McCluskey A, Lannin NA, Schurr K, & Dorsch S. (Pre-publication copy, 2017). Chapter 40: Optimizing motor performance and sensation after brain impairment. In M Curtin, M Egan & J Adams (Eds.). Occupational therapy for people experiencing illness, injury or impairment: Promoting occupation and participation (7^th ed.). Elsevier

This chapter summarises the process of analysing reach to grasp, postural adjustments when reaching in sitting, common compensations and best-practice teaching of motor skills, and evidence-based interventions including strength training, electrical stimulation, mirror therapy, coordination training, mental practice and CIMT.  Research on the effectiveness of therapy interventions is also summarised.  Available in English, Spanish and Chinese.

McCluskey A, Lannin NA, Schurr K, & Dorsch S. (Pre-publication copy, 2017). Chapter 40: Optimizing motor performance and sensation after brain impairment. In M Curtin, M Egan & J Adams (Eds.). Occupational therapy for people experiencing illness, injury or impairment: Promoting occupation and participation (7th ed.). Elsevier

This chapter summarises the process of analysing reach to grasp, postural adjustments when reaching in sitting, common compensations and best-practice teaching of motor skills, and evidence-based interventions including strength training, electrical stimulation, mirror therapy, coordination training, mental practice and CIMT.  Research on the effectiveness of therapy interventions is also summarised

Bu bölümün Türkçeye çevirisi Fzt. Canpolat Çelik tarafından yapılmıştır.

İzmir, Türkiye. (E-mail: fztcanpolatcelik@gmail.com)

McCluskey A, Lannin NA, Schurr K, & Dorsch S. (Pre-publication copy, 2017). Chapter 40: Optimizing motor performance and sensation after brain impairment. In M Curtin, M Egan & J Adams (Eds.). Occupational therapy for people experiencing illness, injury or impairment: Promoting occupation and participation (7^th ed.). Elsevier

This chapter summarises the process of analysing reach to grasp, postural adjustments when reaching in sitting, common compensations and best-practice teaching of motor skills, and evidence-based interventions including strength training, electrical stimulation, mirror therapy, coordination training, mental practice and CIMT.  Research on the effectiveness of therapy interventions is also summarised

摘要 - 本章节将描述一个关于改善脑损伤后运动表现和感觉功能的知识框架。本章提及的脑损伤主要为脑卒中和脑外伤，但也可以应用于其他的神经系统疾病。同时本章会以进食活动作为主要范例。研究生阶段所需要的知识和技能会特别指出来，包括运动行为的知识、伸手抓握和坐位拿取物品动作的组成成分、以及如何识别代偿策略、提出并验证一个运动假设。我们也会讨论促进技能学习的因素，包括任务的特异性，锻炼的强度和及时的反馈，以及治疗师教授技能时的技巧。最后，会基于循证依据给出一份改善运动表现和感觉的干预方式，包括高强度任务为导向性的训练、镜像疗法、想象疗法、电刺激和强制性运动训练。

Acknowledgements: Thankyou to the following therapists who completed the translation into Chinese and back translation in 2018:

1) From Shanghai Ruijin Rehabilitation Hospital 上海市瑞金康复医院 

YUANFENG SUN   孙远丰    ZHENG WANG   王正   ZIHAO XIAO 肖梓豪   ZHENNI WANG  王臻旎

2) Dr Tim XU TIANMA,  Health & Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, SINGAPORE 138683

Email: tim.xu@singaporetech.edu.sg

3) Ms YU GU, Physiotherapy Department,  Royal Prince Alfred Hospital & Discipline of Physiotherapy,

Faculty of Health Sciences,  The University of Sydney,  AUSTRALIA - Email: yugu5468@uni.sydney.edu.au

Acknowledgement: Thankyou to Mireya Osario Verdejo &  Sebastián Contreras Marcone from Chile, who generously translated the book chapter into Spanish.  

Traducción del capítulo de inglés a español realizada por Mireya Osorio Verdejo, Kinesióloga y Sebastián Contreras Marcone, Kinesiólogo. Centro Comunitario de Rehabilitación Física. La Pintana, CHILE

McCluskey A, Lannin NA, Schurr K, & Dorsch S. (Pre-publication copy, 2017). Chapter 40: Optimizing motor performance and sensation after brain impairment. In M Curtin, M Egan & J Adams (Eds.). Occupational therapy for people experiencing illness, injury or impairment: Promoting occupation and participation (7^th ed.). Elsevier

This chapter summarises the process of analysing reach to grasp, postural adjustments when reaching in sitting, common compensations and best-practice teaching of motor skills, and evidence-based interventions including strength training, electrical stimulation, mirror therapy, coordination training, mental practice and CIMT.  Research on the effectiveness of therapy interventions is also summarised

This 20-minute lecture was delivered by Dr Annie McCluskey as an invited presentation at the Occupational Therapy Australia 28th national conference in Sydney, 10th July 2019.  A PDF of the accompanying PPT slide handout is also provided.

