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Upper limb therapy at PhysioFunction

To regain and maximise use of arm function, the team discuss a range of approaches

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PhysioFunction uses GripAble technology for its clients' rehab

Neurological illness or injury can have profound effects on the whole body and often the upper limb is significantly affected.

Rehabilitation of the lower limb is often prioritised to aid return to activities such as transfers and standing. However, it goes without saying that activities of daily living are challenging with an upper limb that is impaired.

The sensory and motor homunculi show us just how much of the brain is configured towards the hand. This is great news for rehabilitation as the neuroplasticity within the nervous system can be harnessed to re-educate these centres and significantly alter the function of the upper limb.

Figure 1: The sensory (left) and motor (right) homunculus.

Evidence has taught us that effective upper limb rehabilitation must include highly repetitive, task specific training to restore or build new networks within the brain and body and recondition the motor and sensory systems. 

At PhysioFunction we use a Triad approach to our therapy, this approach incorporates hands on therapies, use of technology and exercise. In our experience the, combination of all of these techniques facilitates the best outcomes.

Hands-on therapy with a specialist neurological physiotherapist will include techniques to modulate tone, facilitate normal movement patterns and guide sensory and proprioceptive recovery. 

Technology such as the RT300 upper limb Functional Electrical Stimulation FES Cycle provides the potential for highly repetitive action, stimulating patterned muscle activation of the major upper limb muscle groups to mimic the important gross motor tasks of hand to mouth (backwards cycling) and reach, grasp and retract (forward cycling). FES Cycling has been demonstrated to reduce muscle atrophy, reduce spasticity, improve circulation and improve range of motion, all of which are essential to the restoration of upper limb function. FES or Neuromuscular Electrical Stimulation (NMES) can also be employed alongside functional activities, using devices such as the Bioness H200, Intellistim, Xcite 2 and Stiwell, to assist with  specific aspects of the movement (such as correction of a shoulder subluxation or opening of the hand to grasp).

Mechanical technology in the form of the SaeboStretch, SaeboGlove and SaeboMAS can also be employed to aid in supporting the weight of the limb and applying a stretching force to the fingers, assisting in opening the hand.

   

Gamified rehabilitation is gaining growing attention within neurological rehabilitation, such as that offered by GripAble, due to the creation of the virtual environment providing cognitive focus for the individual and allowing them to succeed in tasks and games, enhancing motivation and participation.

At PhysioFunction we work with the MindMotion GO system which uses the Kinect motion sensor to track body movements and replicate on screen. This software offers a range of activities for the hand, arm, trunk and whole body to replicate movements involved in daily functional activities. We are also excited to be receiving the brand new Izar device to develop refined and discriminate hand functions.

Another aspect of technology that is rapidly growing in neurorehabilitation is robotics. PhysioFunction has recently begun working with the ArmMotus – an end effector (movement of the hand to drive movement) based robotic rehabilitation system that employs games alongside passive, active assisted, active and resisted activities depending on the ability of the user to improve range of motion, dexterity, strength and, ultimately, function.

The final part of the triad – exercise – is equally important and upper limb rehabilitation commonly involves replication and practice of functional tasks (or broken-down components of these tasks) away from the clinic. The purpose of completing these activities away from the clinic is to take advantage of the neuroplasticity and excitation of the nervous system and consolidate the new or recovered neural networks allow progressive improvement of upper limb functions.

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