EPISODE TITLE: Reconnecting With Your Hand After Stroke Parts 1 & 2
EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Deb and her level II fieldwork student Zoe talk with two D’Youville students Abigail and Olivia about all topics regarding hands after stroke with emphasis on recovery. We covered:
Use as natural as possible if using one Deb and students discussed shoulder girdle for upper extremity during therapy and uses during fieldworkDeb made note to “never pull on arm/upper extremity during activities or transfers”Schedules and proper don-doff proceduresDeb made note about not liking low muscle tone splinting unless possibility for subluxation (popping out of shoulder socket) or injury prone with neglect/forgetfullness of that limbNeglect and sensory impairment briefly noted with concern for injuryStrategies with slings for the upper extremity to prevent subluxation of limb if applicableAbigail discussed use of trays for UE positioning to prevent injuryFear of transferring: getting limb with low sensation and muscle tone stuckDiscussion of injury prevention seen with untrained providers in hospital settings and the need to train mobilization of patients during transfers for safetyDeb and students mention the use of kinesiotape (KT) tape for incorporating sensory and awareness of hand positioning for strategy in joint positioning and decrease contractureSlight introduction and awareness of preparatory activities and how they are used in OTImportance of education for any strategies or interventions is needed for families/caregivers and patientsSpasticity introduction with a statistic found from students research provided(https://www.mdpi.com/2077-0383/12/23/7497)One combined flexed pattern (shoulder lift, bend elbow, wrist bends) causes shortening of muscles --> possible leading to contractureDue to weak extensors flexors dominate leading to limitations of opening the hand for fine motor/precise movements80 % of post-stroke patients present with Upper limb limitations, motor deficits, and hemiplegia (https://www.mdpi.com/2077-0383/12/23/7497)”Upper limb spasticity affects 17–40% of people” Abigail and Olivia discuss about patient treatment with spasticity post stroke seen in fieldwork placementOlivia and Deb describe vibration technique use within clinics to facilitate muscles that were not activating during movements that were considered “stuck” in this phase of recoveryFlexors are stronger more often than extensors causing contractures within hands and development of flexion synergyGross grasp/release patterns and statistic found from students research providedIntroduction of electrical stimulation (ESTIM):Examples: lifting and dropping towels during cleaning activity; picking up blocks and moving from one side of table to otherDeb and students explain how electrical stimulation (ESTIM/FES) was used within an intervention/prep activity for gross motor grasp/release patterns and how these can be used during ADL activities Range of motion (ROM) education and activities to maintain muscle length in order to prevent contractures within the hand and shoulder/upper extremityTook not how important to not over work or stretch muscles with force, it can cause more harm than good Theraputty is a good tool to use for hand strengthening exercisesImportance of handouts, caregiver training, and education/mass practice Discussed that if patient is bored within room during recovery, to increase mass practice of exercises to regain range of motion (ROM) and strengthDeb mentioned strategies to improve active movement using hand-over-hand (HOH) techniques and resistive training Corticospinal tract (26:30) introduction and how it is important with movement within the hand/upper extremityThis is how flexion synergy can occur due to this impairmentDeb mentioned use of mirror therapy for these patients as a form of intervention to improve fine motor movements using repetition for brain to create neuroplasticity and reorganize brain patterns Importance of evidence-based practice for motor relearning strategies and excitement for participation in activities with patientsAbigail discussed use of mirror therapy in fieldwork placement with shoulder/upper extremity strategiesOlivia discussed her use of seeing mirror therapy in her fieldwork placements including applying a mirror therapy activity presentation for her final project at her fieldwork placement How important is to look back at our biases based on interventions and research to make sure up-to-date and specifically changingRange of motion (ROM) and thumb exercise importance to regain function within hand Conclusion of first episodeDeb presents information about a document that should be used when working with stroke providers from Chapter 10 of the EBRSR for motor rehab interventions filled with multiple articles about need for repetitionIn 2017 by Waddle et al. discussing the intensity of task-specific rehab (13.6 hours of task-specific training with x100 reps) In 2016 by Lang et al., discussed using 3200 reps of upper limb training If unable to physically move, patients want to do repetitions for brain engagement and if physically able to move use interventions giving ability to move with repetitions is even