Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS): A practical and evidence-based framework for clinical rehabilitation management

Abstract

The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF) and arm-hand skill performance (ASHP) in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS) is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARAS is based on four constructs: (a) stratification according to the severity of arm-hand impairment (using the Utrecht Arm/Hand-Test [UAT]), (b) the individual's rehabilitation goals and concomitant potential rehabilitation outcomes, (c) principles of self-efficacy, and (d) possibilities to systematically incorporate (new) technology and new evidence-based training elements swiftly. The framework encompasses three programs aimed at treating either the severely (UAT 0-1), moderately (UAT 2-3), or mildly (UAT 4-7) impaired arm-hand. Program themes are: taking care of the limb and prevention of complications (Program 1), task-oriented gross motor grip performance (Program 2), and functional AHSP training (Program 3). Each program is preceded and followed by an assessment. Training modularity facilitates rapid interchange/adaptation of sub-elements. Proof-of-principle in clinical rehabilitation has been established. The CARAS facilitates rapid structured design and provision of stateof-the-art AHF and ASHP treatment in stroke patients.

Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study

“…After having been admitted to the Concise Arm and hand Rehabilitation Approach in Stroke (CARAS) [14], all participants were coached in arm-hand training, how to cope with their affected hand and to (re-)explore how to use their arm-hand in daily life activities or, in case dexterity was lacking completely, how to learn to keep and maintain the affected arm-hand in an optimal condition. CARAS targets a broad spectrum of arm-hand impairments typically seen in a heterogeneous stroke rehabilitation population.…”

“…the standard rehabilitation approach for patients who cope with arm-hand deficits due to stroke occurrence. A more detailed description of the therapy content and the basic assumptions of CARAS have been presented elsewhere by Franck and co-workers [14].…”

“…The course of AHF and AHSP of a broad range of sub-acute stroke patients during and after rehabilitation involving a well-defined arm-hand rehabilitation program (i.e. CARAS) [14] has been reported by Franck et al [15]. The present paper provides data concerning actual arm-hand use in the same study population, and focuses on two objectives.…”

“…Numerous interventions and arm-hand rehabilitation programs have been developed in order to resolve arm-hand impairments in stroke patients [6, 13]. In the Netherlands, a number of stroke units in rehabilitation centres implemented a well-described ‘therapy-as-usual’ arm-hand rehabilitation program, called CARAS (acronym for: Concise Arm and hand Rehabilitation Approach in Stroke)[14], serving a broad spectrum of stroke patients across the full stroke severity range of arm-hand impairments. The arm-hand rehabilitation program has been developed to guide clinicians in systematically designing arm-hand rehabilitation, tailored towards the individual patient’s characteristics while keeping control over the overall heterogeneity of this population typically seen in stroke rehabilitation centres.…”

Classifying Imaginary Hand Movement through Electroencephalograph Signal for Neuro-rehabilitation

“…Stroke is a brain functional disease in the form of impaired neural function locally or globally and appears suddenly, progressively, and quickly [1]. Strokes may cause partial paralysis of the body, and after a healing period or post-stroke period, about 50 % of stroke survivors have unilateral motor deficits that lead to decreased chronic upper extremity function [2]. This motor deficit affects hand or arm function of the post-stroke patients' body in everyday life even several years after the stroke.…”