Course Description

Research indicates that "up to 85% of stroke patients show an initial deficit in the upper limb, and the recovery of the upper-limb function is often poor and only seen in less than half of the patients." (Stroke. 2005; 36:2665-2669). The purpose of this lecture based course is to provide a review of neurorehabilitation techniques used for the hemiplegic upper extremity. This course will present topics using research and evidence based practice to explain pathology, resulting impairments and applicable treatment interventions for the hemiplegic upper extremity. Topics to be discussed are: apraxia, pain (shoulder hand syndrome - CRPS I); ataxia; pusher syndrome; subluxation; bimanual tasks; thermal agents and lastly, a summary of neuroplasticity and constraint-induced movement therapy. Treatment interventions to reduce shoulder subluxation and facilitate overall upper extremity movement will include electrical stimulation; taping; and proprioceptive adaptation. A review of the literature will provide examples of clinical interventions for treatment presented. A case study will be discussed using the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) to describe upper extremity neurologic dysfunction and treatment.

Course Level (As defined by the APTA): Intermediate - Assumes that participants have a general familiarity with topic (the upper extremity). The focus is on increased understanding and application of information (neurological impairment and neurorehabilitation strategies).

Participants

Occupational and Certified Occupational Therapy Assistants; Physical Therapists and Physical Therapist Assistants

Course Objectives

After completing this course, the participant will be able to:

1. Articulate the pathology involved in apraxia, pain (shoulder hand syndrome - CRPS I); ataxia; pusher syndrome.
2. Explain the three types of shoulder girdle subluxation.
3. Describe the rationale for a variety of treatment interventions to reduce apraxia, pusher syndrome, ataxia and the debilitating effects of shoulder hand syndrome (CRPS-I).
4. Differentiate between rigid versus elastic taping for upper extremity impairment.
5. Discuss the current treatment interventions for the upper extremity based on the research.
6. Use the World Health Organization International Classification of Functioning, Disability and Health (ICF) as a model of treatment intervention for the hemiplegic upper extremity.

Continuing Education Units

A certificate of attendance will be issued denoting eight (8) contact (clock) hours or .8 CEUs of continuing education. The contact hours or CEUs will vary in each state according to licensure boards, state associations, or sponsoring entities.

For this Course, Please Note:

1. A video camera will be used to videotape speaker as she is demonstrating electrode placement and taping techniques for the audience to view on screen if this course will take place in an auditorium setting. The video can be fed directly into the LCD projector or through the lap top computer.
2. This is not a hands on lab course but lecture only with two periods of demonstrations
3. If class is under 34 participants, they can gather around speaker and observe demonstrations.
4. If class is under 34 participants:
   1. Bring scissors, Cover-Roll Stretch or similar under cover tape, a roll of rigid tape (eg Leukotape P), elastic tape (kinesio-tape), skin protectorant and tape adhesive removal if you want to practice taping skills
   2. Bring an electrical stimulation unit and four (4) electrodes if you want to practice electrode placement