OTHY603 - Advanced Occupational Therapy Practice 2 Optimising Participation Through Upper Limb Management

Year

Credit points

Campus offering

Prerequisites

HLSC632 Holistic Rehabilitation and Restoration 2 AND (OTHY602 Advanced Occupational Therapy Practicum 2: Optimising Participation for Home, Work and Leisure OR OTHY604 Advanced Occupational Therapy Practice 3 Cognitive Rehabilitation for Everyday Living )

Teaching organisation

Unit rationale, description and aim

This unit provides students with the opportunity to update and enhance theoretical knowledge and clinical skills to a Master's level in order to enable participation through upper limb management for clients across the lifespan with neurological disorders. An enhanced understanding of the causes of upper limb impairment alongside rehabilitation and management techniques will be developed. Practical components focus on current assessment and intervention rationales and practice. Specifically designed workplace activities present opportunities for occupational therapists to align theory and research, through interpretation and translation of evidence based knowledge and skills to their practice. Within their clinical setting students can develop and apply their enhanced knowledge and skills and demonstrate critical analysis of upper limb assessment, goal setting, use of functional and collaborative person centred rehabilitation models and application of evidence based techniques.

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Integrate and apply enhanced knowledge of upper limb anatomy and underlying impairments that lead to functional changes in the upper limb impacting daily activity and participation in adults. (GA4,5,6)

LO2 - Critically analyse upper limb movement and function with selected clients to inform goal setting and comprehensive management plans. (GA4,5,6,7,8)

LO3 - Select, apply and critique evidenced based treatment strategies including the potential use of available technologies and relevant outcome measures to optimise holistic upper limb rehabilitation for clients with age related, neurological or other disorders. (GA4,5,6,7,8)

LO4 - Demonstrate effective communication and application of evidence based practice; as well as enhanced skills in upper limb assessment and management, when working in a clinical context, including mentoring and coaching peers in advanced practice. (GA4,5,6,7,8,9)

LO5 - Justify the benefits of a holistic, functional and collaborative interprofessional approach to person-centred upper limb rehabilitation. (GA3,4,5,6,7,8)

Graduate attributes

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA6 - solve problems in a variety of settings taking local and international perspectives into account

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

Content

Control of upper limb movement  

• Neuro-motor control 
• Origins of dysfunction leading to upper limb impairments; e.g. central nervous system (CNS), arthritis, trauma
• Reviewing common impairments including spasticity, flaccidity, strength, co-ordination, sensation, apraxia/ dyspraxia, tremor, and proprioception. 
• Linking impairments in upper limb to functional abilities and participation in activities of daily living

Functional assessment 

• Functional assessment analysis of upper limb movements related to task and purpose of activity; normal versus abnormal movement, strength, range of movement, spasticity/ tone, co-ordination, sensation, proprioception and functional assessment methods
•  reaching / placement / support  
• reaching, grasping and manipulation (Bimanual / unimanual) 
• holding and transporting objects during standing / walking / lifting (dual tasking)
• Review of standardised and non – standardised outcome measures; impairment based versus functional
• Assessment of Participation and function use (ie. Chedoke hand and upper limb inventory)
• Assessments of Impairment – dexterity and sensation (i.e. Peg tests)
• Assessments of Activity (ie. Action Research Arm Test) 
• Setting functional goals for upper limb rehabilitation and outcome measurement 
• Setting goals for management of the non- functional upper limb within everyday activities and outcome measurement

Critical review of evidenced based interventions for retraining/ rehabilitation upper limb function:

• Retraining though functional practice/ upper limb groups
• Functional Electrical Stimulation (FES)
• Constraint Induced Movement Therapy (CIMT) including home programs
• Robotic training and virtual reality
• Mirror therapy and mental rehearsal
• Sensory acuity and discrimination, coordination and dexterity 
• Sensory retraining, praxis, coordination and dexterity retraining
• Awareness training for sensory inattention / neglect  

Critical review of evidenced based interventions for management of non-functional upper limb:

• Management of Impairments; tremor, stiffness, pain, oedema, subluxation, contracture
• Role and evidence for splinting/ positioning/ stretching/ pain
• Botulinum Toxin type A
• FES 
• Management of activity limitations and participation

o   Use of equipment to enable enhanced functional use

o   Adaptations to enable increased participation

Application of evidenced based knowledge and skills within the work-setting: analysis and clinical problem-solving for upper limb rehabilitation in clinical settings

