For example, how can we teach a person with right hemiplegia, 3 months post-stroke and having no to minimal voluntary control in upper limb and hand to eat independently using task oriented approach? What are all the factors that will influence your clinical decision making?
Dear Dr. Seelen,
I will contact Dr. Franck shortly.
A meta-analysis of clinical trials evaluating the functional outcomes of task-oriented practice for upper limb impairments has not reported satisfactory results [French et al, 2010]. I am interested to know how to prescribe task oriented exercises, set the dosage and decide the type of practice for upper limb. How to design exercises satisfying the fundamentals of task oriented activities? What are the various factors to be considered in our clinical decision making process?
Thanks and regards.
Dear Mr Ganesh,
that is a difficult question, first of all, some information is missing, as for instance age, localisation area, is the paretic arm flaccid or rather spastic / hypertone?, is he or she cognitively well, how is the perception of the affected arm and hand?
and what is the task exactly? for someone who meets a moderate / severe affected arm and hand, the goals set have to be attainable, and simple, like for instance active stabilisation tasks, (fixating the slice of bread while using the non-affected arm to put butter on it), starting with meaningfull and attainable goals will lead to a growing insight if recovery or usefull compensations are beneficial.
Also it has te be evaluated which underlying symptoms of the affected arm and hand can be manipulated to extract more voluntary movements. in other words: what are the exaxt underlying impairements? is that for instance; loss of strenght, voluntary movement/ selectivity, tone, perception, awareness etc..
done this will give you insight for the task - oriented training
I hope you these answers are helpfull in a kind of way..
with kind regards,
Han Franck
It is important that the patient has retained a feeling of deep, what is the cooperation of the patient (cognitive impairment and aphasia) or jast reinstatement of active movement, if there is paralysis.
In the rehabilitation department in Olsztyn (Poland) in therapy we use the methods.: Bobath , PNF, therapy enforce movement ( healthy limb immobilization)
If there is a deep feeling we should also practice example, the method by Perfetti.
In terapiii You can also use a mirro
Joanna Białkowska
Dear Franck,
That was a hypothetical question. I do agree with your goal setting approaches.
However, your answers kindled more questions in me. Does the area of infarct really affect functional recovery? Previous studies are divided in their conclusions. So can we conclude task oriented approach are appropriate for certain populations? If you were to select a criteria for those participants who will benefit from task oriented activities, what will be they?
Thanks and regards
Dear Shankar,
To my experience,Mirror therapy and robotic training are usefull approaches for arm and hand rehabilitation in patients with hemiplegia.
But, the motor and cognitive level of patients is very important
dear Shankar, I suggest you have a look at the website that Jan Davis has made for this patient group. She shares her knowledge and organizes courses answering the question you have posed. www.icelearningcenter.com
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