A Clinician s Perspective of the ViaTherapy App for Upper Extremity Stroke Rehabilitation Anik Laneville, OT Reg. (Ont.) Best Practice Occupational Therapist CRSN Dana Guest BSc. PT Best Practice Physiotherapist CRSN Acknowledgements: Mark Bayley MD, FRCPC Debbie Hebert OT, PhD
Feedback We would appreciate feedback on this presentation either by going to this link http://bit.ly/2bhz0v0
Or by using this QR code
Questions We will have time for questions at the end of the presentation. OTN participants can ask via their microphones Alternatively you can text (613-297-9861)or email (mthornton@toh.ca )questions to us.
Disclosure of Commercial Support This program has not received any commercial support. Potential for conflict(s) of interest: None
OBJECTIVES By the end of the presentation, participants should be able to: Explain how to use ViaTherapy to support best practice in upper extremity care post stroke. List the prognostic indicators used within ViaTherapy to determine the optimal interventions based on evidence and efficacy.
To access the ViaTherapy app: 1. Go to the App Store or Google Play 2. Search viatherapy 3. Download the app for free
Why an App? http://viatherapy.org/
5+ Years of Research in the Making Initiated in 2010 App prototype completed in 2015 Launched on the App Store and Google Play in April 2017 International panel of stroke and rehabilitation researchers and clinicians from Physiatry, Neurology, and Physical & Occupational Therapy. Collective expertise encompassed research interests in epidemiology, motor control, and knowledge translation. Initiated 2010 Launched
INTERNATIONAL REPRESENTATION Canada United States Australia Netherlands Sweden New Zealand United Kingdom UBC Laval Dalhousie U of T McGill Western McMaster
RECOVERY OF BODY FUNCTIONS AND ACTIVITIES Not yet Not yet Reassess weekly Progression weekly Prognostic algorithm for the upper paretic limb Can the patient produce any voluntary muscle activity in the affected upper limb? Yes Return of shoulder abduction and elbow extension simultaneously? Yes With the forearm prone on a table and the hand and fingers unsupported: can the patient initiate finger (and/or thumb) extension three times within a minute? Not yet Not yet Not yet Yes Box 1 Compensatory Techniques Box 2 Hand Edema Cryotherapy Passive ROM Robotics Motor imagery Mirror Box FES Spasticity mgmt Shoulder ( Box 9) Not yet Reassess weekly Box 3 Strengthen Shoulder and Elbow control by: Robotics -Trunk restraint -Motor imagery -Bilateral Arm Training -Video games -FES Facilitate wrist finger Extn. By Exercise, FES, motor imagery, Not yet Reassess weekly Box 4 Task Specific Mod-CIMT or signature CIMT, trunk restraint mental practice functional Strengthening (e.g. GRASP) Video Games Virtual Reality >12w >12w >12w >12w At 12 weeks Review goals and determine if a new approach is required Early Rehabilitation Late Rehabilitation Chronic phase 0-24 h Days 12 weeks TIME Courtesy of G. Kwakkel WEEKLY MONITORING CHANGE OF VOLUNTARY MOTOR CONTROL
Backbone of the App = Algorithm PROGNOSTIC INDICATORS: Motor Impairment: SAFE Model strong prognostic indicator for upper limb function Shoulder Abduction Finger Extension Time: 12 week timeline developed based upon rehab phases of recovery/spontaneous neurological recovery literature Days 12 Weeks: Restore impairments to regain body functions and activities back > 3 Months: Allow task-oriented practice with adaptive learning & compensation strategies
What if there is pain? Pain is not a prognostic indicator. Presence of pain leads to the additional recommendations for shoulder management within the App
Video thanks to Dr. Mark Bayley
Video reproduction thanks to Dr. Bayley
Video reproduction thanks to Dr. Bayley
3 weeks later Video reproduction thanks to Dr. Bayley
Levels of Evidence
Star Rating Most bang for your buck Effectiveness Feasibility Expert opinion
Treatment Recommendations What is the treatment? Benefits of treatment Who is it for? Dosage Group Self administered
Outcome Measures Outcomes categorized for Impairment Activity Participation Quality of life Outcome measures recommendations based upon ones used in literature/research
Inclusions & Exclusions
References Provides clinicians with list of references for each intervention for further detailed information
Filters Filters can be added to the prognostic indicators to assist in selection of interventions. Based upon how the intervention will be delivered Group Self administered Based upon impairments such as Inattention/neglect Apraxia Cognitive Issues Significant language impairment
Shoulder Pain
Clinician s Perspective QUICK REFERENCE TIME SAVER TEACHING TOOL PATIENT/FAMILY EDUCATION DOCUMENTATION AND GOAL SETTING
Questions?
References http://viatherapy.org/ Best practice for arm recovery post stroke: an international application. Physiotherapy. 2016 Mar;102(1):1-4. Prediction of recovery of motor function after stroke. Lancet Neurol 2010; Dec;9(12):1228-32. Understanding pattern of functional recovery after stroke. Stroke. 2010;41:745-50 What Is the Evidence for Physical Therapy Post stroke? A Systematic Review and Meta -Analysis. PLoS ONE 9(2)