Carolinas HealthCare System

Following an acquired brain injury due to stroke or trauma, many individuals are left with decreased functional use of an arm, hand and fingers. This has a significant impact on their ability to manage self-care, home management tasks and participate in community activities.

Occupational therapists at Carolinas Rehabilitation initially provide intervention that focuses on therapeutic and/or neuromuscular exercises, functional tasks and strategies, splinting as well as teaching one-handed techniques and providing education regarding adaptive equipment. Despite their best efforts, individuals sometimes experience continued limitations in their hand and arm use that affects daily living. Recently, there have been some promising new approaches to addressing these concerns.

Electrical Stimulation Therapy Hand Rehabilitation

Therapeutic and functional electrical stimulation utilizes five surface electrodes to stimulate selected muscles in order to facilitate hand movements. This type of therapy is intended to improve hand muscles and voluntary movements, as well as to treat impairments such as spasticity, disuse atrophy and edema. Individuals with lower muscle tone will usually progress further.

Contraindications for use include:

  • Individuals with a cardiac pacemaker
  • Fractures
  • Tumor in the arm and/or joint deficiency in the hand

Electrical stimulation therapy may be used in the clinic for therapeutic activities. However, for long-term gains, it is recommended that the individual participate in a daily home program using the orthosis.

Orthosis Training

Orthosis training is used to assist neurological patients with performing grasp and release activities using their affected arm and hand. The spring-loaded finger extension orthosis positions the wrist and fingers in extension in preparation for functional activity. The user grasps an object by voluntarily flexing his or her fingers. The extension springs assist in reopening the hand to release the object. The recommended exercises can be performed at the care location or at home.

Individuals most appropriate for the orthosis training exhibit some shoulder and elbow movement but are unable to open their hand secondary to spasticity and weakness. Active movement requirements include: shoulder elevation at 15 degrees; elbow flexion at 15 degrees; ability to flex digits at least one-quarter range.

Constraint Induced Activity Program

This program has been developed for individuals at least three months post acquired brain injury due to stroke or trauma. The aim is to improve the functional use of participants' affected arm and hand. Participants must have some movement in the involved arm, including the ability to extend the wrist, voluntarily open the fingers and have good balance with some protective extension in the event of a fall.

The program is scheduled for a two-week period. Participants wear a mitt on the non-affected arm for 90 percent of each waking day. In addition, they participate in functional activities and exercises in the clinic for four hours per day and perform a home program. They are also provided functional tasks to perform at home.

This treatment technique has been shown to improve function during the training period but also to transfer to real-life daily living situations after the intensive training period ends.