Task-Specific Therapy Post Stroke - Recovery of a stroke-affected arm and hand

Constraint Therapy Will it work for me? Research has shown that constraint therapy can have a significant impact on the function of a stroke-affected arm, but ONLY if:  It’s additional to task specific therapy  You have at least 20° of unassisted movement in your stroke-affected wrist and 10° in at least one finger or your thumb If you can’t move your hand this much on your own, then it is best to NOT apply a constraint to your stroke-affected hand, as there is no guarantee that all your hard work and task- specific practice will be beneficial. There is no research that indicates that simply wearing a constraint mitt will improve the function of your stroke-affected arm or hand. How often do I need to wear the mitt? We recommend 5 x 5 x 5: At least five hours a day, five days a week, for five weeks. It’s important to select:  Five consecutive hours: perhaps those hours when you’re busiest in everyday tasks  Five consecutive days: we suggest the five week days with the weekends off  Five consecutive weeks: the same weeks as your therapy sessions, if possible When should I NOT wear the mitt? When:  There is no-one else around  It’s too tight around your wrist  You go to the toilet It’s best to not wear the mitt for extra hours, particularly in the earlier weeks, as you may fatigue with the demanding constraint routine. Arm and Hand Therapy If you experience pain in your stroke-affected arm, hand or shoulder, it is really important to:  Tell someone else about it and if it persists, make an appointment with your doctor  Record where the pain was, what you were doing and the time of day  Immediately cease your arm and hand therapy program  Discuss future therapy plans with your therapist at the next visit Task-Specific Therapy It’s important to......... 1. Use everyday tasks in your therapy program 2. Select tasks that are meaningful to you 3. Use your stroke-affected arm and hand as much as you possibly can 4. Practice, practice and practice Your Therapist is: ..................................... To contact them, ring: ............................... This brochure was produced as part of the Acute Stroke team’s research program. This team is based in the Neurology Department at the John Hunter Hospital. Its author is Isobel Hubbard, an Occupational Therapist and stroke researcher. t,tk Health NSW Hunter New England Task-Specific Therapy Post Stroke Recovery of a stroke-affected arm and hand GOVERNMENT Local Health District How often should task-specific therapy occur? When you are actively involved in any everyday task you are doing “therapy”. The important thing is to make sure that the stroke-affected arm and hand is as involved as it possibly can be. If it’s possible, we recommend formal therapy sessions at least three times a week, for one hour at a time and scheduled over at least five consecutive weeks. How do I know that this will be worth all the effort? Obviously there are no guarantees, but research indicates that if we should use the following guidelines in arm and hand, task-specific therapy, it will be effective in most stroke survivors: Insert sub-heading Task-Specific Therapy What is Task-specific Therapy? Task-specific therapy uses ordinary, everyday tasks as the basis of arm and hand therapy. Task-Specific therapy should...... 1. Focus on tasks which are important to you. If you work on tasks and activities which are important to you and/or give you personal satisfaction, research indicates that Therapy should How to put this into practice.... this is an important consideration in task- be... specific therapy. We suggest you: Relevant  Select tasks that are importan  Focus on the 5 tasks which are important meaningful to you  Practice in the usual place an to you  Begin by working on the partial tasks which ultimately make up the whole task Random  If possible, don’t follow the sa  Always work toweaarcdhs teimventually achieving of the whole task Repetitive  Training should be repetitive,  Practice what you ‘can almost do’ same thing over and over  Press towards what you ‘can’t do’ 2. Use everyday tasks, in everyday contexts. Rewarded  Make sure you’re rewarded fo Where do you normally do the selected tasks work and receive encouragem and in what position? Try to make sure that  BUT, the rewards and encour you re-learn to do them, and practice them in should “fade” over time the usual place and in the usual way. Reconstructing the  Stay focussed on the whole ta whole task  Don’t get bogged down in part 3. Use motor relearning: Motor relearning: non-specific exercises  Is aimed at regaining the ability to move  Aim at achieving the whole ta your arm freely and as a coordinated ‘unit’  Should achieve the task orientated goals which you identified as personally important  Uses lots of exercises and plenty of repetitive practice  Works on partial tasks, combining the partial tasks to achieve the whole task Practice, practice and practice!! Therapy should How to put this into practice.... be... How to make sure this happens....  The therapist may use test (COPM or GAS) to help you work this out  Therapy should be based in the real- world, if possible  In each session, we suggest you prioritise the tasks by shuffling task cards  We focus on 5 tasks only and you will need to practice, practice, and practice!  Record your extra practice  Record how much encouragement you received  Don’t become dependent on the encouragement and rewards  Think through the purpose of the exercises to decide whether or not it is going to help you achieve the task Relevant  Select tasks that are important and How to make sure this happens.... t and d position me routine Repetitive practicing the Rewarded r your hard       meaningful to you  Practice in the usual place and position The therapist may use test (COPM or GAS) to help you work this out  If possible, don’t follow the same routine Therapy should be based in the real- each time world, if possible In each session, we suggest you  Training should be repetitive, practicing the prioritise the tasks by shuffling task Random ent sk  ial tasks and sk  BUT, the rewards and encouragement Record how much encouragement should “fade” over time you received same thing over and over cards We focus on 5 tasks only and you will need to practice, practice, and  Make sure you’re rewarded for your hard practice! Record your extra practice work and receive encouragement Reconstructing the  Stay focussed on the whole task agement  whole task Don’t become dependent on the encourageDmoenn’t gaentdbroegwgaerdsdown in partial tasks and non-specific exercises Think through the purpose of the  Aim at achieving the whole task exercises to decide whether or not it is going to help you achieve the task What is “Constraint Therapy” and how does it work? Understandably, when you’ve had a stroke you learn to manage as quickly and efficiently as you can. However, research has shown that even though a stroke-affected arm could be more actively involved in everyday tasks, it often “learns” to stay out of the way. This is referred to as “learned non-use”. Constraint therapy can overcome learned non-use in those who have some movement in their wrist and fingers. It is additional to task-specific therapy and involves constraining the unaffected arm! Yes, that’s right, the arm that’s NOT affected by the stroke. This therapy actively encourages the stroke-affected arm to become more involved in everyday tasks. We recommend a thumbless mitt applied to the unaffected hand that’s loosely fastened at the wrist.