Occupational Therapy Innovations for the Neuro Patient

1. Occupational Therapy Innovations for the Neuro Patient Saebo Stretch, Flex and Reach Presented by Sarah Sanderman, MOTR and Karen Hookstadt, OTR

2. UE Concerns Post Stroke • Only 50% of survivors are likely to regain some functional use of an UE • Spasticity, primarily higher distally in an UE • Luxation, instability of joints • Atrophy • Muscle imbalance • Contracture

3. Saebo StretchSaebo Flex / Reach • Saebo Stretch is a dynamic resting hand splint; a flexible splint with progressive inserts to increase force application based upon the presence of tone (Saebo) • Saebo Flex and Reach allow for integration of the arm and hand during functional activities • Promotes activities that require new learning; challenging and novel activities that promote brain rewiring • Addresess spasticity; defined as a velocity-dependent hyper-excitability of the muscle stretch reflex resulting in increased muscle tone (Saebo) • Trains a client in compensatory movement which speeds recovery • Allows a client to “turn off” their tone (flexors)

4. Saebo Stretch • Dynamic hand piece • Strapping system that accommodates finger alignment and joints • Hand is not functional while in this splint. • Allows for movement with reactions and exertion.

5. Saebo Stretch • A flexible splint with progressive inserts based on the client’s tone • Soft tissue shortening can start within 7 daysof incident • Saebo Stretch offers “low load, long duration” of impact – 6 to 8 hours per day • Typical result is a 5 – 7% increase in ROM

6. Appropriate ClientsSaebo Stretch • Client must show: • 35° active wrist extension with MCPs, PIPs and DIPs in neutral • Should be able to tolerate splint for 6-8 hours • Pediatric sizes available

7. Appropriate Clients Saebo Flex / Reach • Client must show a minimum of: • 15° active shoulder elevation • 15° active elbow flexion • ¼ range of active finger flexion • Full passive finger IP/MCP extension with the wrist passively extended to 15° (at minimum) and 35° optimally *If the client is an inpatient, there are no active shoulder or elbow movement requirements.

8. Customized FittingSaebo Flex / Reach • Components include customized forearm shell, dorsal plate, digicaps and standard springs, mounts, bead lines and lead lines. • With the Saebo Flex, the client has free use of the elbow, the Saebo Reach assists with elbow extension.

9. Prescribed ActivitiesRepetition is the key! • Clients should wear the device for two sessions totaling 45 minutes each per day • Prescribed activities with equipment include: • Crates and balls • Use of a height adjustable target (HAT) • Use of cylinders, PVC trees and pegs Functional activities include loading a dishwasher, placing items in a fridge, sweeping with a whisk broom, answering a phone, folding laundry.

10. Video • Saebo Flex in use with a client.

11. Availability • Insurance varies and may cover some of the cost of a device. • Currently Medicare covers the Saebo Reach only • To pay out of pocket for a device, the Saebo Reach is approximately $2000, Saebo Flex $1500, Saebo Stretch $300.

12. Take Away Gems • These devices, although potentially expensive, have been proven to increase the function in a hand exhibiting a neurologically based deficit. • The Saebo Stretch is worn for long periods of time, during times of rest; the Saebo Flex and Reach are worn only during functional training with the device. • Devices may be trialed before purchase, contact an OT to recommend clients who may benefit from aggressive UE training after a neurological incident.

13. Questions?References • Improving Upper Extremity Motor Recovery Following Neurological Injury, Saebo Course Manual 2012 • Photos courtesy of Google Images, 2012 • Video courtesy of Spalding Rehabilitation Hospital, 2012.