| Action observation |
Action observation involves the person observing the performance of a motor task (live or video), followed by a series of repeated demonstrations, the person attempts to perform the same action |
| Bilateral arm training |
Simultaneous bilateral arm training uses activities for which both arms perform identical movements at the same time. Different forms of simultaneous bilateral arm training are available |
| Biofeedback |
Biofeedback provides enhanced awareness of movement or function, with the goal of improving voluntary control of that movement or function |
| Bobath therapy |
"A problem solving approach to the assessment and treatment of individuals with disturbances of function, movement, and postural control due to a lesion of the central nervous system" |
| Brain stimulation: Transcranial magnetic stimulation (TMS) |
Thought to have an effect similar to that of TMS (above), it is applied through two surface electrodes placed on the skull |
| Complementary therapies |
Includes traditional Chinese therapies, such as acupuncture |
| Constraint-Induced Movement Therapy (CIMT) |
In CIMT, or 'forced use therapy,' the non-affected hand is placed in an arm sling or a mitt that prevents its use during fine movement; used to increase task difficulty for the affected hand in small amounts |
| Electrical stimulation |
Usually delivered with the aim of strengthening a muscle contraction or improving voluntary motor control, or both. Functional electrical stimulation (FES) involves stimulation aimed at replacing or assisting a voluntary muscle contraction during a functional task |
| Gaming |
Gaming devices (e.g. Nintendo Wii or Sony Playstation) may be used to encourage repetitive arm movements, and may motivate people to spend more time using their upper limb |
| “Hands-on” therapy (manual therapy techniques) |
Includes passive movement and joint mobilisation. The arm and hand joints are moved by a therapist providing partial or full assistance if active control is inadequate. Can be aimed at maintaining joint and soft tissue mobility |
| Mental practice |
Mental practice, sometimes called mental imagery or motor imagery, involves no actual movement. It involves mental rehearsal, which is often combined with (or followed by) physical practice; the type used most often in stroke rehabilitation involves cognitive rehearsal of specific activities by imagining task performance |
| Mirror therapy |
Based on visual stimulation; a mirror is placed in the patient's sagittal plane, thus reflecting the non-affected side as if it were the affected side, so that movements of the non-affected limb give the illusion that the affected limb is moving |
| Music therapy |
Can stimulate movement, cognition and speech, to enhance relaxation or to reduce pain. May include listening and moving to music, performing, improvising or composing music, singing or performing vocal activities |
| Orthotics |
Orthotics are external devices (similar to splints) applied to elbow, wrist and/or finger joints to optimise position, provide stability and prevent, limit or assist movement. These may be used alone or with electrical stimulation |
| Pharmacological interventions |
Generally used to reduce spasticity, including baclofen, diazepam and dantrolene. Botulinum toxin can be injected to provide a focal treatment when spasticity in a specific muscle or muscle group is the cause of problems |
| Repetitive task training |
Repetitive task training is an umbrella term for a range of interventions that involve the repeated practice of functional tasks (whole task practice when possible), combining elements of intensity of practice and functional relevance (see also 'Task-specific training,' below) |
| Robotics / electromechanical devices |
These devices can move passive limbs while providing assistance or resistance to movement of a single joint or control of intersegmental co-ordination. Devices may be used to deliver or enhance repetitive task training or task-specific training; thought to support motor learning and increase motor control and strength |
| Sensory interventions |
Strategies to enhance movement and somatosensory awareness including techniques e.g. sensory re-education, tactile kinaesthetic guiding, repetitive sensory practice or desensitisation. Sensory and positional awareness may be stimulated by passive or active-assisted movement, and stimulatory techniques such as stroking and tapping |
| Strength training |
Directed at contracting a specific muscle, or group of muscles, by using voluntary control. Movement may be assisted or resisted by a therapist or by gym equipment |
| Stretching & positioning |
Used to prevent or manage joint contractures, optimise joint position and to maintain or regain soft tissue length. There are several techniques, including manual therapy or self-stretching, and often supportive devices, splints and orthoses are involved |
| Surgical interventions |
Includes tendon surgery to relieve shoulder pain and reduce spasticity in the upper limb after stroke; not part of routine clinical practice in the UK |
| Task-specific training (functional task training) |
Involves practice of tasks relevant to daily life, including part- and whole-task practice. The 'motor learning,' 'motor relearning' or 'movement science' approach involves functional or task-specific training, often supplemented by other modalities, such as assistive technologies |
| Virtual reality |
Involves interactive simulations created with computer hardware and software to provide a simulated practice environment, as well as feedback on movement execution or goal attainment, or both. Enables engagement in activities that appears and feels similar to real-world objects and events, using devices such as a keyboard and a mouse, or through multi-modal devices such as a wired glove |
| Rehabilitation setting |
In addition to the interventions listed above, upper limb rehabilitation may be delivered in a range of different ways. For example; in-patient or out-patient rehabilitation, home-based rehabilitation, telerehabilitation or self-management |
| Combined interventions |
Single interventions, listed above, are often delivered in combination. For example; biofeedback plus electrostimulation |
