed muscles?

This workshop focuses on helping therapists to minimise upper limb impairments post-stroke, and increase engagement in activities.

Course notes and content will be based on published research and movement science/motor relearning.

This workshop is now run over 3 days and accepts 24 registrants

This enables small groups to work with clients and receive feedback from the presenters during clinical sessions.

Target audience
The workshop will be of interest to occupational therapists and physiotherapists from hospital and community based settings, who teach adults following stroke and acquired brain impairment, as well as university lecturers. The workshop focuses on upper limb rehabilitation.
Pre-reading
will be provided to the organising group for distribution to participants

Learning Objectives

At the end of the workshop, participants will be able to:

Name

the essential components (invariant kinematic features) of normal reach and manipulation.

Recognise

common compensations when observing people with stroke/brain injury attempting to reach for and use everyday objects; understand and explain why these compensatory strategies should be discouraged during practice.

Discuss

factors thought to contribute to the development of muscle overactivity/spasticity, and strategies to prevent these secondary problems.

Explain

the relationship and differences between spasticity/overactivity, muscle length changes, missing essential components and compensations.

Plan and conduct

an observational analysis and motor training session with a person who has had a stroke

Name

key factors that affect motor learning, and how these factors can be modified to enhance learning and increase intensity of practice.

Use

an electrical stimulation machine to stimulate paralysed muscles.

Discuss

evidence related to various interventions including constraint-induced movement therapy and mirror therapy to improve motor recovery and function of a person’s upper limb.

Presenters

Dr Annie McCluskey
Dr Annie McCluskey
Occupational therapist, health services researcher and educator. She has 30+ years experience in stroke and brain injury rehabilitation.

Karl Schurr
Karl Schurr
Clinical experience in stroke and brain injury rehabilitation for 30 years+ in Australia and the UK.

Workshop Timetable

Time Day 1
8.00 Housekeeping, introductions; workshop overview
8.20
Session 1
Analysis of normal movement: Essential components of reach and grasp (cup, pen, cutlery, brush). Anatomy revision.
10.00 Morning Tea
10.20
Session 2
Analysis of Abnormal Movement: Missing components and compensations with videos. Allocate groups.
12.15 Lunch
1.00
Session 3
Being an Effective Coach 1: Focus on goal setting, feedback, practice intensity and measurement, with feedback video.
2.15
Session 4a
Demonstration 1: Analysis and training of stroke participants 1 and 2; provision and set-up/video of overnight practice by tutors
3.15 Afternoon Tea
3.30
Session 4b
Demonstration 2: Analysis and training of stroke participants 3 and 4; provision and set-up/video of overnight practice by tutors
4.30 Large group discussion and questions. Evaluation form. Round robin with each person stating “One thing I learnt today…..”
5.00 FINISH
Time Day 2
8.00
Session 5
Implications of evidence for clinical practice: A case example. Muscle length changes and spasticity. Interventions including stretching, splinting, casting, positioning and botulinum toxin
9.30
Session 6
Training Ideas and Being an Effective Coach 2: With videos
10.10 Morning Tea
10.30
Session 7
Training Ideas / Being an effective Coach 2 (continued) Setting up the Physical Environment to Optimise Practice: Videos /practical
12.15 Lunch
1.00
Session 8a
Clinical Session 1: Review practice and homework from Day 1 with 4 stroke participants (by tutors).
1.40 Groups meet for 15-20 mins to plan for Clinical Session 2 (eg Equipment needed; tasks to analyse; sequence of coaches)
2.00
Session 8b
Clinical Session 2: Groups assess /analyse (20-30 mins) together, then take turns training a new stroke participant. Aim for 300 repetitions. Write up /video overnight practice for hospital/home.
3.30 Working afternoon tea – Meet in small groups to discuss session, including coaching
4.00 (Evaluation form). Meet for debrief and discussion as a large group. Round robin with each person stating ‘One thing I learnt today….”
4.30 FINISH
Time Day 3
8.00
Session 9
Evidence of Therapy Effectiveness -Lectures interpersed with videos and practical: (i) Electrical stimulation (ii) Mental practice
10.15 Morning Tea
10.30 Session 9 continued – (iii) Constraint therapy (iv) Mirror box therapy
12.30 Lunch
1.15
Session 10a
Clinical Session 3: Groups review practice and goals for stroke participant from Day 2. Re-measure performance. Progress practice.
2.00 Stroke participants have a short break. Groups provide verbal handover to the next group, including suggestions for training. Plan tasks to analyse, equipment needed and sequence of coaches
2.15
Session 10b
Clinical Session 4: Groups analyse and train another stroke participant. Aim for 300 repetitions. Audio-record coaching. Observe and record other coaches giving feedback. Set-up /video take-home practice.
3.00 Working afternoon tea – Groups meet to discuss session including coaching
3.30 Discussion as a large group/ Qs arising over 3 days. Statement of goal intentions. Evaluation form. Round robin with each person stating ’When I return to work next week, one thing I will do is ….”
4.00 FINISH