10 things I wish Id known about stroke and upper limb retr

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Title: 10 things I wish I'd known as a new graduate about stroke and upper limb retraining

Description: This 20-minute lecture was delivered by Dr Annie McCluskey as an invited presentation at the Occupational Therapy Australia 28th national conference in Sydney, 10th July 2019.

Introduction: Occupational therapy graduates are often uncertain about their role in stroke rehabilitation, particularly how to improve upper limb function. Historically this lack of confidence has been due to limited content in undergraduate curricula, particularly in diploma-level courses. The apprenticeship model of practice also affected therapists’ confidence, where graduates learned by watching more experienced therapists. Those therapists may (or may not) have had the necessary skills and knowledge. When I graduated, I was shown and practiced facilitation techniques and compensatory strategies, but had no science to inform my practice, and no outcome measures were used. Continuing education about upper limb retraining was rare. I mostly learned from books and my Australian physiotherapy colleagues. Now, universities with an occupation-based curriculum teach intervention at the level of activity and participation, but may not teach body-function or impairment -level intervention. Graduates may be unsure if or how they should train upper limb impairments, yet rehabilitation teams and stroke survivors expect occupational therapists to assume this role.

Objectives: To highlight skills and knowledge needed by occupational therapists in 2019 and beyond, to retrain upper limb function and improve occupational performance after stroke.

Approach: Knowledge and skills will be presented related to motor control (anatomy, biomechanics and movement science; video, task and activity analysis), strength and coordination training, motor learning (instructions, goals, feedback, active participation) and evidence-based practice (critical appraisal skills, decision-making, outcome measurement).

Practice implications: This presentation is aimed at students, novice and experienced clinicians and academics responsible for shaping university rehabilitation curricula. Audience members can identify knowledge and skill gaps requiring continuing education.

Conclusions: Occupational therapy clinicians need strong foundation skills in motor control and motor learning to work in stroke rehabilitation, to think like a movement scientist, an occupational scientist and an evidence-based practitioner.

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