Neurorehabilitation of the Upper Limb Across the Lifespan

Acknowledgements ix

1. Seeing the Bigger Picture: Using Clients' Experiences to Shape Clinical Practice 1

1.1. Appreciating the client's experiences 1

1.2. Providing or assisting access to long-term services 1

1.3. Initiating and supporting transitions from one service to the next 3

1.4. Listening carefully and providing relevant information 4

1.5. Collaborating on achievable goals 5

1.6. Actively supporting and involving caregivers 6

1.7. This book: Promoting collaborative client-centred intervention 7

References 7

2. What Happens to the Upper Limb After Brain Injury? 9

2.1. Motor control and normal movement 9

2.2. Upper limb movement 17

2.3. Brain injury and movement dysfunction 19

2.4. Upper motor neuron syndrome 20

2.5. The clinical picture: Interaction of positive and negative features 37

2.6. Summary 45

References 45

3. The Hypertonicity Intervention Planning Model for Upper Limb Neurorehabilitation 54

3.1. Decision-making in clinical practice 54

3.2. Evidence-based practice: What it is and what it isn't 56

3.3. Clinical reasoning: A process of integration and differentiation 61

3.4. The hypertonicity intervention planning model for upper limb neurorehabilitation 65

3.5. Summary 73

References 73

4. Making Sense of the Clinical Picture 80

4.1. The ICF as an assessment framework 80

4.2. Gathering information 81

4.3. Upper limb assessment 87

4.4. Goal formulation 107

4.5. Summary 110

References 111

4.A. Information Gathering Using a Concept Map Structure 116

4.B. Upper Limb Performance Analysis (ULPA) Part 2: Comparative Analysis of Performance - Motor (CAP-M) 117

4.C. Upper Limb Hypertonicity Assessment Form 119

5. Case Studies 128

5.1. Wendy 128

5.2. Harry 134

5.3. Tony 138

5.4. Summary 144

6. Movement and Strength Training 145

6.1. Changes in rehabilitation theory and practice 145

6.2. Common rehabilitation approaches: Assumptions principles and strategies 146

6.3. A selection of contemporary techniques: Indications and considerations 149

6.4. Summary 176

References 177

7. Splinting 186

7.1. Splinting: Proposed mechanisms of effect 186

7.2. Splinting research: A narrative review 190

7.3. Hypertonicity intervention planning model (HIPM): Indications for splinting 202

7.4. Splint prescription 202

7.5. Common splint designs 213

7.6. Adapting splint designs 214

7.7. Commercially-produced Splints 214

7.8. Wearing schedules 216

7.9. Fabrication principles 218

7.10. Summary 223

References 223

7.A. Common Splint Designs Patterns and Fabrication Instructions 230

7.B. Splint Care and Precautions 274

7.C. Example of a Photographic Splint Programme 275

8. Casting 278

8.1. Casting classification 278

8.2. Casting research: A narrative review 282

8.3. Indications for casting 284

8.4. Contraindications for casting 284

8.5. Casting considerations 290

8.6. Casting process 294

8.7. Post-casting follow-up programme 298

8.8. Summary 301

References 301

8.A. Casting Procedures 304

8.B. Casting for Arms and Hands: Information Sheet 316

8.C. Casting Agreement 317

8.D. Casting Documentation Form Page 1 318

8.D. Casting Documentation Form Page 1 319

8.E. Precautions and Cast Care During Casting Series 320

9. Botulinum Neurotoxin 321

9.1. Clostridium botulinum 321

9.2. Mechanism of effect 323

9.3. Botulinum neurotoxin research: A narrative review 326

9.4. Guidelines for practice 329

9.5. Summary 335

References 335

10. Surgery 339

10.1. Classification of surgical procedures 339

10.2. Surgery: A narrative review 340

10.3. Indications for surgical intervention 347

10.4. Surgical consultation: Information sharing 350

10.5. Post-surgery follow-up 351

10.6. Summary 352

References 352

11. Case Studies Revisited 355

11.1. Wendy - intervention process and outcomes 355

11.2. Harry - intervention process and outcomes 360

11.3. Tony - intervention process and outcomes 362

11.4. Summary 366

Index 369