Occupational Therapy Innovations for the Neuro Patient Saebo Stretch, Flex and Reach Presented by Sarah Sanderman, MOTR and Karen Hookstadt, OTR

UE Concerns Post Stroke Only 50% of survivors are likely to regain some functional use of an UE Spasticity, primarily higher distally in an UE Luxation, instability of joints Atrophy Muscle imbalance Contracture

Saebo Stretch Saebo Flex / Reach Saebo Stretch is a dynamic resting hand splint; a flexible splint with progressive inserts to increase force application based upon the presence of tone (Saebo) Saebo Flex and Reach allow for integration of the arm and hand during functional activities Promotes activities that require new learning; challenging and novel activities that promote brain rewiring Addresess spasticity; defined as a velocity-dependent hyper- excitability of the muscle stretch reflex resulting in increased muscle tone (Saebo) Trains a client in compensatory movement which speeds recovery Allows a client to “turn off” their tone (flexors) What is tone Why dynamic vs static resting Because you are moving, you are learning a new way to complete the motion, versus prohibiting any motion and having no gain/function Spasticity in layman’s terms

Saebo Stretch Dynamic hand piece Strapping system that accommodates finger alignment and joints Hand is not functional while in this splint. Allows for movement with reactions and exertion.

Saebo Stretch A flexible splint with progressive inserts based on the client’s tone Soft tissue shortening can start within 7 days of incident Saebo Stretch offers “low load, long duration” of impact – 6 to 8 hours per day Typical result is a 5 – 7% increase in ROM

Appropriate Clients Saebo Stretch Client must show: 35° active wrist extension with MCPs, PIPs and DIPs in neutral Should be able to tolerate splint for 6-8 hours Pediatric sizes available

Appropriate Clients Saebo Flex / Reach Client must show a minimum of: 15° active shoulder elevation 15° active elbow flexion ¼ range of active finger flexion Full passive finger IP/MCP extension with the wrist passively extended to 15° (at minimum) and 35° optimally *If the client is an inpatient, there are no active shoulder or elbow movement requirements. Claw hand

Customized Fitting Saebo Flex / Reach Components include customized forearm shell, dorsal plate, digicaps and standard springs, mounts, bead lines and lead lines. With the Saebo Flex, the client has free use of the elbow, the Saebo Reach assists with elbow extension. Pass around digicaps and cuffs. Anatomical landmarks are used to determine which size of forearm shell and dorsal plate should be used. Digi caps are sized per individual finger. Pass around components. Fit Saebo to Karen.

Prescribed Activities Repetition is the key! Clients should wear the device for two sessions totaling 45 minutes each per day Prescribed activities with equipment include: Crates and balls Use of a height adjustable target (HAT) Use of cylinders, PVC trees and pegs Functional activities include loading a dishwasher, placing items in a fridge, sweeping with a whisk broom, answering a phone, folding laundry. Session One focuses solely on the hand and Session Two focuses on isolated, multi-directional or functional activities. Crates: Crate right, crate left adjusting height For functional tasks, objects chosen should be 3-4” in diameter or built up to reach this measurement. Chosen activities must be purposeful to the client. Client should lead the problem solving for a specific task rather than being instructed by the therapist. At the end of each session, the device should be removed and the client should continue to perform the activity using the practiced movement pattern.

Video Saebo Flex in use with a client. Kathy Onset May 8, 2012 Swedish Rehab until June 15 Home health until July 30 Started at SRH soon after 12 OT visits Completely self pay, no OP benefits remaining 58 year old L CVA Lives alone, daughter assists

Availability Insurance varies and may cover some of the cost of a device. Currently Medicare covers the Saebo Reach only To pay out of pocket for a device, the Saebo Reach is approximately $2000, Saebo Flex $1500, Saebo Stretch $300. Splints are sold and distributed locally through a prosthetics company, for example Hangar.

Take Away Gems These devices, although potentially expensive, have been proven to increase the function in a hand exhibiting a neurologically based deficit. The Saebo Stretch is worn for long periods of time, during times of rest; the Saebo Flex and Reach are worn only during functional training with the device. Devices may be trialed before purchase, contact an OT to recommend clients who may benefit from aggressive UE training after a neurological incident.

Questions? References Improving Upper Extremity Motor Recovery Following Neurological Injury, Saebo Course Manual 2012 Photos courtesy of Google Images, 2012 Video courtesy of Spalding Rehabilitation Hospital, 2012.