Clinicians can use this helpful guide when treating patients with higher levels of function.
Once the client is displaying fair muscle strength (3/5) or greater in the shoulder and elbow, begin to apply resistance (manually, T-Band, etc.). As the client performs isotonic shoulder elevation/extension or elbow flexion/extension, provide manual resistance to increase recruitment. For a home program, teach the client to apply T-band to the wrist mount of the SaeboFlex to increase resistance.
When developing an exercise plan, emphasize multi-directional movements to further challenge the client (i.e., ER followed by horizontal adduction and elbow extension).
When appropriate, work on reaction time. For instance, have the client positioned at one end of the table and the therapist at the other end. Roll the foam balls down the table, one at a time and have the client grasp and release the ball into a crate on the floor. To advance, increase the speed and frequency of balls being delivered.
As the client decreases his or her tone and learns how to effectively deactivate the flexors, it is time to decrease the spring strength for the fingers and thumb. The weaker the spring, the more challenging it is for the client to deactivate the flexors and release the ball. Gradually progress the client to the weakest spring (i.e., silver). If he or she can release with the silver spring, consider lengthening the bead line to further challenge the client. One additional tip is to switch from a spring to a rubber band to make it further challenging. Please remember to do a bead count. If you change the bead length during treatment at your clinic, you will need to re-set the beads back to the original length for the HEP.
Releasing the ball (deactivating the flexors) during a table-top activity is much easier than during a high-level shoulder/elbow activity (increase proximal exertion). After you successfully switch to a weaker spring, progress the client from low-level proximal drills to high-level drills. It will increase the challenge for the client to deactivate the flexors.
In addition to decreasing the spring strength for tone management, consider switching to a stronger spring on certain days to focus on improving finger and thumb strength.
As clients progress, consider the SaeboGlove as an add-on, or replacement, to the SaeboFlex.