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

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. 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.

10. 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

11. 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.

12. 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.

13. 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.