Therapeutic interventions to improve upper extremity recovery and function

Many of the techniques currently in use in therapy clinics incorporate some but not all of the principles of practice that facilitate retention of motor skills that can be used to perform a variety of skilled actions. Despite the lack of control groups, small sample sizes, limited measures of functional use of the affected UE, and lack of measures of long-term retention, it appears that most techniques in use can promote positive changes in motor skills poststroke at the neuromuscular or movement levels, at least for some individuals. Across the majority of the studies, those who benefitted the most were typically those who entered the intervention with better motor skills (but see the work of Feys and colleagues). Some approaches, such as CI therapy, currently are effective only in those with distal voluntary movement. Interestingly, it is often these individuals - those most likely to benefit from motor rehabilitation - who receive the least amount of rehabilitative services. The common denominator of all of these approaches is that they recommend extensive practice using the affected UE. In particular, motor-skill gains at the action level may require extensive practice in everyday tasks. Based on the current literature, it appears that the technique used may be less important than creating the opportunity for individuals with stroke to practice using the affected UE as they would in the course of their daily lives.