Hemiparetic UE

Question 1

Which scapular PNF feeds into a synergy?

Answer 1

D2

Question 2

Incidence of shldr subluxation in hemiparesis?

Answer 2

50-75%

Question 3

What stage does shoulder subluxation typically start in?

Answer 3

Flaccidity stage

Question 4

What is the alignment of the glenoid fossa w/ FLACCIDITY during hemiparesis

What about the humerus

Answer 4

Vertical orientation due to downwardly rotated scapula (bc of gravity)

Internal rotation of the humerus further causes downward glide of humerus and potential inferior subluxation

Question 5

T or F: there is a direct correlation between shoulder pain and shoulder subluxation in hemiparesis

Answer 5

F

Question 6

What is the position of the scapula during SPASTICITY?

Answer 6

Scapular depression and downward rotation due spasticity in the latissimus dorsi, rhomboids, Levator scapulae, and upper trap and flaccidity in the supraspinatus

Question 7

What is the risk of using lap boards, half lap boards, or arm troughs to fix shoulder subluxation

Answer 7

Might overcorrect

Question 8

T or F: Sling/supports have good evidence for treatment of subluxation

Answer 8

F. Da Silva said during lecture that all treatments have mixed evidence

But she did provide a systemic review that said these were effective

As well as a meta analysis saying taping is effective

Question 9

According to the article in the lecture what device was best for managing a hemiparetic arm?

What was worse?

What devices overcorrected sometimes?

Answer 9

Sling

Hook Hemiharness

Arm Trough and Lap Tray

Question 10

What is the worst part about the sling?

Answer 10

Holds arm in resting synergy position

Question 11

What does the evidence say about use of FES/NMES for shoulder subluxation

Answer 11

Can strengthen the muscles to hold it in place

Good evidence!

Question 12

What is shoulder-hand syndrome?

Answer 12

Disabling pain, edema, caused by failure of arterial, venous, or lymphatic pumps

Question 13

What does Shoulder-hand syndrome look like?

First symptom?

Answer 13

Edema of hand primarily dorsal surfaces of MCP PIP is the first symptom

Skin becomes shiny and atrophic with edema and has web-like adherent scar tissue. Osteoporosis develops

Question 14

How do we prevent hand-shoulder syndrome

Answer 14

Raise arm up to the heart level to help w/ circulation

(Multiple pillows!)

PROM

Compression

Massage

NMES

Question 15

How can shoulder-hand syndrome prevent finger flexors from working

Answer 15

Edema elevates the extensor tendons and flexion is prevented

Question 16

If a patient has sympathetic nervous system involvement in shoulder-Hand syndrome, what is it called?

What are the signs of this?

Answer 16

Reflex sympathetic dystrophy (now called: Complex regional pain syndrome)

Skin pigment changes, sweating, nail changes

Question 17

When do signs of shoulder-hand syndrome first appear

Answer 17

1-3 months after the stroke

(Not in acute care)

Question 18

Should pts with hemiparetic arms use arm pulleys?

Answer 18

No

Question 19

Ideal therapy for hemiparetic arm

Answer 19

Repetitive and intense use of novel tasks

Motor learning to maximize recovery

Group therapy

Question 20

A stroke in what artery commonly paralyzes the arm

Answer 20

MCA

Question 21

What is the most common complication to affect stroke survivors

Answer 21

Shoulder pain

Question 22

T or F: An arthrography is recommended to diagnose frozen shoulder in these patients

Answer 22

F since it does not alter modalities of treatment

Question 23

If a patient has atypical functional return or segmental muscle atrophy after recovering from flaccidity then what are we suspecting

Answer 23

Brachial plexus or peripheral nerve injury

Question 24

What tendon is commonly inflamed when it is aggressively ranged throughout its ROM and can progress to adhesive capsulitis

Answer 24

Biceps long head

Question 25

Where does HO normally occur in the arm

Answer 25

Extensor side of the elbow, proximal radioulnar joint is not involved