Neurorehabilitation of the Upper Limb Across the Lifespan Neurorehabilitation of the Upper Limb Across the Lifespan Managing Hypertonicity for Optimal Function Dr. Jodie Copley SeniorLecturerandClinicalEducator SchoolofHealthandRehabilitationSciences TheUniversityofQueensland,Australia Dr. Kathy Kuipers OptimiseRehab,Queensland,Australia Lecturer,SchoolofHealthandRehabilitationSciences TheUniversityofQueensland,Australia Thiseditionfirstpublished2014©2014byJohnWiley&Sons,Ltd. 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LibraryofCongressCataloging-in-PublicationData Copley,Jodie,author. Neurorehabilitationoftheupperlimbacrossthelifespan:managinghypertonicityforoptimal function/Dr.JodieCopley,Dr.KathyKuipers. p.;cm. Includesbibliographicalreferencesandindex. ISBN978-0-470-67031-6(pbk.) I. Kuipers,Kathy,author.II. Title. [DNLM: 1. MuscleHypertonia–rehabilitation.2. UpperExtremity–physiopathology. 3. BrainInjuries–complications.4. MovementDisorders–therapy.5. OrthopedicFixation Devices.6. Patient-CenteredCare. WE805] RC387.5 617.4′810443–dc23 2013049512 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynot beavailableinelectronicbooks. Setin9/11ptMinionProbyLaserwordsPrivateLimited,Chennai,India 1 2014 Contents Acknowledgements,ix 1. SeeingtheBiggerPicture:UsingClients’ExperiencestoShapeClinical Practice,1 1.1. Appreciatingtheclient’sexperiences,1 1.2. Providingorassistingaccesstolong-termservices,1 1.3. Initiatingandsupportingtransitionsfromoneservicetothenext,3 1.4. Listeningcarefullyandprovidingrelevantinformation,4 1.5. Collaboratingonachievablegoals,5 1.6. Activelysupportingandinvolvingcaregivers,6 1.7. Thisbook:Promotingcollaborative,client-centredintervention,7 References,7 2. WhatHappenstotheUpperLimbAfterBrainInjury?,9 2.1. Motorcontrolandnormalmovement,9 2.2. Upperlimbmovement,17 2.3. Braininjuryandmovementdysfunction,19 2.4. Uppermotorneuronsyndrome,20 2.5. Theclinicalpicture:Interactionofpositiveandnegativefeatures,37 2.6. Summary,45 References,45 3. TheHypertonicityInterventionPlanningModelforUpperLimb Neurorehabilitation,54 3.1. Decision-makinginclinicalpractice,54 3.2. Evidence-basedpractice:Whatitisandwhatitisn’t,56 3.3. Clinicalreasoning:Aprocessofintegrationanddifferentiation,61 3.4. Thehypertonicityinterventionplanningmodelforupperlimbneurorehabilitation,65 3.5. Summary,73 References,73 4. MakingSenseoftheClinicalPicture,80 4.1. TheICFasanassessmentframework,80 4.2. Gatheringinformation,81 4.3. Upperlimbassessment,87 4.4. Goalformulation,107 4.5. Summary,110 References,111 4.A. InformationGatheringUsingaConceptMapStructure,116 4.B. UpperLimbPerformanceAnalysis(ULPA)Part2:ComparativeAnalysisofPerformance– Motor(CAP-M),117 4.C. UpperLimbHypertonicityAssessmentForm,119 5. CaseStudies,128 5.1. Wendy,128 5.2. Harry,134 5.3. Tony,138 5.4. Summary,144 v vi Contents 6. MovementandStrengthTraining,145 6.1. Changesinrehabilitationtheoryandpractice,145 6.2. Commonrehabilitationapproaches:Assumptions,principlesandstrategies,146 6.3. Aselectionofcontemporarytechniques:Indicationsandconsiderations,149 6.4. Summary,176 References,177 7. Splinting,186 7.1. Splinting:Proposedmechanismsofeffect,186 7.2. Splintingresearch:Anarrativereview,190 7.3. Hypertonicityinterventionplanningmodel(HIPM):Indicationsforsplinting,202 7.4. Splintprescription,202 7.5. Commonsplintdesigns,213 7.6. Adaptingsplintdesigns,214 7.7. Commercially-producedSplints,214 7.8. Wearingschedules,216 7.9. Fabricationprinciples,218 7.10. Summary,223 References,223 7.A. CommonSplintDesigns,PatternsandFabricationInstructions,230 7.B. SplintCareandPrecautions,274 7.C. ExampleofaPhotographicSplintProgramme,275 8. Casting,278 8.1. Castingclassification,278 8.2. Castingresearch:Anarrativereview,282 8.3. Indicationsforcasting,284 8.4. Contraindicationsforcasting,284 8.5. Castingconsiderations,290 8.6. Castingprocess,294 8.7. Post-castingfollow-upprogramme,298 8.8. Summary,301 References,301 8.A. CastingProcedures,304 8.B. CastingforArmsandHands:InformationSheet,316 8.C. CastingAgreement,317 8.D. CastingDocumentationFormPage1,318 8.D. CastingDocumentationFormPage1,319 8.E. PrecautionsandCastCareDuringCastingSeries,320 9. BotulinumNeurotoxin,321 9.1. Clostridiumbotulinum,321 9.2. Mechanismofeffect,323 9.3. Botulinumneurotoxinresearch:Anarrativereview,326 9.4. Guidelinesforpractice,329 9.5. Summary,335 References,335 10. Surgery,339 10.1. Classificationofsurgicalprocedures,339 10.2. Surgery:Anarrativereview,340 10.3. Indicationsforsurgicalintervention,347 10.4. Surgicalconsultation:Informationsharing,350 Contents vii 10.5. Post-surgeryfollow-up,351 10.6. Summary,352 References,352 11. CaseStudiesRevisited,355 11.1. Wendy–interventionprocessandoutcomes,355 11.2. Harry–interventionprocessandoutcomes,360 11.3. Tony–interventionprocessandoutcomes,362 11.4. Summary,366 Index,369
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