Early Rehab Of The Trunk And Upper Limb Flashcards
What problems may neuro patients have with their upper limb?
Weakness/low tone High tone or rigidity Contractures Loss of function Pain Change of sensation Loss of coordination Tremors
What is the standard assessment of the upper limb
Observation AROM Prom/tone Strength Coordination Sensation Function
What do you look at during a routine observation from behind?
From behind: Levels of shoulders (UF traps). Spine to medial border of scapula Spine to inferior angle of scapula Position of inferior angle Scapula to humerus Skin folds
What do you look at from the front in a routine observation?
Position of head, trunk, elbow, wrist and hand
Supra scapular fossa should be equal, and should increase equally with protraction
Arms should be flexed forward to 90 degrees with dimples above deltoid
What individual components of Active rom should be looked at?
Quality of movement
Rhythm, associated reactions, pain, compensations/abnormal movement
What to look at when doing prom?
Range, end feel, pain
What is shoulder subluxation?
The humerus partially slides in and out of place quickly of the fossa
What is inferior subluxation?
Scapula loses stability on the thorax
It depresses and medially rotates, the joint is unprotected by the stability of the capsule and supraspinatus
What are some early treatment options for stroke and TBI?
Care of shoulder- education, positioning, supportive devices,
Hand oedema- passive, measure oedema, prevents CRPS, CP, hand, FES hand
Whole arm- strengthening, mirror box, mental practice, sensory retaining, compensatory techniques, spasticity, mgmt, Botox- botulinum toxin, FES, strength training/ task specific, robot assisted therapy and video gaming
What to look at when assessing care of shoulder?
Importance of not pulling on shoulder or arm when moving in bed, transfers etc.
Educating family and carers about care of shoulder
Shoulder subluxation cuffs
What simple early strengthening techniques can be done on the arm?
Holding, following, placing, combine with tapping and approximation
What does CIMT (CONSTRAINT INDUCED MOVEMENT THERAPY) involve?
It is used in stroke rehab where the patient where a mitt on their unaffected arm and this forces the affected arm to carry out daily tasks
CIMT reissues the patient to wear it 90% of waking hours on non affected limb and shaking- specific training tasks, patient orientated, 6 hours a day/ 2-3 weeks
Modified CIMT -3 hours a day for 2-3 weeks
This exercises requires a lot of commitment from patient, need wrist extension and finger extension but can be effective for being able to be more independent with functional activities
What influences muscle tone?
For a person with high tone the environment should be quiet, warm and relaxing, the therapists approach should be gentle, quiet and calming. The patients base of support should be large, their COG should be low. The therapists handling should be firm, slow and calming with lots of support and a slow speed of movement
For a person with low tone the environment should be stimulating and cool, the therapists approach should be fun, loud and firm, their base of support should be small and their COG high, the therapeutic handling should be brisk and stimulating with minimal support, fast speed of movement.
