PREP2 in Clinical Practice

 

 

Using PREP2 to focus upper limb rehabilitation

PREP2 predictions can be used to focus upper limb rehabilitation.
A one-page summary of PREP2 in clinical practice can be downloaded, shared and cited here.

PREP2 information to give to patients, their families, and clinicians can be found here.
Information and strategies to assist with delivering PREP2 predictions to patients and families can be found here.

Excellent
The patient is most likely to have an excellent upper limb outcome within the next 3 months. They can expect to be using their upper limb fairly normally for most activities of daily living. As these patients are often mildly affected, and soon discharged from hospital, they can be prescribed a self-directed hand and arm exercise programme to help them reach their potential. The rehabilitation focus is to Promote Normal function.

Good
The patient is most likely to have a good upper limb outcome within the next 3 months. They can expect to be using their hand for most activities of daily living, though function may remain affected by slowness, weakness or clumsiness. Upper limb rehabilitation can focus on improving function by increasing strength, coordination and fine control. For patients who have a Day 3 SAFE score less than 5 and are found to be MEP+, rehabilitation may need to initially focus on assisting the return of voluntary muscle
activity and then be progressed. Repetitive practice of movement and everyday tasks should help. The affected hand and arm should be used for safe daily activities, and compensation with the stronger arm should be minimised. The rehabilitation focus is to Promote Function.

Limited
The patient is most likely to have a limited upper limb outcome within the next 3 months. They can expect to regain some movement and possibly grasp function,
though recovery of dextrous hand function is unlikely. Upper limb rehabilitation can focus on improving strength, active range of motion, and joint flexibility, and adapting daily activities to incorporate both upper limbs when necessary to achieve a task. The rehabilitation focus is to Promote Movement.

Poor
The patient is most likely to have a poor upper limb outcome within the next 3 months. They may regain some movement, but are unlikely to recover useful upper limb function. They may be able to use their weaker hand to stabilise objects in bimanual tasks. Upper limb rehabilitation can focus on prevention of secondary complications, such as pain, spasticity, and shoulder instability, and helping the patient   to do everyday activities with the stronger arm and hand. The rehabilitation focus is to Promote Compensation.