OT Toolkit for Stroke Recovery

Introduction

As an occupational therapist specializing in stroke rehabilitation, I’ve dedicated my career to helping individuals reclaim function and independence after neurological injury or illness.

With nearly two decades of clinical practice in upper extremity rehabilitation, I’ve witnessed firsthand the transformative power of occupational therapy (OT) in assisting stroke survivors. Currently serving as the Clinical Relations Manager at Neurolutions, a pioneering medical technology company dedicated to transforming the lives of patients suffering from neurological conditions, I am passionate about utilizing evidenced-based and innovative approaches to enhance motor recovery and function. 

My enduring mission is to empower individuals and organizations to reach their fullest potential in service of the patient’s well-being. This can be achieved through collaboration and the application of innovative approaches and techniques for motor recovery.

In this article, I’ll share insights from my “OT Toolkit” for stroke rehabilitation, highlighting the crucial role of OT in upper extremity recovery.

The Vital Role of the Occupational Therapist in Upper Extremity Rehabilitation 

Occupational therapy is critical in aiding stroke survivors to regain upper extremity functionality by utilizing comprehensive care.

Before introducing my OT Toolkit, let’s take a moment to highlight the crucial role that OT plays in upper extremity rehabilitation and helping individuals reclaim their lives after stroke.

OT is instrumental in addressing the unmet needs in rehabilitation, especially in chronic stroke survivors, by helping individuals with neurological conditions or injuries regain functionality in their upper extremity. By addressing physical, cognitive, and emotional factors, OT interventions facilitate the relearning of essential skills and promote independence in daily activities. Through personalized treatment plans and support, OT empowers patients to improve their functional use of their upper extremities, leading to enhanced quality of life and long-term recovery.

As occupational therapists (OTs), we must stay updated on neurorehabilitation advancements to provide effective care. It is important to integrate new research, technologies and treatments into our practice to optimize outcomes for patients. 

Possessing a variety of “tools” in our OT toolkit allows us to customize treatment plans in stroke rehabilitation more effectively. Having a diverse range of assessment tools, therapeutic modalities, and technologies at their disposal, OTs can tailor interventions to meet the specific needs and goals of each individual client. 

The OT Toolkit for Upper Extremity Rehabilitation: An Overview

A mix of low-tech and high-tech tools and strategies enable personalized and evidence-based treatments for effective stroke recovery.

In my OT Toolkit for upper extremity rehabilitation, I integrate a range of specialized low-tech and high-tech tools, strategies, and approaches to address the diverse needs of my clients. This includes a combination of innovative techniques alongside traditional methods, allowing for a comprehensive and personalized approach to treatment. 

Having a variety of evidence-based tools in my OT toolkit allows me to make individualized treatment decisions based on each patient’s unique circumstances. As OTs, we understand the importance of the patient’s occupational profile. We understand that we may need to be flexible, depending on changes that arise along their rehabilitation journey. We consider factors such as a stroke survivors environment, finances, technology preferences, motivation, and support system to tailor interventions that are effective, feasible, and meaningful for their day-to-day lives. This personalized approach ensures that patients receive the most suitable and impactful therapy, promoting better outcomes and engagement in their recovery process.

In-Depth Look at My OT Toolkit for Upper Extremity Rehabilitation

Assessment tools and resources mainly help adults recover from stroke in the long term, but they can also be useful in the early stages of stroke recovery. It’s important to focus on what’s best for the patient when picking treatments from the OT Toolkit.

Throughout the article, we’ll delve into the tools and techniques I employ for upper extremity rehabilitation.

It’s important to mention that most assessment tools, such as outcome measures, along with technology, therapeutic methods, resources, and professional connections, are geared towards supporting chronic motor rehabilitation in the adult stroke population. However, you may find that there are some crossovers into acute and subacute practice environments. It’s important to note that there are additional OT tools available that are not covered in this article for the sake of brevity and focus.

