Page 122 - Hospital Authority Convention 2017

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2017

F1.4 Better Manage Growing Service Demands 10:45 Room 421

Stratified Upper Limb Training Programme for Stroke Patients in Rehabilitation Stroke Unit in Occupational
Therapy Department of Tuen Mun Hospital
Lam CM, Cheung WL, Cheung TY, Poon HK
Occupational Therapy Department, Tuen Mun Hospital, Hong Kong

Introduction
Every year, stroke affects millions of people worldwide, leaving survivors with different severities of disabilities affecting
their daily activities (World Heart Federation). Upper limb function training is one of the key interventions of occupational
therapy in stroke rehabilitation. To address the high volume of stroke patients in need of rehabilitation in Tuen Mun Hospital,
occupational therapists introduced stratified upper limb training programmes to remove constraints of limited inpatient
rehabilitation training capacity.

Objectives
To stratify training activities according to the severity of upper extremity impairment of stroke clients in the Rehabilitation
Stroke Unit.

Methodology
Tuesday, 16 May The Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK) is adopted as the stratification
Stratified Upper Limb Training Programme for stroke patients:

tool. It is a standardised upper limb assessment of stroke patient in Hospital Authority settings. The assessment includes
seven functional levels of upper limb of stroke patients. The programme will stratify clients’ upper extremity impairment into
mild, moderate and severe groups. Treatment components and treatment intensity are allocated according to the stratification
level.
Level 1 to level 2: For clients with severe motor impairment of upper extremity and functional deficits, individual bedside
activities of daily living training will be implemented in wards. Emphasis will be on proper position, support of upper limb and
weight bearing activities during activities of daily living training and seating system prescription.
Level 3 to Level 4: Clients with moderate impairments who also demonstrate high motivation and active participation in
training, repetitive and high intensity training programme will be provided in integrated rehabilitation area. Besides individual
training time by occupational therapist, patient will also attend group training programme which includes robotic-assisted
training, virtual reality, Modified Constraint Induced Movement Therapy and conventional training. The use of robotic
technology in guiding highly specific training regimes might allow a sufficient number of repetitions to be delivered in a
motivating environment.
Level 5 to level 7: Clients with mild impairments will also receive group activities training which emphasises on hand functional
training with virtual reality for fine motor training and object manipulation.
Results
Stratified upper limb training programme can triage patients for different levels of training programmes according to upper
extremity functions. Through this programme, stroke patients are able to receive daily intervention, ranging from individual
therapy to group based training, from basic positioning/facilitation to advanced technology such as virtual reality and
robot-assisted training. Through empowerment and designation of training tasks, assistants are able to focus and develop
operation skills on advanced technology.

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