Learning and teaching strategy and rationale

This unit is offered through multi-mode and online delivery for inclusion of onshore and specific offshore student participation that aims to facilitate learner centred activities and workplace learning. Learning and teaching strategies for this Masters level advanced practice unit are based on a blend of constructivism, social constructivism, and experiential learning within a framework of active participation within a community of inquiry. Purposefully designed content and activities that are the same or similar for all participants regardless of the mode of delivery have been identified. This has led to the development of purposefully designed learning activities that are transferable and work well across both delivery mediums whilst maintaining the flexibility to create and deliver mode specific activities focusing on inquiry based learning principles aimed at encouraging critical thinking, application of knowledge and skills, evidence for practice, collaborative peer learning and self-reflection. In addition, students participate in individual and small group activities based on analysis of current practice, assimilation and application of enhanced knowledge leading to the development of tools to facilitate translation of learning into clinical practice and encourage engagement in extended dialogue and guide change to a more inter-professional, person-centred practice. Unit activities include: guided readings, synchronous on-line tutorials, work-based activities with reflection, use of a reflective journal during applied, experiential learning, peer review with facilitated reflection and, mentoring to enhance practice, skill development and self-reflection. Activities undertaken are aimed to facilitate acquisition of advanced knowledge and skills in collaborative and occupational therapy specific, upper limb assessment and intervention strategies. 

Assessment strategy and rationale

OTHY603 assessments have been purposefully designed to replicate authentic clinical practice. Unit assessments have also been designed from an “Assessment for Learning” approach in order to not only provide evidence for judgement of learning, but also to reinforce, facilitate and support learning and application of learning. The assessment tools have been designed to provide for a broad range of tasks aligned to andragogic principles of adult learning, facilitating choice and self-direction for the post graduate student. The design enables timely judgement to ensure students have appropriate knowledge and skills prior to the workplace application segment of the unit. In addition, the range of assessment activities at the end of the unit encourage application of evidence to practice and embed clinical reasoning, problem solving and implementation of advanced knowledge and skills.   

The first assessment task provides students with the opportunity to demonstrate advanced and critical analysis of a case study performing an upper limb related task and to identify and apply evidence based interventions. The focus of the final two assessment items, is to reflect on personal and collaborative practice, and communicate reflections, evidence based reasoning and decision making, to management and peers. In the second assessment task students will identify an evidence based intervention for implementation in their work setting. Students will outline the evidence gap, appraise the relevant evidence and apply to their work setting, and communicate the implementation plan for this evidence practice gap within their work setting. Assessment task 3 enables students to demonstrate the application of advanced skills in the delivery on an evidence based intervention with a client, their clinical reasoning and clinical decision making.  

These assessments incorporate the advanced level of professional knowledge and skills, enhanced critical analysis and professional presentation modes developed throughout the Master’s program. All assessments will be submitted electronically. 

Overview of assessments

Representative texts and references

Carr, J., & Shepherd, R. (2011) Neurological Rehabilitation: Optimising motor performance. (2nd Ed.) Edinburgh: Churchill Livingstone. 616.8043 CAR 

Connell, L.A., Tyson, S.F. (2012) Clinical reality of measuring upper-limb ability in neurologic conditions: A systematic review, Archives of Physical Medicine and Rehabilitation, 93, (2):221-228  

Copley J, Kuipers K. (2014). Neurorehabilitation of the upper limb across the lifespan: managing hypertonicity for optimal function. Hoboken: John Wiley & Sons.  

Dovern, A., Fink, G.R., Weiss, P.H. (2012) Diagnosis and treatment of upper limb apraxia. Journal of Neurology, 259(7):1269-1283  

Iruthayarajah, J., Mirkowski, M., Foley, N., et al., (2018) Chapter 10. Upper Extremity Interventions. In Teasell, R., & Iruthayarajah, J., Evidence based Review of Stroke Rehabilitation http://www.ebrsr.com 

Lannin, N.A., McClusky, A. (2008) A systematic review of upper limb rehabilitation for adults with traumatic brain injury. Brain Impairment.9(3):237-246  

McCluskey, A., Lannin, N.A., & Schurr, K. (2009). Optimising motor performance following brain impairment. Chapter 37 in Curtin, M., Molineux, M., Supyk-Mellson, J. (Eds). Occupational therapy and physical dysfunction: enabling occupation (6th ed.). London, UK, Churchill Livingstone.  

Ranka, C.L., & Chapparo C,. (2011) Motor aspects of upper limb functioning and occupational analysis pp 264-279. Chapter 18 in Mackenzie, L. & O’Toole, G. Eds Occupation Analysis in Practice Hoboken: John Wiley & Sons  

Sahin, N., Ugurlu, H., & Albayrak, I. (2012) The efficacy of electrical stimulation in reducing the poststroke spasticity: a randomized controlled study. Disability and Rehabilitation 34(2):151-6.  

Skirven, T.M. (2011). Rehabilitation of the hand and upper extremity, Expert Consult (6th ed.). Mosby.   

Yue, S. (2011) Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation 92(6): 972 -982.