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F - Reaching, Grasping and Manipulation

Current Practice: Customized Approaches for Upper Limb Rehabilitation in Individuals with SCI Prosthetic and orthotic services to support splinting, as a therapeutic approach, are reported in 11 sites; but only four sites have formalized Rehabilitation Engineering expertise as part of SCI rehabilitation services. Engineering application, coupled with occupational therapy and physical therapy, is becoming important. Improvements in upper limb function, during rehabilitation, are accomplished by using emerging technologies to facilitate the natural recovery of upper limbs (such as Functional Electrical Stimulation Therapy5 or FEST) or assisted reaching, grasping and manipulation using robotics6; or supportive, in-home technology approaches.7 These relatively new approaches are being tested along with other assessments, in Canada and internationally. Tendon transfers are being performed in five sites only. With the lack of cross-provincial healthcare, Canada has areas where individuals cannot get access to surgeons, with expertise in tendon transfer. This may be, in part, due to changes in consumer willingness to undergo surgical intervention, including tendon transfer and interphalangeal or finger joint fusions; and the delisting of elective procedures of this nature, in some jurisdictions. Clearly, retention of relevant expertise, and a focus on the service void, requires national reflection. There are several novel and exciting approaches, being developed in Canada to enhance individual participation in therapy, and provide new ways to evaluate outcomes: Armeo Therapy Concept, being tested at ICORD by John Steeves and at Toronto Rehabilitation Institute-UHN by Milos Popovic, is proposed to improve the efficiency of therapy treatments. Exercises are selfinitiated, self-directed, functional and intense, and incorporate arm weight support, augmented feedback and accurate monitoring of the individual’s recovery. ReJoyce, developed in Edmonton by Arthur Prochazka, is a therapeutic workstation that allows a clinician to work with individuals as they participate in arm-hand function therapy sessions, in the clinic or remotely in their own home. Computer software uses various “games” to guide the individual through a series of upper limb and hand exercises. Most importantly, the ReJoyce workstation features a set of spring-loaded manipulanda, each of which represents a typical grip posture required during one of many tasks of daily life. Outcomes of these interventions are automatically logged by the ReJoyce Arm-Hand Function Test, which uses recordings from ReJoyce systems and integrates them into a measure of the upper limb function. Compex Motion electric stimulator, developed by Milos Popovic, provides FES-designed stimulation protocols to generate power (palmar grasp and lateral pinch), and precision grasps (opposition with two and three fingers) on demand. The stimulation sequence (protocol) for power and precision grasps is customized for each individual, using the fully-programmable stimulator. The approach is being used successfully in the rehabilitation phase to supplement training during recovery. These approaches form the foundation of current evolving upper limb research in multiple Canadian sites (Figure 4.0). Current Prevention and Management of Upper Limb Secondary Conditions in Individuals with SCI Upper limb pain and injury, following SCI, are secondary conditions that affect individuals with both tetraplegia and paraplegia. The Consortium for Spinal Cord Medicine (CSCM) developed Clinical Practice Guidelines, in 2005, for both individuals and healthcare providers.8 Under the categories of Evaluation, Management, and Prevention and Treatment, the Consortium created 35 recommendations for the prevention and management of secondary upper limb complications, based on clinical and epidemiological evidence.8 A user guide for individuals with SCI accompanies the guideline. Some aspects have been implemented at E-Scan sites but adherence to these guidelines has not been formally evaluated. The authors suggest that the guidelines be adopted in Canada, and become part of the Accreditation Canada Standards for SCI. REACHING, GRASPING AND MANIPULATION | BODY STRUCTURE AND FNUCTION 71


F - Reaching, Grasping and Manipulation
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