hemiplegic upper limb Flashcards
what is the combined action of the RC muscles?
to stabilise the head of the humerus in he glenoid cavity
briefly describe the scapulohumeral rhythm?
-2 degrees of GH movement for every 1 degree of scapular movement
ratio is 2:1
what are the consequences of UL dysfunction?
-pain
-recovery and outcome of rehab
-interferes w. rehab
-interferes w. transfers
-ADLs
-depression
-sleep disturbance
what are the causative factors of post stroke UL dysfunction?
-paralysis / loss of mvt post stroke
-muscle weakness
-muscle imbalance
-abnormal tone
-sensory loss
-dependent limb
-forced ROM
-poor handling
- trauma
what are examples of secondary impairments/ effects on patient post stroke in hemiplegic UL?
-immobility
-weakness
-abnormal tone
-adaptive soft tissue changes
-degenerative changes
-restricted joint ROM
what are the 3 types of shoulder dysfunction after stroke?
-hemiplegic shoulder pain HSP- very common
-subluxation
-shoulder hand syndrome - chronic pain, changes in skin, swelling etc in affected area
describe HSP
-common post stroke -
may get it in acute stage or later on
-there can be a presence of abnormal tone and or subluxation
-sharp pain at end of ROM
-night pain
what are examples of causes of hemiplegic shoulder pain?
-loss of co-ordination joint motion eg abnormal scapula-humeral rhythm, loss of external rotation
-muscle imbalance
-forced / passive ROM
-incorrect handling / trauma eg fall
what is subluxation? discuss it with regards to the shoulder
partial dislocation of the joint
-scapula is depressed or retracted and there is an impaired locking mechanism
what are examples of factors that can cause subluxation of the shoulder in neuro patients?
-paralysis of RC muscles
-abnormal tone
-gravity
-weight of limb
-loss of locking mechanism
how does subluxation present in neuro patients?
-may or may not be painful - due to loss of sensation
-could be inferior, superior or anterior subluxation
-they could describe a dragging
-mal alignment of shoulder
relieved by passive elevation
-there is a palpable dip
how do you check for a hemiplegic shoulder subluxation?
-patient should be in sitting
-palpate from the SC joint along the clavicle to the AC joint
-check for a gap
- a gap of 1-2 fingers indicates subluxation
what are the signs of stage 1 shoulder hand syndrome?
-tender swollen hand
-sensitivity
-diffuse aching pain
-discolouration
-warm / moist
-loss of mvt
describe the signs of stage 2 shoulder hand syndrome
-marked pain and swelling
-progressive loss of mvt
-oedema loss of skin elasticity
describe the signs of stage 3 shoulder hand syndrome
-decreased ROM
-muscle atrophy
-soft tissue changes
-joint contracture
-deformity - eg flexion
-resolution of pain and oedema
how is shoulder hand syndrome managed?
-normalise tone
-normalise alignment
-sensory re -education
-handling and positioning
-facilitate normal motor control and muscle activity
list examples of approaches for management of hemiplegic shoulder dysfunction
-positioning NB - if supine - keep arm up and away and not in high tone position
-education
-normalise tone and alignment
-posture
-mobilise scapula
-restore function
-strapping and taping
-external rotation rehab
how is subluxation managed?
-correct position of scapula - eg slings and position
-minimise trauma
-facilitate muscle handling
what are good positions for care of the hemiplegic UL?
-NB SUPPORTED IN ALL POSTURES
eg lying on hemiplegic sides, sitting in bed with pillows supported hemiplegic limb
list the stroke arm position tool
-sit up straight
- stroke shoulder slightly forward
-stroke elbow away from the body
-stroke forearm slightly forward
-palm down and finger straight
how should you support a hemiplegic limb during transfers and mobility?
-slings should only be used for transfers and walking
-when in bed / chair - sling should be removed and arm should be positioned appropriately
what are the factors to consider if using NMES?
-sensation of area
-tissue viability - what kind of condition is it in?
what are the aims of NMES?
-reduce pain
-reduce atrophy
-reduce risk of subluxation
-increase ROM
-assist w/ muscle activation
what does GRASP stand for?
graded repetitive arm supplementary program
ready made exercise program w/ 3 levels
what is constraint induced movement therapy?
-form of rehab therapy which forces the use of the limb affected by stroke and reduces the use of the unaffected limb
what is mirror therapy ?
a mirror is used to create a reflective illusion of an affected limb in order to trick the brain into thinking movement has occurred without pain, or to create positive visual feedback of a limb movement
