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Task Oriented, Reach, Grasp, Manipulation

This document discusses techniques for training reaching and manipulation skills. It identifies therapeutic approaches like compensatory training, neurofacilitation, and motor learning models. Guidelines are provided for critical components of reaching, grasping, releasing and manipulating objects. Common adaptive movements are described and a shortlist of specific training tasks is given, like picking up and transporting objects. Evidence-based techniques include practice of concrete actions using objects, forcing use of the affected limb, and repetitive, intensive training of task-specific skills.

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154 views

Task Oriented, Reach, Grasp, Manipulation

This document discusses techniques for training reaching and manipulation skills. It identifies therapeutic approaches like compensatory training, neurofacilitation, and motor learning models. Guidelines are provided for critical components of reaching, grasping, releasing and manipulating objects. Common adaptive movements are described and a shortlist of specific training tasks is given, like picking up and transporting objects. Evidence-based techniques include practice of concrete actions using objects, forcing use of the affected limb, and repetitive, intensive training of task-specific skills.

Uploaded by

awais mp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Techniques to teach skill in

reaching and manipulation


Unit objectives
 Identify therapeutic techniques to train reaching-
manipulation, including appropriate use, theory
base, and potential issues in administration
 List guidelines for administering reaching-
manipulation techniques
 Describe specific techniques for training reaching-
manipulation
 Describe the evidence for reaching-manipulation
techniques
Path to abnormal movement

Attempt to move

Obstacles to efficient movement

Compensatory movement strategy

Repeated practice of compensatory strategy

Learned use of compensatory strategy
Path to abnormal movement

Maintenance of posture / attempt to move



Obstacles to efficient posture / movement

Abnormal, stereotyped postural / movement pattern

Predominance of abnormal postural / movement pattern

“Hardwiring” of abnormal postural / movement pattern in CNS;
development of secondary complications
Obstacles to efficient movement
Compensatory approach

 Focus on simplification / energy conservation,


substitution, and adaptation
 Examples: Use of UL orthosis
Training on new functional movement
patterns in completing UL tasks
Modification of environment to allow
ease of UL movement
Neurofacilitation /
neurophysiological approach

 Sensorimotor stimulation
 Neurodevelopmental therapy
 Proprioceptive neuromuscular facilitation
 Movement therapy
Motor learning /
task-oriented approaches

 Motor Relearning Programme


 Task-oriented approach
 Movement science / motor learning model
Motor Relearning Programme

 Focus on practice of missing task components


and whole tasks, and transference of learning
 Examples: Use of “real-world” environments
“Forced use” of affected UL
Eliciting activity in key UL muscles
Stretching of key UL muscles
Progression via  complexity and
variety, and  feedback and guidance
Task-oriented approach

 Focus on addressing UL dyscontrol at 3 levels:


impairment, strategy, and function
 Examples: Use of “real-world” environments
Use of modalities to treat impairments
Retraining of reach-grasp, grasp-
manipulation, and release components
and task-dependent characteristics
Forced use of affected UL
Movement science /
motor learning model

 Focus on teaching how to organize movement to


achieve action-goal under varying conditions
 Examples: Use of “regulatory conditions”
Early start of muscle activity and
prevention of tissue shortening
Forced use of affected UL
Retraining of reach-manipulation with
balance activities
Common adaptive movements
 Flexion at the hips instead of flexion at the GHJ during
reach
 Shoulder girdle elevation, spinal lateral flexion, GHJ
abduction with elbow flexion, and GHJ IR with
forearm pronation during reach
 Excessive hand opening for grasp
 Excessive flexor force during grasp
 Finger extension with the wrist flexed and thumb
CMC and MCP extension during release
UL training guidelines

Critical components
 Reaching
 Grasp
 Release
 Manipulation
UL training guidelines

Critical components of reaching


 Forward: flexion at the GHJ
 Sideways: abduction at the GHJ
 Backward: extension at the GHJ with
elevation of the shoulder girdle
external rotation at the GHJ
extension at the elbow
supination and pronation of the forearm
extension at the wrist
UL training guidelines

Critical components of grasping


 Extension at the wrist
 Extension of the fingers
 Abduction at the CMC joint of the thumb and 5th digit
 Flexion of the fingers and thumb around an object
UL training guidelines

Critical components of releasing


 Extension at the wrist
 Extension at the MCP joint of the fingers
 Abduction and extension at the CMC joint of the thumb
UL training guidelines

Critical components of manipulation


 Flexion and extension at the MCP joint of the fingers, with the
wrist in extension
 Palmar abduction and rotation at the CMC joint of the thumb
 Combined flexion and rotation at the CMC joint of the thumb
and 5th digit (e.g., cupping)
 Independent flexion and extension of the fingers (e.g., tapping)
 Key grasp configurations: thumb – 2nd digit; thumb – 5th digit; 4th
and 5th digits into palm; thumb with MCP flexion – fingers with
IP extension (e.g., paper-holding grasp)
UL training guidelines
 Task-specific / context-specific
 Practice of concrete actions
 Involves an object
 Active participation and movement
 Forced use
 Repetitive and intensive practice
 Bimanual training
UL training “shortlist”
 Pick up, grasp and release objects of different
configurations
 Hold and transport objects from one place to
another
 Move objects within the hand
 Manipulate objects for specific purposes
 Reach for objects in all directions in sitting and
standing
UL training “shortlist”
 Use two hands to accomplish specific tasks*
 Throwing and catching actions to regain the ability
to time action and respond to an object’s speed
UL training techniques

Extremely useful for practical class


Carr, J. H., & Shepherd, R. B. (2003). Stroke rehabilitation:
Guidelines for exercise and training to optimize motor
skill. London: Butterworth-Heinemann.
*pp. 177-193, on reaching and manipulation
In summary…

Techniques to teach skill in reaching


and manipulation

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