Table 1 Experimental intervention as per the type of sensory impairment and motor recovery stage of the hand
Sensory Impairment | Level of therapy | Motor Recovery Stage | |||
|---|---|---|---|---|---|
BRS-H 1 & 2 | BRS-H 3 | BRS-H 4 | BRS-H 5 & 6 | ||
Light touch | Level-I | MT (unilateral) – cotton / wool /soft toy | MT (bimanual) – cotton / wool /soft toy | MT (bimanual) – grasp-release, lateral prehension-release using cotton / wool /soft toy | MT (bimanual) – grasp and release, prehensile activity using cotton / wool /soft toy |
Level-II | Bilateral and unilateral perception of cotton / wool / soft toy (therapist applied) | Bilateral and unilateral perception of cotton / wool / soft toy | Bilateral and unilateral perception of cotton / wool / soft toy by grasp-release, lateral prehension and release | Bilateral and unilateral perception of cotton / wool / soft toy by prehensile activity | |
Level-III | Bilateral movements of upper limb joints holding cotton /wool /soft toy | Unilateral movements of upper limb joints holding cotton /wool /soft toy | Unilateral perception of cotton / wool / soft toy by grasp-release, lateral prehension and release | Unilateral movement (constraining the non-paretic limb) for prehensile activity using cotton / wool /soft toy | |
Level-IV | Bilateral functional tasks – lifting cloth / pillow | Unilateral functional tasks – lifting cloth / pillow | Unilateral functional tasks – grasp-release, lateral prehension and release of cloth / pillow | Unilateral functional tasks (constraining the non-paretic limb) – grasp-release, lateral prehension and release of cloth / pillow | |
Pressure | Level-I | MT (unilateral) - clay (graded resistance) activity, ball squeezing | MT (bimanual) - clay (graded resistance) activity, ball squeezing | MT (bimanual) – grasp-release, lateral prehension and release of - clay (graded resistance) activity, ball | MT (bimanual) – pinching clay (graded resistance) activity |
Level-II | Bilateral and unilateral perception of clay (graded resistance) activity, ball squeezing (therapist applied) | Bilateral and unilateral perception of clay (graded resistance) activity, ball squeezing | Bilateral and unilateral perception of– grasp-release, lateral prehension and release - clay (graded resistance) activity, ball | Bilateral and unilateral perception of pinching clay (graded resistance) activity | |
Level-III | Bilateral movements of upper limb joints holding high- density foam cylindrical blocks | Unilateral movements of upper limb joints holding high- density foam cylindrical blocks | Unilateral movements of grasp-release, lateral prehension and release - high- density foam blocks | Unilateral movement (constraining the non-paretic limb) for pinching clay (graded resistance) activity | |
Level-IV | Bilateral movements of upper limb joints holding textured water glass/bottle | Uilateral movements of upper limb joints holding textured water glass/bottle | Unilateral movements of grasp-release, lateral prehension and release - textured water glass/bottle, key, cardboard | Unilateral functional tasks (constraining the non-paretic limb) – pinching and picking grains/coins | |
Pin prick | Level-I | MT (unilateral)– Scrubber / Steel wool/Velcro (rough) | MT (bimanual) – Scrubber / Steel wool/Velcro (rough) | MT (bimanual)– grasp-release, lateral prehension and release of Scrubber / Steel wool/Velcro (rough) | MT (bimanual)– prehensile activity using Scrubber / Steel wool/Velcro (rough |
Level-II | Bilateral and unilateral perception of Scrubber / Steel wool/Velcro (therapist applied) | Bilateral and unilateral perception of Scrubber / Steel wool/Velcro | Unilateral perception of grasp-release, lateral prehension and release of Scrubber / Steel wool/Velcro | Unilateral perception of prehensile activity of items textured with Scrubber / Steel wool/Velcro | |
Level-III | Bilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) cylindrical blocks | Unilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) cylindrical blocks | Unilateral movements of upper limb joints comprises grasp-release, lateral prehension and release of textured (Scrubber / Steel wool/Velcro) blocks | Unilateral movements (constraining the non-paretic limb) of upper limb joints comprises prehensile activity of items textured with Scrubber / Steel wool/Velcro | |
Level-IV | Bilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) water glass/bottle | Unilateral movements of upper limb joints holding textured (Scrubber / Steel wool/Velcro) water glass/bottle | Unilateral movements of grasp-release, lateral prehension and release of textured (Scrubber / Steel wool/Velcro) daily use items | Unilateral movement (constraining the non-paretic limb) of prehensile activity of daily use items textured with Scrubber / Steel wool/Velcro | |
Sharp-blunt discrimination | Level-I | MT (unilateral)- Dellon’s Discriminator disc (therapist applied) | MT (bimanual) - Dellon’s Discriminator disc (therapist applied) | MT (bimanual) – sharp and blunt textured items alternatively | MT (bimanual) – prehensile activity of sharp and blunt textured items |
Level-II | Bilateral and unilateral sharp and blunt discrimination (therapist applied) | Bilateral and unilateral sharp and blunt discrimination | Unilateral sharp and blunt discrimination | Unilateral prehensile activity of sharp and blunt textured items | |