Expertise, clinical judgment, and best-practice guidelines serve as a foundation for determining the appropriate interventions and their timing. However, it’s equally crucial to adopt a patient-centered approach when selecting interventions from the OT Toolkit. This ensures that the chosen interventions align with the individual patient’s goals, preferences, and unique needs, promoting more effective and personalized rehabilitation outcomes.

As a disclaimer, I am not affiliated with any other organizations or companies, apart from Neurolutions.

Assessment Tools for Upper Extremity Sensorimotor Rehabilitation of the Upper Extremity

Standardized assessment tools hold significance in guiding the rehabilitation process with objective progress measures.

As OTs practice in the modern healthcare environment, it is critical to have standardized assessment measures as a part of our OT toolkit. Standardized assessments provide a consistent and objective way to evaluate patients’ progress, ensure accurate diagnosis and treatment planning, and facilitate communication among healthcare professionals involved in the patient’s care.

As part of the OT evaluation or reassessment, I provide neurological assessments on patient’s upper extremity to understand their abilities and limitations with active and passive range of motion, joint integrity, muscle tone, muscle strength, presence of edema, skin integrity, sensory and proprioceptive awareness, and analyzing their to ability to use their arm and hand to manipulate and reach during functional tasks.

In addition to the aforementioned assessment, I always select at least one standardized outcome measure. Having an outcome measure that is standardized for upper extremity motor recovery means that we can follow a consistent and established protocol for assessing the progress or changes in motor function specifically related to the arms, hands, and shoulders.

The primary resource I frequently utilize for comprehensive information on the reliability, validity, applicable populations, and general overview of assessments is the Shirley Ryan Ability Lab Database. You can access this resource directly at Shirley Ryan Ability Lab Database. 

Upper Extremity Fugl-Meyer (UEFM)

The Upper Extremity Fugl-Meyer Assessment (UE-FMA) is a component of the broader Fugl-Meyer Assessment (FMA) scale, specifically focusing on evaluating sensorimotor impairment in the upper extremity of individuals who have experienced a stroke. This assessment tool is renowned for its effectiveness in quantifying motor recovery and function in stroke survivors, making it a gold standard in the field of stroke rehabilitation. Fugl-Meyer Assessment of Motor Recovery after Stroke

Action Research Arm Test (ARAT)

The Action Research Arm Test (ARAT) is a widely used assessment tool for evaluating upper limb function in individuals who have experienced a stroke. It consists of a series of tasks designed to measure the patient’s ability to perform various reaching and grasping movements, providing valuable insights into their motor recovery progress. Action Research Arm Test

Arm Motor Ability Test (AMAT)

The Arm Motor Ability Test (AMAT) is a comprehensive assessment tool specifically designed to evaluate upper limb motor function in stroke survivors. It assesses various aspects of arm movement ability, including reaching, grasping, and manipulating objects, providing valuable information for treatment planning and monitoring progress in rehabilitation. Arm Motor Ability Test

9-Hole Peg Test (9HPT)

The 9-Hole Peg Test (9HPT) evaluates manual dexterity and fine motor coordination. It involves the task of placing and removing pegs into and from a pegboard as quickly as possible, providing valuable insights into upper limb function and dexterity, particularly in stroke survivors. Stroke survivors with some prehensile abilities are most appropriate for this standardized assessment tool. 9-hole Peg Test

Box and Blocks Test (B&B): 

The Box and Blocks Test is a common assessment tool used in stroke rehabilitation to evaluate upper limb function, specifically gross manual dexterity. It involves moving blocks from one compartment of a box to another within a set time frame, providing valuable insights into a stroke survivor’s arm and hand coordination and dexterity. This test is not time consuming and can be completed in only 1-minute per hand. However, it requires at least partial ability to elevate the arm against gravity and reach horizontally while utilizing a gross grasp or a more precise 3-jaw chuck or pincer grasp. Box and Blocks Test

Canadian Occupational Performance Measure:

The Canadian Occupational Performance Measure (COPM) is a client-centered assessment tool used in stroke rehabilitation to identify and prioritize individualized goals related to occupational performance. It involves a structured interview for clients to rate their performance and satisfaction in various activities of daily living. COPM allows therapists to tailor interventions specifically to the client’s needs and goals, enhancing engagement and outcomes in stroke rehabilitation. Canadian Occupational Performance Measure

Therapeutic Tools, Approaches, and Equipment: 

A variety of essential interventions, from traditional methods to technological innovations, can optimize neurological condition recovery.

