ALHT601 - Optimising Upper Limb Management in Rehabilitation Populations

Year

Credit points

Campus offering

Prerequisites

HLSC672 Enhancing Clinical Reasoning in Rehabilitation for Healthcare Professionals AND HLSC630 Holistic Rehabilitation and Restoration 1

Teaching organisation

Unit rationale, description and aim

In this unit students are provided with the opportunity to update and enhance theoretical knowledge and clinical skills in order to enable participation through upper limb management for clients across the lifespan requiring rehabilitation. An enhanced understanding of the causes of upper limb impairment alongside rehabilitation and management techniques will be developed. There will be a focus on current assessment and intervention rationales and practice. Specifically designed workplace activities present opportunities for healthcare professionals 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. (GA4, GA5, GA6); 

LO2 - Critically analyse upper limb movement and function with selected clients to inform goal setting and comprehensive management plans. (GA4, GA5, GA6, GA7, GA8);

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. (GA4, GA5, GA6, GA7, GA8); 

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, GA5, GA6, GA7, GA8, GA9); 

LO5 - Justify the benefits of a holistic, functional and collaborative interprofessional approach to person-centred upper limb rehabilitation. (GA3, GA4, GA5, GA6, GA7, GA8). 

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

Topics will include: 

Control of upper limb movement   

• Neuro-motor control  
• Origins of dysfunction leading to upper limb impairments; CNS, arthritis, trauma 
• Reviewing common impairments i.e. ROM, spasticity, flaccidity, co-ordination, sensation, apraxia/ dyspraxia, tremor, and proprioception.  
• Linking impairments in upper limb to functional abilities and participation in ADLs 

Functional assessment  

• Functional assessment analysis of upper limb; normal versus abnormal movement (MMT), ROM, spasticity/ tone, co-ordination, sensation, proprioception and functional assessment methods 
• Review of standardised and non – standardised outcome measures; impairment based versus functional - in relation to EB; 
• Assessment of Participation – Use - Chedoke 
• Assessments of Impairment – dexterity and sensation i.e. Peg tests & RASP 
• Assessments of Activity – Grasp / eg Jebsen 
• 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 & Virtual Reality 
• Mirror Therapy/ Mental Rehearsal 
• Sensory acuity and discrimination, coordination and dexterity  
• Sensory stimulation retraining for awareness (Neglect) vs coordination and dexterity – needs developing 

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

• Management of Impairments; Tremor, Stiffness, Pain, Oedema, Subluxation, Contracture 
• Critical review of available evidence for Splinting/ Positioning/ Stretching/ Pain 
• BoTN 
• FES  
• Management of Activity Limitations and Participation 
• Use of equipment to enable enhanced functional use 
• Adaptations to enable increased participation 

Learning and teaching strategy and rationale

This unit is offered through multi-mode and online delivery for specific on and off shore cohorts. Both modes aim to facilitate learner centred activities and workplace learning. Learning and teaching strategies for this advamced 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. To facilitate practical application of knowledge and skills, multi-mode delivery requires participation in a required mid unit intensive practical workshop. Where possible, workshop activities are designed as reusable learning objects able to be provided online or modified slightly as required for current information and communication technologies for online delivery. As required, for example in different time zones learning and teaching strategies will be adapted for online delivery for specific cohorts. Activities undertaken in both modes are aimed to facilitate acquisition of advanced knowledge and skills in collaborative upper limb assessment and intervention strategies.   

Assessment strategy and rationale

ALHT601 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 optimal evidence-based interventions. The focus of the second and third assessment tasks, 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 to practice 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. The third assessment task requires 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 post graduate program. Scheduling of assessments will be equitable for both modes of delivery. Assessment tasks may be delivered and assessed locally with moderation according to University Policies and Procedures. 

Overview of assessments

Representative texts and references

Amini, D. (2021). Hand impairments. Chapter 43 in D. P. Dirette & S. A. Gutman (Eds.), Occupational therapy for physical dysfunction (Eighth edition). Wolters Kluwer.

Carr, J., & Shepherd, R. (2011). Neurological rehabilitation: Optimising motor performance. (2nd ed.). Edinburgh: Churchill Livingstone.

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

Corbetta, D., Sirtori, V., Castellini, G., Moja, L., & Gatti, R. (2015). Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Systematic Reviews. 2015 Oct 8;2015(10):CD004433. doi: 10.1002/14651858.CD004433.pub3. PMID: 26446577; PMCID: PMC6465192.

Iruthayarajah, J., Mirkowski, M., Foley, N., et al., (2018). Chapter 10. Upper extremity interventions. In R. Teasell & J. Iruthayarajah, J. (Eds.), Evidence based review of stroke rehabilitation. 

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.

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.

Shishov, N., Melzer, I., & Bar-Haim, S. (2017). Parameters and measures in assessment of motor learning in neurorehabilitation; a systematic review of the literature. Frontiers in Human Neuroscience, 11, 82-82.

Skirven, T. M., Osterman, L., Fedorczyk, J., Amadio, P. D., Felder, S., & Shin, E. K. (2021). Rehabilitation of the hand and upper extremity (7th ed.). Mosby.

Wattchow, K.A., McDonnell, M. N., & Hillier, S. L. (2018). Rehabilitation interventions for upper limb function in the first four weeks following stroke: A systematic review and meta-Analysis of the evidence. Archives of Physical Medicine and Rehabilitation, 99(2), 367-382. doi: 10.1016/j.apmr.2017.06.014. Epub 2017 Jul 20. PMID: 28734936.