Level-III | Bilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) cylindrical blocks | Unilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) cylindrical blocks | Unilateral movements of upper limb joints comprises sharp and blunt textured items along with manipulation; grasp-release, lateral prehension and release | Unilateral movements (constraining the non-paretic limb) of upper limb joints comprises prehensile activity of sharp and blunt textured items | |
Level-IV | Bilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) water glass/bottle | Unilateral movements of upper limb joints holding dual spikes/textured (blunt and sharp) water glass/bottle | Unilateral sharp and blunt textured daily use items manipulation; grasp-release, lateral prehension and release | Unilateral movements (constraining the non-paretic limb) of upper limb joints comprises prehensile activity of sharp and blunt textured daily use items | |
Proprioception | Level-I | MT (unilateral)- task-based movements of shoulder, elbow, wrist; Movement of non-paretic upper limb and perceiving the limb position and movement with vision occluded. | MT (bimanual) - task-based movements of shoulder, elbow, wrist; Movement of the upper limbs and perceiving the limb position and movement with vision occluded. | MT (bimanual) - task-based movements of shoulder, elbow, wrist, hand, thumb and fingers; Movement of the joints and perceiving the limb position and movement with vision occluded. | MT (bimanual) - task-based movements of all upper limb especially fingers; Movement of the joints and perceiving the finger position and movement with vision occluded. |
Level-II | Bilateral movements of shoulder, elbow, wrist with visual feedback followed by vision occluded | Unilateral movements of shoulder, elbow, wrist with visual feedback followed by vision occluded | Unilateral movements of shoulder, elbow, wrist hand, thumb and fingers; with visual feedback followed by vision occluded | Unilateral movements (constraining the non-paretic limb) of all upper limb especially fingers; with visual feedback followed by vision occluded | |
Level-III | Bilateral activity-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded | Unilateral activity-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded | Unilateral activity-based movements of shoulder, elbow, wrist hand, thumb and fingers; with visual feedback followed by vision occluded | Unilateral activity based movements (constraining the non-paretic limb) of all upper limb especially fingers; with visual feedback followed by vision occluded | |
Level-IV | Bilateral functional task-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded | Unilateral functional task-based movements of shoulder, elbow, wrist with visual feedback followed by vision occluded | Unilateral functional task-based movements of shoulder, elbow, wrist, hand, thumb and fingers; with visual feedback followed by vision occluded | Unilateral functional task-based movements (constraining the non-paretic limb) of all upper limb especially fingers; with visual feedback followed by vision occluded | |
Stereognosis | Level-I | MT (unilateral) – 10 objects | MT (bimanual) – 10 objects; similar objects on both the sides. | MT (bimanual) – 10 objects; similar objects on both the sides; manipulation of objects by grasp-release, lateral prehension and release | MT (bimanual) – 10 small objects such as beads; similar objects on both the sides along with the manipulation of objects |
Level-II | Perceiving the 10 objects bilaterally with visual feedback followed by vision occluded | Perceiving the 10 objects unilaterally with visual feedback followed by vision occluded | Perceiving the 10 objects unilaterally with visual feedback followed by vision occluded; manipulation of objects by grasp-release, lateral prehension and release | Perceiving the 10 small objects unilaterally with visual feedback followed by vision occluded | |
Level-III | Bilateral manipulation (reaching, lifting, placing) of 10 objects with visual feedback followed by vision occluded | Unilateral manipulation (reaching, lifting, placing) of 10 objects with visual feedback followed by vision occluded | Unilateral manipulation (reaching, lifting, placing, grasp-release, lateral prehension and release) of 10 objects (mixed together) with visual feedback followed by vision occluded | Unilateral manipulation (reaching, lifting, placing, in-hand manipulation) of 10 small objects (mixed together) with visual feedback followed by vision occluded | |
Level-IV | Bilateral manipulation (reaching, lifting, placing) of variety of daily use items with visual feedback followed by vision occluded | Unilateral manipulation (reaching, lifting, placing) of variety of daily use items with visual feedback followed by vision occluded | Unilateral manipulation (reaching, lifting, placing, grasp-release, lateral prehension and release) of 10 daily use items (mixed together) with visual feedback followed by vision occluded | Unilateral manipulation (reaching, lifting, placing, in-hand manipulation) of 10 small daily use objects (mixed together) with visual feedback followed by vision occluded | |