This section of my OT Toolkit highlights an array of “best practice” interventions and technology aimed at enhancing upper extremity rehabilitation. From low-tech solutions to advanced technological innovations, I selected these interventions to showcase what I use to optimize the recovery process for stroke survivors and individuals with neurological conditions. Occupational therapy interventions represent the core of our work: tailoring our efforts skillfully to address the unique needs of each patient, recognizing that a one-size-fits-all approach is not always effective.

A comprehensive understanding of knowledge, practical experience, and proficiency with tools and devices are essential factors that influence intervention selection. I recommend referencing the Educational Resources section of this article for evidence-based practice guidelines that have significantly informed my decision-making process for interventions.

It’s important to acknowledge that stroke survivors with motor impairments often encounter specific challenges like shoulder subluxation, edema, or contractures. While I won’t be providing a comprehensive discussion of these interventions, you can explore more detailed information in the blogs available on Neurolutions’ page (link provided).

Interventions

Effective therapeutic interventions like task-specific training, electrical stimulation, and motor priming strategies are crucial in enhancing rehabilitation outcomes.

Task-specific Training

Task-specific training in upper extremity rehabilitation involves practicing activities relevant to daily life goals by stimulating the brain to adapt and improve motor function through repetition and skill acquisition. This promotes recovery in stroke survivors. An example of this would be having a stroke survivor practice moving a cup to a shelf. The challenge would be increased or decreased by changing factors such as height, the shape or weight of the cup, speed, doing the task while performing a cognitive task, and more. 

Electrical Stimulation 

Functional electrical stimulation (FES) and neuromuscular stimulation (NMS) are innovative modalities that have been increasingly employed in stroke rehabilitation to facilitate motor recovery and improve upper extremity function. 

In my clinical practice, I employ both functional electrical stimulation (FES) and neuromuscular electrical stimulation (NMES) to address various upper extremity impairments observed in stroke survivors. This could include limited movement, sensory deficits, reduced strength, muscle atrophy, and altered muscle tone.

Within my practice, I often pair NMES with range-of-motion exercises during the first few skilled therapy sessions, primarily for initial assessment purposes. I advocate for the ongoing utilization of NMES-assisted exercises in home programs while providing education and support to patients and their families in acquiring and utilizing NMES devices independently at home.

I incorporate FES into my skilled treatment for upper extremity rehabilitation because of its ability to target specific muscle groups, facilitate muscle contraction, and promote functional movement patterns. FES helps to activate muscles that may be weak or paralyzed due to stroke or other neurological conditions, allowing patients to participate more actively in therapy sessions and engage in meaningful activities.

Mobile Arm Supports 

During skilled care sessions, I integrate mobile arm supports to provide assistance to weak or unstable proximal joints in the upper extremity. These supports enable my patients to reach into various planes and promote reach, grasp, and the potential manipulation of objects. During basic range-of-motion exercises, I may utilize mobile arm supports to alleviate the weight of the arm, allowing patients to focus on developing strength and stability. Moreover, I incorporate these supports into functional tasks to facilitate independence in daily activities. Commercially available mobile arm supports offer a range of options from non-motorized designs to those incorporating robotics, catering to diverse patient needs and preferences.

Motor Priming

Motor priming in neurorehabilitation for stroke survivors involves preparatory activities or stimuli designed to enhance the brain’s responsiveness to subsequent therapeutic interventions, optimizing motor learning and recovery. These activities trigger neuroplastic changes in the brain, promoting the formation of new neural connections and pathways. Once primed, the brain may enter a state of heightened readiness for change, facilitating more effective and lasting motor learning outcomes over time.

