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Effective Interventions to Promote Participation and Functional Use of the

Affected Upper Extremity for Clients Post-Stroke

Spalding UniversityJodi Combs, OTS

jcombs01@spalding.edu

Why Clients Post-Stroke?

It is estimated there are approximately three million stroke survivors in this country, 70 percent of whom experience “significant

functional disability” (Hayner, Gibson, & Giles, 2010)

Occupational Therapy and Stroke

Occupational therapy practitioners address the physical, cognitive, and mental challenges brought on by a stroke

The effects of stroke can be devastating but most can be improved with rehabilitation.

Some of these effects include: loss of balance, paralysis, vision problems, loss of coordination, and also decreased sensation

Level II FW Experience

Focused Question

What is the evidence for effective occupational therapy interventions to promote participation

and functional use of the affected upper extremity for clients post-stroke?

Effective Treatments

Constraint-Induced Movement Therapy

Meaningful Task-Specific Training

Mirror Box Therapy

Gaming Systems

Mental Practice

Bilateral Treatment

Constraint- Induced Movement Therapy

Constraint-induced movement therapy (CIMT) consist of the sound arm being restrained, typically in a sling, mitt, or both, for an established percentage of the day. During restraint, the patient performs selected activities using the affected upper extremity.

Meaningful Task-Specific Training

Task-specific training provides goal-directed repetitive practice of motor tasks to improve functional abilities.

Mirror Box Therapy

Patients who engage in mirror therapy realize greater recovery of function in their upper

extremities than those who receive conventional therapy alone.

Other Effective Treatments

Gaming Systems

Mental Practice

Bilateral Treatment

Questions?

Thank You!!!

References

Arya, K., Verma, R., Garg, R. K., Sharma, V. P., Agarwal, M., & Aggarwal, G. G. (2012). Meaningful Task- Specific Training (MTST) for Stroke Rehabilitation: A Randomized Controlled Trial. Topics In Stroke Rehabilitation, 19(3), 193-211. doi: 10.1310/tsr1903-193Cameiraoa, M.S., Badiaa, S.B., Duartee, E., & Verschure, P. (2011). Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: A randomized controlled pilot study in the acute phase of stroke using the Rehabilitation Gaming System. Restorative Neurology and Neuroscience, 29, 287– 298. doi:10.3233/RNN-2011-0599Christian, D., MPhil, J. P., Antje, N., Jutta , K., Christian, R., & Hans, K. (2008). Mirror therapy promotes recovery from severe hemiparesis: A randomized controlled trial. Neurorehabilitation and Neural Repair, 23(3), 209-217. doi: 10.1177/1545968308324786Hayner, K., Gibson, G., & Giles, G. M. (2010). Research Scholars Initiative Comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic

upper-extremity dysfunction after cerebrovascular accident. American Journal of Occupational Therapy, 64, 528–539. doi: 10.5014/ajot.2010.08027McCall, M., McEwen, S., Colantonio, A., Streiner, D., & Dawson, D. R. (2011). Modified constraint-induced movement therapy for elderly clients with subacute stroke. American Journal of Occupational Therapy 65, 409–418. doi: 10.5014/ajot.2011.002063Nilsen, D. M., Gillen, G., DiRusso, T., & Gordon, A. M. (2012). Effect of imageryperspective on

occupational performance after stroke: A randomized controlled trial. American Journal of Occupational Therapy, 66, 320–329. http://dx.doi.org/10.5014/ajot.2012.003475Wu CY, Lin KC, Chen HC, et al. (2007). Effects of modified constraint-induced movement therapy on movement kinematics and daily function in patients with stroke: A kinematic study of motor control mechanisms. Neurorehabiltation Neural Repair,21, 460–466. DOI: 10.1177/1545968307303411