The treatment of patients who suffer from non-congenital brain problems due to a stroke or another trauma, who experience problems in performing skills because of a paretic arm-hand, is a great challenge for (rehabilitation) physicians, physical therapists, and occupational therapists. Guiding these patients in the most efficient way during their rehabilitation process is often influenced by various factors such as the heterogeneity of the target group, the continuous developments in neurological knowledge, the application of technology and the need to stay focused on client-centered practice.
The aim of the Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS) is to optimally guide and train patients in post-stroke phase who experience problems in daily activities as a result of an affected arm-hand.
CARAS is module based, incorporating high intensity task oriented training combined with principles of self-efficacy, and is capable to train multiple stroke patients at the same time. Training modularity facilitates rapid interchange/adaptation of sub-elements.
CARAS is based on four constructs. First, CARAS consists of group treatments, equipped for three different groups: people with mild, moderate or severe arm-hand problems, stratified according to the severity of arm–hand impairment (using the Utrechtse-Arm-Test (UAT). Second, the individual’s rehabilitation goals and concomitant potential rehabilitation outcomes are developed. In the mild and moderate groups, the training is aimed at arm-hand skill performance. For patients with a severely affected arm-hand, the scope is learning these patients to cope with their non-functional arm-hand. Third, principles of self-efficacy is applied. Fourth, the program is designed to systematically incorporate (new) technological developments and new evidence-based training elements as they become available. CARAS facilitates rapid structured design and provision of state-of-the-art arm and hand treatment in stroke patients.
Proof-of-principle for CARAS in clinical rehabilitation has been established scientifically. CARAS is implemented in Adelante rehabilitation centre and multiple other rehabilitation centres in the Netherlands. Content and Results of CARAS are available in the peer-reviewed journal publications as listed in literature references.