Action observation, mirror therapy, and mental practice are three essential motor-priming interventions that OTs can integrate into the rehabilitation process for stroke survivors across all stages of recovery. These interventions capitalize on the brain’s ability to learn and adapt by enhancing neural pathways associated with motor function, ultimately supporting the individual’s progress towards improved movement and function in the affected limb.

Action Observation:

• Involves observing and imitating purposeful movements performed by others.
• Stimulates the mirror neuron system, which enhances motor learning.

Mirror Therapy:

• Utilizes a mirror to create the illusion of movement in the affected limb by reflecting the movement of the unaffected limb.
• Helps rewire the brain’s perception of movement and reduces pain perception.
• Can be easily incorporated into therapy sessions and continued as a home exercise.

Mental Practice:

• Involves mentally rehearsing motor tasks without physical movement.
• Activates similar brain regions as physical practice, facilitating motor imagery and motor planning.
• Can be combined with other interventions or used independently as a supplemental strategy.

I have noticed that despite there being ample evidence validating the efficacy of diverse motor priming techniques, they are not fully utilized in rehabiliation practices.There are many reasons for this, such 

I suggest that therapists conduct their own exploration of these techniques by reviewing summaries of best practice guidelines and publications. This will inform them in making decisions regarding the application of these techniques within the plan of care and the patient’s home exercise program.

Additionally, it’s crucial to monitor your patient’s adherence to your recommendations. These techniques may be overlooked if progress isn’t immediately apparent, leading to a diminished perceived value.

Constraint-Induced Movement Therapy/Modified Constraint Induced Movement Therapy (CIMT)

In my clinical practice, I may utilize Constraint-Induced Movement Therapy (CIMT) to help stroke survivors and individuals with neurological conditions improve upper extremity function. It is important to note that an individual must meet minimal elibility criteria prior to participating in CIMT. The process of CIMT begins by immobilizing or constraining the unaffected limb, therefore encouraging the use of the affected limb during functional activities and exercises. This intensive and repetitive task-oriented training aims to promote neuroplastic changes in the brain, facilitating motor recovery and enhancing functional independence. There is also a modified version of CIMT, known as Modified Constraint-Induced Movement Therap (MCIMT). It is clinically validated, and the protocol requires a reduced time-duration for constrain than the orginal CIMT. 

Patients enrolled in CIMT or CIMT are provided with a comprehensive home program consisting of specific tasks with designated repetitions or durations. These tasks are tailored to the individual’s goals and are progressed accordingly as they make improvements. Before starting CIMT or CIMT, a contract is typically signed between the patient and their care provider, ensuring commitment to the program for the required duration. It’s important for the patient to understand that consistent practice, even if initially challenging, is essential for achieving optimal outcomes and maximizing their potential for motor recovery.

The core of my CIMT/MCIMT therapy sessions and home programs revolves around functional tasks tailored to the individual’s goals. Following a thorough assessment of their needs, I design a program featuring task-specific training activities. Through task analysis, I adjust the level of difficulty to match their current abilities, ensuring progression. Below are a few examples of the task-specific training activities I incorporate into their treatment plan:

• Pouring liquid from a container
• Drinking from a cup
• Holding a phone to the ear
• Using utensils to eat
• Opening and closing a door
• Picking up a pen
• Using a computer mouse
• Brushing teeth 

Bilateral Arm Training

While Constraint-Induced Movement Therapy (CIMT) restricts the use of the less affected arm, bilateral arm training operates on the principle that “the good trains the bad.” This approach capitalizes on the inherent coordination between both arms during most upper and lower extremity movements. The brain’s motor networks in both hemispheres facilitate this coordination, a phenomenon observed even in individuals without a history of stroke. While there is no universal agreement on the most effective methods for bilateral arm training, I have integrated elements of this approach into my neurorehabilitation strategy.

“In-phase” bilateral arm training involves both arms moving together in the same direction and at the same time. 

