Functional Hand use in Hemiplegia: course feedback

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February 28, 2020 by permanentred

RCOT London Region gave a Life-Long-Learning Grant to one of our members to help with funding for a course. Here is his report from the course. If you would like more information about Lifelong learning Grants, you can find information and an application form on our website.


In May I was privileged to attend a two day course: ‘Functional Hand use in Hemiplegia’ by Dr Brian Hoare from CPTeaching. Thank you to RCOT London region for partial sponsorship of the course fees. The course, by leading clinician and researcher from Australia focused on evidence based practice to support functional hand use for children with hemiplegia. As an Occupational Therapist working with children and young people in a community setting in London it was enormously helpful in guiding our work with children with hemiplegia. We are in the process of establishing a clear pathway to provide evidence based intervention for these children, and attending the course has supported me to understand this area more and contribute to service development.

The course covered assessment, intervention and outcome measures for this population. There was a strong emphasis on interventions, which included constraint induced movement therapy, bimanual therapy and goal directed training. Examples and videos were used for these intervention types to help participants get a clear sense of what they are and how they are carried out. Brian used audience participation and case studies to challenge our thinking and help us decide when to choose particular types of intervention. This aided my clinical reasoning since returning to work after the course in considering which children are most appropriate for which type of therapy.

Following evidence based practice in this area was emphasised strongly and each of us was challenged to ensure our practice is following latest research. There were clear messages around shifting away from fixing body structure and function impairments (ICF levels) and focusing practice on supporting children at an activity and participation level. This occupation focus is important, as there can be a tendency to focus only on muscle tone and strength and lose sight of what is important, supporting children and young people to take part in the daily activities or occupations that are important and essential for them. A further area emphasised on the course was consideration of the dosage and intensity of therapy needed to achieve goals. Brian challenged conventional therapy models which may involve low intensity therapy over a long period of time, instead presenting strong evidence that shorter intensive blocks of therapy can achieve better results for children and young people. The model he uses in his practice and his research involves 8 week blocks of weekly therapy with clearly prescribed home programmes to achieve a high dosage.

I would highly recommend this course for occupational therapists working with children and young people with neurological conditions and hemiplegia, for its strong emphasis on evidence based practice and for how it supports attendees to understand and utilise current research. The learning is directly applicable to our work, and will support and guide therapists to develop confidence in service design and delivery for this population. Thank you again to the London Region for supporting.

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