Rehab of R&G

• Rehabilitation - some general rules about space:

  • Start ipsilaterally progress to contralaterally
  • Start near, central progress to near periphery, far periphery
  • Remember we need to reach objects at different heights too (high and low) - Start sitting progress to standing
• Rehabilitation - some general rules about Practice:

  • Meaningful task specific practice
  • May address impairments but try to do it in task (salience)
  • Focus on missing component (e.g. wrist extension, aperture etc). May focus on part practice but put it into full task as able. May need to simplify the task to help achieve (e.g. a lighter or smaller cup)
  • Use real functional objects
  • Goal directed
• Rehabilitation - some general rules about feedback:

  • Demonstrate exercise first
  • Use short cue (e.g. “look and reach”, “forward” “lift and hold” “ squeeze” or use a metaphor)
  • Give targets so know if successful or not and what to do to improve (e.g. dots on a ball or cup to increase aperture, place to reach on a ruler, ball behind trunk that has to keep there while reaching, pick up squeaky toy and make it squeak (if too much force in stabilization)
  • Bandwidth
  • Fade as able
• Rehabilitation - some general rules about Progression:

  • Change task – reach further, higher
  • Move more into full task practice
  • Increase speed, distance, weight, size, texture, accuracy required
  • Fade feedback
  • Change practice conditions (blocked, constant distributed to variable and random with fewer rest periods)
  • Change environment – distractions, kitchen or work like environment
• Training Principles for Vision in Reach and Grasp pt1:

  • Observation: not looking at object they are reaching for (even when directed), so transport slow with inappropriate aperture
  • Possible reasons: ? poor postural control, visual field deficit, ? Visual fixation neuro problem so unable to do saccadic movts, ? Object recognition (agnosia)
  • Additional tests, agnosia, check postural control, balance, trunk strength, neck strength and ROM, additional eye tests
• Training Principles for Vision in Reach and Grasp pt2:

  • Train co-ordination of eye and head movements towards the target in a systematic way
  • Practice eye to target co-ordination in central vision, progress to peripheral and across midline
  • Increase distance, speed, practice regime (variable and random)