Examples of in-phase bilateral arm training for stroke survivors may include:

• Bilateral arm reaching exercises: Both arms reach forward simultaneously to grasp an object placed in front.
• Bilateral arm cycling: The individual pedals a stationary bike using both arms simultaneously in a coordinated manner.
• Bilateral arm rowing: Pulling resistance bands or cables with both arms simultaneously in a rowing motion.
• Bilateral arm punching: Punching a punching bag or padded surface with both arms simultaneously.

Alternatively, “anti-phase” bilateral arm training involves moving both arms in opposite directions or with alternating movements. Examples of anti-phase bilateral arm training for stroke survivors may include:

• Bilateral arm swinging: Swinging both arms in opposite directions while standing or walking.
• Bilateral arm tapping: Tapping the knees or alternating tapping movements with both hands in front of the body.
• Bilateral arm marching: Lifting and lowering the knees alternately while simultaneously swinging both arms in opposite directions.
• Bilateral arm throwing: Throwing a ball against a wall with one arm while catching and returning it with the other arm in a synchronized but alternating pattern.

Robotics

In my experience as a neurorehabilitation therapist, I’ve had the privilege of utilizing various types of robotics in clinical practice to aid in the recovery of individuals with neurological conditions. These robotics range from motor-driven devices to those utilizing electromyography (EMG) technology, each offering unique benefits and applications in rehabilitation.

Having access to robotics in the clinic can help provide targeted and repetitive movements that help promote motor learning and recovery. Whether it’s assisting with passive range-of-motion exercises or facilitating active engagement in functional tasks, robotics offer a controlled and adaptive environment for patients to work on improving their movement abilities.

For patients seeking neurorehabilitation services, inquiring about the availability of robotics at the clinic can be beneficial. By asking prior to enrollment, individuals can gain insight into the specific types of robotics offered and how they align with their rehabilitation goals. This proactive approach allows patients to make informed decisions about their care and potentially benefit from the unique advantages that robotics bring to the rehabilitation process.

Virtual Reality

While not all clinics may have virtual reality (VR) technology readily available, I have been fortunate to trial many VR systems for use in my clinic. Utilization of VR in rehabilitation settings is becoming increasingly common, and more companies are adopting products to prove an immersive and engaging platform for therapeutic interventions, particularly in stroke rehabilitation. 

For OTs, VR can be an essential tool for enhancing therapy sessions by providing interactive and motivating exercises tailored to each patient’s needs. It allows for the simulation of real-world activities in a controlled environment, facilitating task-specific training and promoting neuroplasticity. Additionally, VR systems often include features for progress tracking and performance feedback, enabling OTs to monitor patients’ rehabilitation progress more effectively. Overall, integrating VR into rehabilitation programs can enhance patient engagement, improve treatment outcomes, and provide innovative solutions for addressing upper extremity motor deficits post-stroke. 

It is important to approach the use of VR with caution and awareness of potential downsides. One concern is the risk of overstimulation or sensory overload, especially for individuals with sensory deficits or cognitive impairments. VR experiences can be intense and may exacerbate symptoms such as dizziness, nausea, or disorientation in some patients. Additionally, not all patients may be comfortable or familiar with VR technology, leading to potential challenges with adoption and engagement.

Non-invasive Brain-computer Interface: 

Reflecting on my time in clinical practice, I’ve witnessed remarkable advancements in neurorehabilitation, particularly with the emergence of non-invasive brain-computer interface (BCI) technology. When I was actively practicing, such innovations were not yet available; now I see the profound benefits they offer, particularly as home-therapy tools complementing skilled therapy in clinical settings.

Non-invasive BCI technology allows individuals to interact with computers or external devices using only their brain activity, without the need for invasive procedures. This groundbreaking approach has significant implications for stroke rehabilitation, as it enables patients to engage in therapeutic activities tailored to their specific needs and abilities from the comfort of their homes. By harnessing the power of neuroplasticity, non-invasive BCI facilitates the retraining of neural pathways and promotes functional recovery in stroke survivors.

