Hemiplegic shoulder Flashcards

Question

subluxation assessment management

Answer 1

``` Shoulder level lower Low tone Scapula retracted Inferior angle adducted Winging of scapula +/- Tight pectorals +/- Medial rotation ``` Correct position of scapula Facilitate muscle activity Minimise trauma Care in handling

Answer 2

``` Stage 1 Tender swollen hand Diffuse aching pain Sensitivity Discoloration Warm / moist Loss of movement ``` Stage 2 Marked pain and swelling Progressive loss of movement Oedema loss of skin elasticity after stroke Swollen left hand and forearm ``` Stage 3 Resolution of pain and oedema Decreased ROM Bone demineralisation Muscle atrophy Soft tissue changes Joint contracture Deformity (flexion) ``` ``` Examination Postural Alignment Mobility Pain Subluxation Tone Movement pattern ```

Answer 3

``` Early - prevention Long-term Facilitate normal motor control Normalise tone Normalise alignment Facilitate muscle activity Sensory re-education ``` ``` Correct handling and positioning Staff - education Deal with perceptual deficits Bilateral activity Prevent secondary soft tissue changes Facilitate functional restoration ```

Answer 4

``` Positioning Handling Normalise tone Education Normalise alignment Posture Facilitate muscle activity Prevent ST shortening Joint mobilisation Restore function Strapping / taping Supports / slings FES/NMES Medication Constraint induced movement Robotics ```

Answer 5

depressed and protracted shoulder arm adducted and IR elbow flexed and pronated wrist and finger flexion - clenched fist with thumb in palm deformity

Answer 6

``` arm supported in supine lying sitting out hemipleic UL supported in all postures sit up straight stroke shoulder slightly forward stroke elbow away from body stroke forearm slightly forward palm down and fingers straight use pillows to support affected arm while seated ``` slings should only be used for transfers and walking when in bed/ chair sling should be removed and arm positioned appropriately

Answer 7

GRASP graded repetitive arm supplementary program improves arm function during impatient stroke rehab has 3 exercise levels to accommodate different levels of stroke severity ROM exercises strenghtening weight bearing exercises functional tasks fine motor skills

Answer 8

used to improve motor function after stroke. During mirror therapy, a mirror is placed in the patient's midsaggital plane, reflecting movements pf the non-paretic side as if it were the affected side.

Answer 9

``` Factors to consider Sensation Tissue viability Skill required in application Aim Reduce pain Counteract traction imposed on joint by weight of limb + gravity Stabilisation / align Provide proprioceptive feedback Promote awareness ```

Answer 10

Factors to consider Pattern of subluxation Skill required in application Presence of sensory loss / neglect ``` Aim of support Reduce pain Counteract traction imposed on joint by weight of limb + gravity Prevent stretch to capsule +ST Stabilisation / align Provide proprioceptive feedback Promote awareness ```

Answer 11

liaise with occupational therapist | provides support to hemiplegic forearm/ hand

Answer 12

Factors to consider Sensation Tissue viability Skill required in application ``` Aim Aim Reduce pain Counteract traction imposed on joint by weight of limb + gravity Assist with muscle activation. Reduce atrophy. Reduce risk of subluxation. Provide proprioceptive feedback Promote awareness Increase ROM ```

Answer 13

- learned non-use theory | - forced-use principle of CIMT

Answer 14

The success of robotic devices in rehabilitation is heavily based upon the evidence that intensity of practice and the task and context specificity are the main drivers that make practice effective.

Answer 15

Time course 3 - 6 months No movement in first 4/52 - poorer prognosis (Heller et al., 1987). Patients with shoulder subluxation poorer outcome (Arsenault et al., 1991). Shoulder shrug/hand movements in first 11/7 good prognosis (Katrak et al., 1998