What do the levels of evidence mean (A, B, C, GPP)?
A - Can be trusted to guide practice
B- Can be trusted to guide practice in most situations
C- Some support for recommendation, but take care in application
GPP - Best practice based on clinical expertise and expert opinion
What does the NSF recommend for spasticity? (3 points, Week 2, p. 5)
- For mild to moderate spasticity, just follow regular, early, comprehensive therapy program - GPP
- For moderate to severe, Botox A can be trialled along with rehabilation which sets clear goals - B.
- For moderate to severe, ES and biofeedback - B.
NSF Guidelines for strength (3 points, week 2, p. 8)
–Progressive resistance exercises - B
-Electrical stimulation - B
Electromyographic biofeedback + conventional therapy - C
NSF guidelines for co-ordination training (1 point, week 2, p. 17)
-Grade A or B recommendation for task specific training
NSF Guidelines for sensation training (2 points, week 2, p. 18)
- Sensory specific training for sensory loss - C
- Sensory training designed to facilitate transfer - C
NSF Guidelines for fitness training (2 points, week 3, p. 2)
- Rehab should include interventions to increase cardiovascular fitness, once there is sufficient strength in the LL - A
- Patients should undertake regular, ongoing fitness training - GPP
NSF Guidelines for contracture (4 points, week 3, p. 3)
- Conventional therapy (a.k.a. early, tailored interventions) - GPP
- Routine use of splints, and prolonged positioning of muscles in lengthened position is NOT recommended - B
- Overhead pulleys should not be used routinely for shoulder ROM - C
- Serial casting can be used to reduce severe, persistent contracture when conventional therapy has failed - GPP
NSF guidelines for people who are immobile, to PREVENT swelling (3 points, week 3. p. 6)
- Dynamic pressure garments - C
- ES - C
- Elevation of the limb when resting - GPP
NSF guidelines for people who are immobile, to REDUCE swelling in the hand and foot (4 points, week 3. p. 6)
- Dynamic pressure garments - C
- ES - C
- Continuous passive motion with elevation - D
- Elevation of the limb when resting - GPP
NSF guidelines for shoulder subluxation prevention (4 points, week 3, p. 7)
For those with severe weakness who are AT RISK:
- ES - B
- firm support devices - GPP
- Education and training for the patient, family, carers and staff on how to handle the limb - GPP
For those who HAVE DEVELOPED a subluxed shoulder:
-Firm support devices to prevent further subluxation - GPP
NSF Guidelines for shoulder pain prevention (5 points, week 3, p. 9)
For people with severe weakness who are AT RISK of developing shoulder pain:
- Shoulder strapping - B
- Education of staff, carers etc. - GPP
For people who DEVELOP shoulder pain:
-Evidence based interventions for acute shoulder pain - GPP
NOT RECOMMENDED as routine interventions:
- Corticosteriod injections - C
- Ultrasound - C
What is the NSF evidence for STS training? (1 point, week 4, p. 7)
Practice standing up - A
What is the NSF evidence for sitting training? (1 point, week 4, p. 2)
Practice reaching beyond arm’s length (in sitting, with supervision). - B
What is the NSF evidence for training standing (still, not STS). (1 point, week 4, p.5)
Task specific standing training with feedback - B