10 things I wish I’d known as a new graduate about stroke and upper limb retraining

• Introduction:  Occupational therapy graduates are often uncertain about their role in stroke rehabilitation, particularly how to improve upper limb function.  Historically this lack of confidence has been due to limited content in undergraduate curricula, particularly in diploma-level courses. The apprenticeship model of practice also affected therapists’ confidence, where graduates learned by watching more experienced therapists. Those therapists may (or may not) have had the necessary skills and knowledge. When I graduated, I was shown and practiced facilitation techniques and compensatory strategies, but had no science to inform my practice, and no outcome measures were used.  Continuing education about upper limb retraining was rare. I mostly learned from books and my Australian physiotherapy colleagues. Now, universities with an occupation-based curriculum teach intervention at the level of activity and participation, but may not teach body-function or impairment -level intervention. Graduates may be unsure if or how they should train upper limb impairments, yet rehabilitation teams and stroke survivors expect occupational therapists to assume this role.
• Objectives: To highlight skills and knowledge needed by occupational therapists in 2019 and beyond, to retrain upper limb function and improve occupational performance after stroke.
• Approach:  Knowledge and skills will be presented related to motor control (anatomy, biomechanics and movement science; video, task and activity analysis), strength and coordination training, motor learning (instructions, goals, feedback, active participation) and evidence-based practice (critical appraisal skills, decision-making, outcome measurement).
• Practice implications: This presentation is aimed at students, novice and experienced clinicians and academics responsible for shaping university rehabilitation curricula. Audience members can identify knowledge and skill gaps requiring continuing education.
• Conclusions: Occupational therapy clinicians need strong foundation skills in motor control and motor learning to work in stroke rehabilitation, to think like a movement scientist, an occupational scientist and an evidence-based practitioner.

This is the first in a series of blogs about spasticity, to help therapists make sense of what continues to be a very fraught issue – despite the strong evidence that spasticity is not the main problem preventing stroke survivors from moving.  These blogs present some of the problems arising from beliefs about spasticity and importantly, provide some evidence-based strategies therapists can use to help stroke survivors learn to move, even in the presence of spasticity.

The second blog will considerthe 1980 definition of spasticity.  This clear unambiguous definition of spasticity attributed to Lance was generated at  convention held in 1980.  That definition is: “a motor disorder characterized by a velocity dependent increase in the tonic stretch reflex (muscle tone) with exaggerated tendon jerks, resulting from hyper excitability of the stretch reflex, as one component of the upper motor neurone syndrome.”

A proposed definition of spasticity by Pandyan et al 2005. Over the years, there has been a reluctance to accept the Lance et al (1980) definition of spasticity (see blog 2). This reluctance seems to arise from the observation that there are many changes to the sensori-motor system that may occur after a stroke including:

• loss of, or decrease in muscle activation (flaccid, weak muscles),
• amplified reflex responses (hyperreflexia),
• loss of co-ordination, excessive muscle activation when attempting to move
• soft tissue adaptations such as stiffness and contracture.

These varied possible sequelae after stroke have led medical staff, therapists and medical companies involved with outcomes after stroke to find the Lance definition of spasticity limiting (Pandyan 2005).  The Lance definition, they claim, excludes these other neural and muscular changes that may be observed after stroke. To compensate for this perceived limitation, Pandyan et al have proposed an alternative definition of spasticity that allows for inclusion of many of these other possible sequelae after a stroke.  Here is their definition: ‘disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles’

Is this definition helpful ? In a word, no! Read this blog to learn why.....

Distinguishing between spasticity, stiffness and contractures can be confusing for many therapists (and medical staff). There are many secondary complications or adaptations which may (or may not) occur after stroke including.  These can include neural (eg hypertonicity) and non-neural adaptations (eg stiffness, contracture, excessive muscle activity associated with compensatory strategies and early skill acquisition).  Because of the lack of agreement about what spasticity actually is, often these secondary complications are assumed to be, or are described, as spasticity.

In this blog, we look at each of these sequelae in turn.

ViaTherapy is a clinical decision making tool that provides best practice and evidence-based recovery interventions for upper extremity stroke rehabilitation. It is available as a free downloadable App

ViaTherapy was developed in Canada by an international panel of rehabilitation researchers and clinicians, and is updated from time to time. References are provided, and dose of intervention is recommended.