For therapists entering the field of neurorehabilitation, it’s essential to be aware of the potential of non-invasive BCI technology and its role in enhancing traditional rehabilitation practices. Integrating these innovative tools into therapy plans can offer patients new opportunities for personalized and effective interventions, ultimately leading to improved outcomes and quality of life. As the landscape of neurorehabilitation continues to evolve, staying informed and proactive in exploring emerging technologies like non-invasive BCI will be crucial for providing the highest standard of care to stroke survivors and individuals with neurological conditions.

The IpsiHand System is a breakthrough therapeutic device and the only FDA-cleared, commercially available solution that enables non-invasive, at-home rehabilitation for stroke survivors affected by chronic motor deficits. Utilizing BCI technology, the IpsiHand enables stroke survivors to engage in thought-actuated therapy, connecting movement to the intent to move signals within the brain, helping rebuild neural pathways. [website link, blog link]

Cognitive and Emotional Support Tools

Cognitive and emotional support, including goal setting, play an important role in improving rehabilitation engagement and success.

In my experience, helping individuals recover upper limb function after a neurological injury like a stroke involves addressing not only physical rehabilitation, but also cognitive and emotional aspects.

Incorporating goal-setting activities has also proven to be highly effective in providing cognitive support during upper limb rehabilitation. By setting specific, measurable, achievable, relevant, and time-sensitive (SMART) goals together with patients, I’ve helped them focus their efforts and track their progress in a tangible way. Breaking down large goals into smaller, achievable tasks has allowed patients to experience a sense of accomplishment with each milestone reached, boosting their confidence and motivation to continue working towards recovery. Moreover, involving patients in the goal-setting process empowers them to take an active role in their rehabilitation, fostering a sense of ownership and autonomy.

Emotional support is equally essential in the rehabilitation process, particularly as patients navigate the emotional challenges that come with physical limitations. I’ve found that our Stroke Support Groups offer a valuable space for patients to connect with others facing similar struggles, share experiences, and receive both encouragement and empathy. By fostering a sense of community and understanding, support groups help individuals cope with emotional difficulties and build resilience. Another setting that involves cultivating a sense of camaraderie is in the gym, enabling patients to cheer each other on during exercises and activities. This not only made therapy more enjoyable, but it also instilled a sense of pride in the patients as they progressed.s

Educational Resources: 

Find below a curated list of books, websites, and courses offering valuable insights for professionals in stroke and neurorehabilitation.

In recommending resources for upper extremity rehabilitation, I suggest exploring various books, websites, and courses that offer valuable insights. 

Books

Below are a few books on neuro and stroke rehabilitation that I keep on hand and frequently consult.:

• “Stronger After Stroke: Your Roadmap to Recovery” by Peter G. Levine: This book offers practical advice and exercises for stroke survivors to regain mobility and independence.
• “The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science” by Norman Doidge: While not specifically focused on stroke rehabilitation, this book explores the brain’s remarkable ability to adapt and heal, offering hope and inspiration to stroke survivors and their caregivers.

• “Healing the Broken Brain: Leading Experts Answer 100 Questions About Stroke Recovery” by Mike Dow and Dr. David Dow: This book provides comprehensive answers to common questions about stroke recovery, offering practical advice and insights from leading experts in the field. It’s a valuable resource for stroke survivors and their caregivers seeking guidance on their rehabilitation journey.
• “Soft-Wired: How the New Science of Brain Plasticity Can Change Your Life” by Dr. Michael Merzenich: Dr. Merzenich explores the concept of brain plasticity and its implications for stroke recovery in this insightful book. Through engaging stories and accessible explanations, he demonstrates how the brain can rewire itself after injury, offering hope and encouragement to stroke survivors.
• “Hope after Stroke: The Seven Steps to Stroke Recovery” by Dr. Tom Balchin: Dr. Balchin outlines a seven-step approach to stroke recovery, focusing on holistic healing and empowerment. Drawing on his experience as a stroke survivor and healthcare professional, he offers practical strategies and exercises to promote physical, emotional, and cognitive recovery.
• “Into the Gray Zone: A Neuroscientist Explores the Mysteries of the Brain and the Border Between Life and Death” by Adrian Owen: While not specifically focused on stroke rehabilitation, this book delves into the complexities of consciousness and brain function. Dr. Owen’s research on patients in vegetative states sheds light on the brain’s capacity for awareness and recovery, offering valuable insights for healthcare professionals working with stroke survivors.
• “My Stroke of Insight: A Brain Scientist’s Personal Journey” by Jill Bolte Taylor: In this memoir, neuroscientist Jill Bolte Taylor shares her own experience of recovering from a stroke, offering insights into the process of rehabilitation and the resilience of the human spirit.
• “Conditions in Occupational Therapy: Effect on Occupational Performance, Sixth Edition” by Atchison and Dirette: This comprehensive guide explores the impact of various medical conditions (including neurological conditions) on individuals’ ability to engage in meaningful activities. The sixth edition details the intricate relationship between health conditions and occupational performance, offering practical insights and evidence-based strategies for occupational therapists. 

