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

Year

Credit points

Campus offering

Prerequisites

OTHY612 Enhancing Clinical Reasoning in Rehabilitation for Occupational Therapists AND HLSC630 Holistic Rehabilitation and Restoration 1

Teaching organisation

Unit rationale, description and aim

In this unit students will be provided 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.

Content

Topics will include:

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 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 students 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 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 pracitce 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 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 Master’s program. 

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.