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Neurology II Test 1 CVA > CVA IV: Upper Extremity in Hemiplegia > Flashcards

CVA IV: Upper Extremity in Hemiplegia Flashcards

1
Q

An inability to fractionate appears to be from damage from what part of the brain?

A

primary cortex and it’s tracts.

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2
Q

Is the percentage of recovery for the LE and UE different or proportional

A

proportional, but the UE appears to be slower because of the more complex tasks it does.

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3
Q

What 3 things must you consider with loss of trunk control with UE dysfunction/pain?

A
  1. Whether pt utilizes feedforward postural control.
  2. How use of the UE within the environment affects trunk function.
  3. Biomechanical considerations (alignment of trunk & scapula).
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4
Q

What is the primary type of postural control that we use, feedback or feedforward (therefore affecting type of treatment that we use)?

A

feedforward

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5
Q

What are 4 common problems of trunk alignment?

A
  1. Posterior pelvic tilt
  2. Kyphosis (goes along with #1)
  3. Lateral flexion
  4. Rotation of ribcage
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6
Q

What 4 impairments could cause posterior pelvic tilt?

A
  1. Weak trunk extensors
  2. Weak abdominals
  3. Loss of lumbar/thoracic spine ROM into extension.
  4. Short hamstrings
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7
Q

What 2 additional impairments (besides posterior pelvic tilt) could cause kyphosis?

A
  1. Compression fractures of the spine

2. Scoliosis

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8
Q

What 3 impairments could cause lateral flexion trunk alignment?

A
  1. Overactivity (spasticity) on one side.
  2. Paresis that allows spine to collapse toward one side.
  3. Perceptual (midline) issues.
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9
Q

What 2 impairments could cause rotation of the ribcage?

A
  1. Paresis of the obliques

2. Overactivity of the obliques.

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10
Q

Function between trunk and scapula is dependent on which muscles?

A

scapula stabilizers (traps, serratus ant. rhomboids, pec minor, levator scap)

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11
Q

Function between the humerus and trunk dependent on which muscles?

A

prime movers (pec major, lats, delts, triceps, biceps)

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12
Q

Function between scapula and humerus dependent on which muscles?

A

rotator cuff (you know these)

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13
Q

What joint or joints connect the UE to the axial skeleton?

A

SC joint only.

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14
Q

The spine of the scapula is normally at what level of the spine? The inferior angle?

A

T2-T3, T7

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15
Q

The normal distance of the medial border of spine of the scapula to the spine? from the inferior angle?

A

3-4 fingerbreadths. 4-5 FBs.

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16
Q

The glenoid fossa points in what direction at how many degrees normally?

A

forward and upwards 30-40 degrees.

17
Q

A scapula that has undergone inferior rotation may result in what 5 impairments?

A
  1. Inferior subluxation?
  2. Abnormal scapulohumeral rhythm.
  3. Impingement and pain.
  4. Possible Shoulder-Hand Syndrome (CRPS)
  5. Decreased function of UE
18
Q

What are three possible causes of inferior rotation of the scapula?

A
  1. Weakness of scapular stabilizers (serratus ant. and lower traps especially).
  2. Muscular imbalance of scapular stabilizers (spasticity of rhomboids, levator scap, lats).
  3. Trunk malalignment (leaning to side).
  4. Weight of flaccid arm.
19
Q

What 3 conditions are needed to maintain static stability of the scapula to prevent shoulder subluxation?

A
  1. Tight joint capsule
  2. Supraspinatous activity
  3. Upward/outward facing of glenoid fossa
20
Q

What is the most common type of subluxation and when does it occur?

A

inferior, in the flaccid stage

21
Q

What are 2 possible causes of inferior subluxation?

A
  1. Upright position with unsupported flaccid arm.

2. Pulling on the arm.

22
Q

What type of subluxation is high tone? What type of subluxation is low tone?

A

High tone: Anterior, superior. Low tone: inferior

23
Q

What type of subluxation is correlated with pain? without pain (initially)?

A

pain: anterior, superior. no pain: inferior.

24
Q

How do you prevent anterior subluxation?

A
  1. put a block on arm of affected side that prevents hyperextension when doing one-armed W/C propulsion.
  2. put a pillow under humerus while in supine.
25
Q

What are 4 things that you need to do to reduce a subluxed shoulder (in general)?

A
  1. Correct trunk alignment
  2. Correct scapular alignment manually (with mobs)
  3. Externally rotate humerus
  4. Replace humeral in glenoid from its subluxed position.
26
Q

What are 4 arguments against using slings for pts with subluxation?

A
  1. Arm is held in position of internal rotation and elbow flexion (contributing to contracture formation).
  2. Encourage abnormal flexor synergies.
  3. Inhibit arm swing in gait.
  4. Decrease body image.
27
Q

What are some of the 9 conditions that shoulder pain in hemiplegics is associated with?

A
  1. Lack of GH joint ext. rotation.
  2. Subacromial trauma.
  3. Shoulder-Hand Syndrome (CRPS).
  4. Biomechanical malalignment?
  5. Neglect?? (not clear)
  6. Inappropriate treatment choice (overhead stuff).
  7. Iatrogenic causes (stupid caregiver pulling arm).
  8. Flaccidity?? (not clear)
  9. Spasticity?? (not clear)
28
Q

What does the research say about FES in treating shoulder pts?

A

Significant improvement in a couple studies, but more studies show no significant improvements. Plus, experimental conditions were long (6 hrs/day, 6 days/wk for 6 wks.)

29
Q

What should you NOT do with pts with hemiplegic shoulder?

A
  1. Pull on the arm
  2. Let it go unsupported during transfers.
  3. Teach self ROM to pt.
  4. Use an overhead trapeze.
  5. put weight directly on the point of the shoulder when lying on the involved side.
30
Q

What is the evidence of using steroid injections for hemiplegic shoulder pts?

A

Not much there to support its use.

31
Q

Evidence for use of slings in subluxation?

A
  1. No evidence it can prevent or reduce subluxation.

2. May help prevent pain and further injury. GiveMohr sling is better than traditional probably.

32
Q

What is an important consideration for treatment of hemiplegic shoulders (and in most neuro rehab in general)?

A

Make it FUNCTIONAL.

33
Q

All done.

A

Go study for research class or ortho quiz… ugh…

Neurology II Test 1 CVA (4 decks)

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