Websites

• Evidence-based review of stroke rehabilitation: A valuable resource for evidence-based practice guidelines and research in stroke rehabilitation. www.ebrsr.com
• Stroke Alert Podcast: A podcast providing insights, tips, and discussions on stroke-related topics for healthcare professionals and stroke survivors. Stroke Alert Podcast
• Stronger After Stroke Blog: An informative blog offering resources, tips, and personal stories to support stroke survivors and their caregivers on the journey to recovery. Stronger After Stroke Blog
• VaDoD Clinical Practice Guidelines: Clinical practice guidelines provided by the Department of Veterans Affairs and Department of Defense, offering evidence-based recommendations for stroke rehabilitation. VaDoD Clinical Practice Guidelines
• AAPM&R Clinical Practice Guidelines: Clinical practice guidelines from the American Academy of Physical Medicine and Rehabilitation, providing evidence-based recommendations for stroke rehabilitation. AAPM&R Clinical Practice Guidelines
• AOTA: The American Occupational Therapy Association website, offering resources, education, and advocacy for occupational therapists working in stroke rehabilitation. AOTA
• APTA: The American Physical Therapy Association website, providing resources, education, and advocacy for physical therapists working in stroke rehabilitation. APTA
• PubMed: A database of biomedical literature, including research articles and clinical studies related to stroke rehabilitation. PubMed
• ClinicalTrials.gov: A database of clinical trials worldwide, including trials related to stroke rehabilitation interventions and treatments. ClinicalTrials.gov

Courses/Professional Collaborations

• Certified Stroke Rehabilitation Specialist (CSRS): Certified Stroke Rehabilitation Specialist (CSRS) “is the field’s stroke certification for occupational and physical therapists.” I consider this course a must-have for therapists that treat stroke to stay updated on the latest evidence-based practices and interventions. CSRS Stroke Certification 

• Certified Brain Injury Specialist (CBIS): Becoming certified as a Certified Brain Injury Specialist allowed me to better understand brain injury and has provided me with a network of of resources and courses nationwide related to brain injury. BIA_CBIS

• MedBridge: MedBridge offers a wide range of online courses and resources for rehabilitation professionals, including stroke rehabilitation and brain injury topics. With MedBridge, I can access high-quality education and earn CEUs to further my professional development. I have several neurological certifications through Medbridge. Medbridge

• PESI, Summit Education and OccupationalTherapy.com: Each platform provides educational seminars, conferences, and online courses covering various rehabilitation topics, including stroke and brain injury rehabilitation. PESI, Summit Education , Occupationaltherapy.com 

• NeuroCollaborative: NeuroCollaborative offers mentorship, networking and courses by some of the top experts in the field of neurorehabilitation. NeuroCollaborative

Professional Network:

A multidisciplinary professional network facilitates enhanced care and recovery for patients undergoing upper extremity rehabilitation.

In my experience, I’ve found that collaboration across disciplines is essential for effective upper extremity rehabilitation. By working closely with physical therapists, speech therapists, neurologists, community leaders, care advocates and influences, and professional organizations, we can ensure that our patients receive comprehensive care that addresses all aspects of their recovery journey. 

