Presenters: Dr Annie McCluskey (occupational therapist) & Karl Schurr (Physiotherapist)
Part 1 – Analysis: Therapists will learn about the essential components of reach to grasp and manipulation, visual cues that can help identify potential impairments, likely causes of the observed movement difficulties (eg hand, thumb, shoulder or a combination), how to distinguish between weakness in some muscles and excessive activity in other muscles which contribute to the observed compensations (kinematic deviations), and the difference between essential components and compensations. Multiple videos and photos will be used during the workshop.
Part 2 – Retraining: Examples of task-specific motor training will be presented targeting tasks of importance to stroke survivors such as using cutlery, writing and drinking. Part and whole practice examples will be presented, including strategies for reducing force and pressure on utensils, a common problem for stroke survivors. Again, multiple videos and photos will be used to aid learning. Other interventions that can improve strength and in-hand coordination include mirror therapy, electrical stimulation, mental practice and constraint-induced movement therapy. Emphasis will be placed on teaching stroke survivors how to practice without 1:1 supervision and without manual guidance, in preparation for home-based practice. A brief summary of the evidence will be presented supporting these therapies, and national guideline recommendations presented.
Learning Objectives: By the end of this workshop learners will be able to:
• Name the essential components of reach, grasp and manipulation.
• Recognise common compensations when observing stroke survivors attempting to reach, grasp and manipulate objects
• Explain how to minimise compensatory strategies or kinematic deviations during upper limb assessment and retraining
• Plan an assessment and retraining session with a stroke survivor using motor learning principles and task-specific practice
• Cite references from systematic reviews and national guidelines that support use of mirror box therapy, mental practice, electrical stimulation and constraint-induced movement therapy for improving upper limb motor recovery and coordination.
Recommended reading & homework (task analysis) will be provided by email.