1.  Effective Interventions to Promote Participation and Functional Use of the Affected Upper Extremity for Clients Post-Stroke Spalding University Jodi Combs, OTS jcombs01@spalding.edu

2. Why Clients Post-Stroke? It is estimated there are approximately three million stroke survivors in this country, 70 percent of whom experience “significant functional disability” ( Hayner, Gibson, & Giles, 2010)

3. Occupational Therapy and Stroke  Occupational therapy practitioners address the physical, cognitive, and mental challenges brought on by a stroke  The effects of stroke can be devastating but most can be improved with rehabilitation.  Some of these effects include: loss of balance, paralysis, vision problems, loss of coordination, and also decreased sensation

4. Level II FW Experience

5. Focused Question What is the evidence for effective occupational therapy interventions to promote participation and functional use of the affected upper extremity for clients post-stroke?

6. Effective Treatments  Constraint-Induced Movement Therapy  Meaningful Task-Specific Training  Mirror Box Therapy  Gaming Systems  Mental Practice  Bilateral Treatment

7. Constraint- Induced Movement Therapy Constraint-induced movement therapy (CIMT) consist of the sound arm being restrained, typically in a sling, mitt, or both, for an established percentage of the day. During restraint, the patient performs selected activities using the affected upper extremity.

8. Meaningful Task-Specific Training Task-specific training provides goal-directed repetitive practice of motor tasks to improve functional abilities.

9. Mirror Box Therapy Patients who engage in mirror therapy realize greater recovery of function in their upper extremities than those who receive conventional therapy alone.

10. Other Effective Treatments  Gaming Systems  Mental Practice  Bilateral Treatment

11. Questions? Thank You!!!

12. References Arya, K., Verma, R., Garg, R. K., Sharma, V. P., Agarwal, M., & Aggarwal, G. G. (2012). Meaningful Task- Specific Training (MTST) for Stroke Rehabilitation: A Randomized Controlled Trial. Topics In Stroke Rehabilitation, 19 (3), 193-211. doi: 10.1310/tsr1903-193 Cameiraoa, M.S., Badiaa, S.B., Duartee, E., & Verschure, P. (2011). Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: A randomized controlled pilot study in the acute phase of stroke using the Rehabilitation Gaming System. Restorative Neurology and Neuroscience, 29, 287–298. doi:10.3233/RNN-2011-0599 Christian, D., MPhil, J. P., Antje, N., Jutta, K., Christian, R., & Hans, K. (2008). Mirror therapy promotes recovery from severe hemiparesis: A randomized controlled trial. Neurorehabilitation and Neural Repair, 23 (3), 209-217. doi: 10.1177/1545968308324786 Hayner, K., Gibson, G., & Giles, G. M. (2010). Research Scholars Initiative Comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascular accident. American Journal of Occupational Therapy, 64, 528–539. doi: 10.5014/ajot.2010.08027 McCall, M., McEwen, S., Colantonio, A., Streiner, D., & Dawson, D. R. (2011). Modified constraint-induced movement therapy for elderly clients with subacute stroke. American Journal of Occupational Therapy 65, 409–418. doi: 10.5014/ajot.2011.002063 Nilsen, D. M., Gillen, G., DiRusso, T., & Gordon, A. M. (2012). Effect of imageryperspective on occupational performance after stroke: A randomized controlled trial. American Journal of Occupational Therapy, 66, 320–329. http://dx.doi.org/10.5014/ajot.2012.003475 Wu CY, Lin KC, Chen HC, et al. (2007). Effects of modified constraint-induced movement therapy on movement kinematics and daily function in patients with stroke: A kinematic study of motor control mechanisms. Neurorehabiltation Neural Repair,21, 460–466. DOI: 10.1177/1545968307303411