WHAT TO DO WITH THE HEMIPLEGIC UPPER EXTREMITY DURING GAIT

COURSE DESCRIPTION The Hemiplegic Arm….Put it in a Sling?!?!?   The hemiplegic arm is not needed to walk, however its residual impairment in chronic hemiplegia accounts for continued rehabilitation intervention. The arm is an extension of the trunk through the shoulder girdle components: the scapula and clavicle. Little attention and effort is expended on the hemiplegic arm because of the push to teach compensatory strategies utilizing the less affected upper extremity due to shorter lengths of stay in order to optimize functional independence prior to discharge. Neuroimaging research indicates there are different recovery levels as indicated by brain activation patterns in the contralateral lesioned site with movement related activity of the hemiplegic arm. Task practice; skill acquisition and how learning occurs are behaviors that contribute to the brain's ability to create new pathways for neuron function, replacing those injured by stroke. Rehabilitative strategies then should attempt to integrate the hemiplegic arm as a base of support prior to gait (sit, sit<--> stand), and incorporate it during daily living skills to perform as the dominant extremity or as a gross assist. This course will address arm movement during gait and strategies to enhance performance during functional activities while ambulating. Treatment ideas incorporating pre-gait & gait activities will be demonstrated and practiced. Evidence based practice models for constraint induced movement therapy (CIMT); bi-manual upper extremity tasks; taping and electrical stimulation will be discussed as rehabilitation interventions to reduce impairment. A prior course on normal and abnormal gait analysis is recommended. OBJECTIVES After completing this course, the participant will be able to: Explain upper extremity kinesiology during the phases of gait. Demonstrate activities that promote normal movement of the hemiplegic arm movement via           weightbearing & non-weightbearing techniques. Analyze normal movement of the arm during functional activities.    Describe adjunctive therapies utilized in the treatment of the hemiplegic   arm. Develop and prioritize treatment interventions based on hemiplegic arm impairment level.   ABOUT THE SPEAKER Jennifaye V. Greene, PT, MS, NCS is a graduate from the University of Miami (Florida) with a Master of Science degree in Physical Therapy and has 16 years of clinical experience focused in neurorehabilitation. She became a board certified clinical specialist in neurology by the American Board of Physical Therapy Specialties (ABPTS) of the American Physical Therapy Association (APTA) in 1995 and re-certified in 2004. The ABPTS appointed Jennifaye to the Specialization Academy of Content Experts (SACE) for a two-year term beginning January 1, 2005, to write and edit items for the neurology specialist certification examination. Jennifaye is also a Credentialed Clinical Instructor by the Clinical Instructor Education Board of the APTA. COURSE LEVEL (As defined by the APTA): Intermediate – Assumes that participants have a general familiarity with topic (gait).  The focus is on increased understanding and application of information (integrating the hemiplegic upper extremity during gait activities). CONTINUING EDUCATION UNITS A certificate of attendance will be issued denoting eight (8) credit (contact) hours or .8 CEUs of continuing competence. The contact hours or CEUs will vary in each state according to licensure boards, state associations, or sponsoring entities. This course meets the requirments for OT and OTA licensure renewal in the state of Alabama, and has been pre-approved by the PT licensure board for PT and PTA licensure renewal. AGENDA Day One 8:00 AM                          Introductions & Pre-test 8:15 AM                          UE Kinesiology Review as it Applies to Gait 9:00 AM                          Pre-requisite Strategies for the UE in Sit 10:00 AM                        Break 10:15 AM                        Pre-requisite Strategies for the UE in Stand & Treatment Interventions During Gait 11:30 AM                        Functional Reach    12:00 PM                        Lunch on your own 1:00 PM                          Shoulder Girdle Taping for an Inferior Subluxation                                       *Demonstration Only 1:45 PM                          Subsensory Electrical Stimulation *Demonstration Only 2:30 PM                          Break 2:45 PM                          Constraint-Induced Movement Therapy; Bimanual Tasks: A Review of the Literature in Evidence Based Practice 3:45 PM                          Lab Practice 4:15 PM                          Group Presentations & Skills Test 5:15 PM                          Questions & Answers; Post-test  Course Evaluation