better ”If you can handle a little bit of frustration, it really helps your outcome!” - OliviaOlivia provided small introduction of CIMT acknowledging safety, behaviors, and frustrationFrustration strategies and how to handle these situations with certain patients and stroke survivors using OT knowledge and core principlesDeb mentioned her new private practice with mirror therapy programs and acknowledged her level II fieldwork student Zoe helping with creating mental practice recordings to go along with the action observation videos for patients to use when at home during recoveryMentioned Pete and his previous research with Dr. Paige about completing interventions cohesively with time control to improve stroke survivor mobility of the upper limb.Students discuss two gaming articles on integrating fun and passion with therapy goals by improving fine motor control in hand movement and gross motor patterns with active engagementLeap motion controller article (https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00654/full)Zoe mentions virtual reality use and Olivia brings up seeing use of it in fieldwork Competition to increase reps and sustained attention for improving goals and better outcomesAbigail mentioned use of Wii for upper extremity training with active feedback and self competition to improve strength Important article of sensory feedback leads to mastered fine motor movements (Post-stroke sensory deficits and re-education (https://www.cuh.nhs.uk/patientinformation/post-stroke-sensory-deficits-and-re-education/)Sensory remediation: retrain and understand sensory input coming in using stereognosis which is the use of feeling and guessing what you are holding or touching without seeing and increase complexity as it becomes easier with less complex itemsSensorimotor article using vibration stimulation and mass practice (https://pmc.ncbi.nlm.nih.gov/articles/PMC9918228/): tried to increase threshold for less sensory input to feel what is being touched and increase motor outcomes at the end of the trialStudents talk about sensory integration interventions seen in fieldwork (sensory bins, prep activities)Discussed safety within the kitchen such as using utensils, working with hot water, and heat appliances due to decrease sensation or impulsivenessInterventions and compensatory strategies:Different use of adaptive equipment: universal cuffs/built-up handles/dressing toolsButton hook used buttons and zippers for decreased fine motor movementSlip-on shoes and elastic shoe laces for decrease hand strength and coordinationWomen dressing adaptive styles Kitchen utensils to assist with hand movementUse of dysem for small activities and safety along with during weight bearing activitiesRecovery time periods: different for everyoneDeb’s article (A critical time period of recovery goes beyond 1 year post-stroke by Ballister et al.) 3-6 month critical window of heightened neuroplasticity post-stroke, but uncover gradient of enhanced sensitivity to treatment that expands farther beyond the "critical window”Student article listed Recovery Time Periods below in Resources Deb and students provide articles that can show multiple timelines of recovery time periodsNeuroplasticity continuously occurs with constant recovery and engagementHope is always there for survivors and caregivers if you have positive mindsets to recovery and treatments; not all survivors experience spontaneous recovery or recover at the same time so take your time and remain open-mindedFinal remarks for survivors and caregivers from Olivia, Abigail, Zoe & DebWe hope you enjoyed this episode of Noggins And Neurons. As always, we want to hear from you! Email us at [email protected]
-Objectifying Measures of Post Stroke Hand Rehabilitation through Multidisciplinary Scales (https://www.mdpi.com/2077-0383/12/23/7497)
-Effect of Sensory Impairment on Hand Functional Improvement Through Therapy and Sensory Stimulation
(https://pmc.ncbi.nlm.nih.gov/articles/PMC9918228/)
-Post Stroke Sensory Deficits and Re-education (https://www.cuh.nhs.uk/patientinformation/post-stroke-sensory-deficits-and-re-education/)
-Hand Resistive Therapy Exercises (https://journals.lww.com/ijpt/fulltext/2024/06010/therapeutic_putty_based_hand_strengthening.7.aspx)
-Hand Exercises for Finger and Thumb for Stroke Recovery (https://www.baystatehealth.org/articles/handexercises-for-strokerecovery)(https://journals.physiology.org/doi/full/10.1152/jn.91310.2008)
-Isometric and Voluntary Action movements for Hand Post Stroke (https://sci-hub.ru/10.1179/1945511915Y.0000000023)
-Video Gaming Article with Leap Motion Controller for Fine Motor Improvement (https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00654/full)
-Another Gaming Article for Hand Recovery (https://journals.sagepub.com/doi/abs/10.3233/NRE-192829)
-Recovery Time Periods and Critical Window (https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/stroke-recovery-timeline)
- A critical time period of recovery goes beyond 1 year post-stroke by Ballister et al.
THERAPY PRACTICE RESOURCES:
PETE’S blog and book, “Stronger After Stroke: Your Roadmap to Recovery” 3rd edition:
DORO’S OT PRACTICE – The Neuro Hub
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