Retraining coordination of reach-to-grasp
SO… HOW CAN WE RETRAIN the coordination between reach (hand transport) and grasp (hand opening) in people with stroke/brain injury?
Here’s some tips…
1.?????Encourage the person to open the hand right at the beginning of the movement, rather than delay hand opening
Why? Because usually hand transport and hand opening begin around the same time (within about 60 ms of each other)
2.?????Once you have practised a component of reach-to-grasp, then straight away get the person practising the whole movement if they can, or some kind of combined transport/grasp movement if they can’t do the whole movement. The combined movement could be some elbow flexion/extension with a bit of hand opening/closing.
Why? Because practising a single component, such as elbow extension for example, won’t activate all the brain areas/pathways involved in the whole reach-to-grasp movement, but only those parts involved in elbow extension. So the person doesn’t have an opportunity to practice activating all of the needed neural pathways at the same time. For example, the parietal lobe has areas involved in temporal coordination of reach-to-grasp, but those areas would not be activated in simple elbow extension.
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3.?????Practising the whole movement also allows the brain the opportunity to get the correlation between kinematic events happening again. For example, peak hand opening and peak deceleration of the hand on the way to an object are found to be significantly correlated in studies with healthy subjects (occurs in around 70% of reach-to-grasp movements), but less so in people with stroke.
So with whole/combined movement practice we can help re-establish the motor schema for reach-to-grasp, which relies on coordination through timing.
In these ways you are giving the CNS an opportunity to re-establish neural pathways for motor control of reach to grasp ??