Building a local, regional, or national professional network takes time and effort, but here are some effective ways I’ve connected with other professionals in the field:

• Attend, participate, and speak at interdisciplinary conferences and workshops
• Join professional organizations and online forums
• Participate in community events and volunteering activities
• Join collaborative coaching groups that foster professional connections and promote personal and career development 
• Provide seminars and workshops in the community or within your health system
• Continue to build your certifications and treatment approaches 

By actively seeking out these networking opportunities, you can build a strong professional network that enhances the quality of care provided to patients.

Keeping Your Toolkit Updated

Continuous learning and staying updated with the latest rehabilitation practices and technologies are fundamental in maintaining the most effective toolkit.

Continuous learning and adaptation are paramount in the field of upper extremity rehabilitation to ensure the delivery of high-quality care and optimal patient outcomes. As a practitioner, I prioritize staying abreast of the latest advancements, research findings, and emerging technologies in the field. This involves actively engaging with current literature, attending conferences, and participating in specialized training sessions focused on upper extremity rehabilitation.

One key aspect of keeping my toolkit updated is staying informed about cutting-edge technologies that have the potential to revolutionize rehabilitation practices. For example, I recommend utilization of breakthrough therapeutic home-friendly approaches, such as non-invasive brain-computer interface using IpsiHand Upper Extremity Rehabilitation. Additionally, I explore virtual reality (VR), robotics, and augmented reality (AR) tools that offer innovative approaches to therapy, providing immersive and engaging environments for patients to practice motor skills and cognitive tasks. By incorporating these technologies into my practice, I can offer novel and effective interventions to my patients, enhancing their rehabilitation experience and outcomes.

Additionally, I actively seek out professional development opportunities specific to upper extremity rehabilitation, such as certifications, workshops, and conferences. These activities allow me to deepen my expertise, learn new assessment and treatment techniques, and network with other rehabilitation professionals. By continuously expanding my knowledge and skill set, I am better equipped to address the diverse needs of my patients and adapt to evolving trends and best practices in the field of upper extremity rehabilitation.

As part of my commitment to providing exceptional care in upper extremity rehabilitation, I actively engage in professional development activities tailored to this specialization. I hold certifications as a Certified Stroke Rehabilitation Specialist (CSRS) and Certified Brain Injury Specialist (CBIS), ensuring that my knowledge and skills in these areas are current and aligned with best practices. Additionally, I completed certifications in Neurodevelopmental Treatment (NDT) through Recovering Function and LSVT BIG for Parkinson’s Disease, enhancing my ability to address the unique needs of patients with neurological conditions.

To stay current with the latest advancements and evidence-based practices, I regularly participate in courses offered by organizations such as the American Congress of Rehabilitation Medicine (ACRM), Brain Injury Association (BIA), and American Occupational Therapy Association (AOTA). These courses provide valuable insights into emerging trends, innovative techniques, and research findings relevant to upper extremity rehabilitation.

Furthermore, I prioritize staying up to date on current literature in the field, regularly reviewing peer-reviewed journals, research articles, and clinical practice guidelines. By staying informed about the latest research and evidence, I can integrate new knowledge and techniques into my practice, ensuring that my patients receive the highest quality of care. Through my ongoing commitment to professional development, I strive to continuously improve my skills and expertise in upper extremity rehabilitation, ultimately enhancing the outcomes and experiences of my patients.

Conclusion

In summary, my OT Toolkit has evolved over nearly two decades of clinical practice to support the rehabilitation journey of my patients facing upper extremity challenges. 

Ultimately, it is the dedicated efforts of therapists and their comprehensive toolkit that drive positive outcomes and foster meaningful progress in upper extremity rehabilitation. I hope other therapists find these insights and strategies useful as they navigate their own clinical practice and continue to make a difference in the lives of their patients.

Emily J. Morgan, MS, OTRL, CSRS, CBIS