Assessment and Treatment of the Hemiplegic UE

Question 1

At 6 months post stroke, ___ of patients with stroke are…

Answer 1

65% are unable to incorporate the impaired UE into daily activities

Question 2

___ to ___ of individuals post stroke will…

Whereas only ___ of individuals will achieve

Answer 2

65-85% will regain walking ability

5% will achieve full functional use of the arm

Question 3

What contributes to the disparity between motor recovery of the UE compared to the LE?

Answer 3

Neurophysiologic and behavioral contributions

Question 4

Arm function is controlled by…

Answer 4

Dorsolateral motor system

Question 5

Fractionated hand motion is controlled by…

Answer 5

Lateral corticospinal tract

Question 6

In Edward Taub’s study, what happened following deafferentation of a single UE?

Answer 6

No use of the surgical arm

Question 7

In Edward Taub’s study, what happened following deafferentation of bilateral UEs?

Answer 7

Normal movement of both UEs were resumed

Question 8

What did Edward Taub’s study learn about?

Answer 8

Learned non-use

Question 9

What contributes to learned non-use of the hemiplegic UE?

Answer 9

Behavioral and even the healthcare system

Question 10

The shoulder is designed for…greater than…

Answer 10

Mobility greater than stability

Question 11

Joint stability of the shoulder joint is dependent on…

Answer 11

Cocontraction

Question 12

Mobility and manipulation of the shoulder joint is dependent on…

Answer 12

Reciprocal inhibition

Question 13

How does the hemiplegic scapula tend to be positioned? What does this implicate?

Answer 13

Downwardly rotated and retracted, which decreases glenohumeral rhythm.

Question 14

Among survivors of a first MCA stroke, what percentage had complete functional recovery of the UE?

Answer 14

Only 11%

Question 15

Among survivors of a first MCA stroke, what percentage had some return of dexterity when measured at 6 months post stroke?

Answer 15

38%

Question 16

Among survivors of a first MCA stroke, what percentage failed to achieve any dexterity when measured at 6 months post stroke?

Answer 16

62%

Question 17

What are the behavioral and/or physiological findings that are predictive of poor UE motor recovery following stroke?

Answer 17

Neuropathic pain
Sensory neglect (visual or somatic)
Subcortical white matter lesions (corona radiata and internal capsule)

Question 18

In general, what is highly predictive of UE function at 6 months post stroke?

Answer 18

UE function at 4 weeks and again at 3 months

Question 19

When does most revovery of distal (reach-grasp) movements occur?

Answer 19

Within the 3 months following stroke

Question 20

Absence of measurable grip after 24 days is associated with what?

Answer 20

No useful arm movements at 3 months

Question 21

Index and middle finger active extension against gravity at 4 weeks is strongly predictive of what?

Answer 21

Grasp at 3 months

Question 22

What does it implicateIf the patient cannot perform activity with the hemiplegic UE without increased pain?

Answer 22

Consider hemiplegic shoulder pain (HSP) or central pain syndrome

Question 23

What are the things you should notice when examining the hemiplegic UE?

Answer 23

ROM, sensation, motor output, joint alignment, and postural control

Question 24

When examining the hemiplegic UE, elaborate on ROM

Answer 24

AROM/PROM: Shoulder external rotation, scapular position, glenohumeral motion

Move down the chain examining the elbow, wrist, and fingers

Question 25

When examining the hemiplegic UE, elaborate on motor output

Answer 25

Muscle tone: passive resistance to slow and fast stretch
strength via dynamometry, in the absence of significant spasticity
Muscle synergies/multijoint coordination/fractionated movement

Question 26

When examining joint alignment in the hemiplegic UE, what should you notice about the shoulders?

Answer 26

Unequal height with more affected shoulder depressed

Humeral subluxation with scapular downward rotation and lateral flexion of trunk

Question 27

When examining joint alignment in the hemiplegic UE, what should you notice about the upper extremity?

Answer 27

More affected UE typically held in a flexed, adducted position, with internal rotation and elbow flexion, forearm pronation, wrist and finger flexion.

Question 28

When examining the hemiplegic UE, elaborate on postural control

Answer 28

Recall the individual (sensory, motor, and cognitive), the task, and the environment.
Recognize how biomechanical constraints can compound impairments.
Realize that when you change the geometry of body segments, you change the capacity for movement