hemiplegic upper limb

Question 1

what is the combined action of the RC muscles?

Answer 1

to stabilise the head of the humerus in he glenoid cavity

Question 2

briefly describe the scapulohumeral rhythm?

Answer 2

-2 degrees of GH movement for every 1 degree of scapular movement
ratio is 2:1

Question 3

what are the consequences of UL dysfunction?

Answer 3

-pain
-recovery and outcome of rehab
-interferes w. rehab
-interferes w. transfers
-ADLs
-depression
-sleep disturbance

Question 4

what are the causative factors of post stroke UL dysfunction?

Answer 4

-paralysis / loss of mvt post stroke
-muscle weakness
-muscle imbalance
-abnormal tone
-sensory loss
-dependent limb
-forced ROM
-poor handling
- trauma

Question 5

what are examples of secondary impairments/ effects on patient post stroke in hemiplegic UL?

Answer 5

-immobility
-weakness
-abnormal tone
-adaptive soft tissue changes
-degenerative changes
-restricted joint ROM

Question 6

what are the 3 types of shoulder dysfunction after stroke?

Answer 6

-hemiplegic shoulder pain HSP- very common
-subluxation
-shoulder hand syndrome - chronic pain, changes in skin, swelling etc in affected area

Question 7

describe HSP

Answer 7

-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

Question 8

what are examples of causes of hemiplegic shoulder pain?

Answer 8

-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

Question 9

what is subluxation? discuss it with regards to the shoulder

Answer 9

partial dislocation of the joint
-scapula is depressed or retracted and there is an impaired locking mechanism

Question 10

what are examples of factors that can cause subluxation of the shoulder in neuro patients?

Answer 10

-paralysis of RC muscles
-abnormal tone
-gravity
-weight of limb
-loss of locking mechanism

Question 11

how does subluxation present in neuro patients?

Answer 11

-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

Question 12

how do you check for a hemiplegic shoulder subluxation?

Answer 12

-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

Question 13

what are the signs of stage 1 shoulder hand syndrome?

Answer 13

-tender swollen hand
-sensitivity
-diffuse aching pain
-discolouration
-warm / moist
-loss of mvt

Question 14

describe the signs of stage 2 shoulder hand syndrome

Answer 14

-marked pain and swelling
-progressive loss of mvt
-oedema loss of skin elasticity

Question 15

describe the signs of stage 3 shoulder hand syndrome

Answer 15

-decreased ROM
-muscle atrophy
-soft tissue changes
-joint contracture
-deformity - eg flexion
-resolution of pain and oedema

Question 16

how is shoulder hand syndrome managed?

Answer 16

-normalise tone
-normalise alignment
-sensory re -education
-handling and positioning
-facilitate normal motor control and muscle activity

Question 17

list examples of approaches for management of hemiplegic shoulder dysfunction

Answer 17

-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

Question 18

how is subluxation managed?

Answer 18

-correct position of scapula - eg slings and position
-minimise trauma
-facilitate muscle handling

Question 19

what are good positions for care of the hemiplegic UL?

Answer 19

-NB SUPPORTED IN ALL POSTURES

eg lying on hemiplegic sides, sitting in bed with pillows supported hemiplegic limb

Question 20

list the stroke arm position tool

Answer 20

-sit up straight
- stroke shoulder slightly forward
-stroke elbow away from the body
-stroke forearm slightly forward
-palm down and finger straight

Question 21

how should you support a hemiplegic limb during transfers and mobility?

Answer 21

-slings should only be used for transfers and walking
-when in bed / chair - sling should be removed and arm should be positioned appropriately

Question 22

what are the factors to consider if using NMES?

Answer 22

-sensation of area
-tissue viability - what kind of condition is it in?

Question 23

what are the aims of NMES?

Answer 23

-reduce pain
-reduce atrophy
-reduce risk of subluxation
-increase ROM
-assist w/ muscle activation

Question 24

what does GRASP stand for?

Answer 24

graded repetitive arm supplementary program
ready made exercise program w/ 3 levels

Question 25

what is constraint induced movement therapy?

Answer 25

-form of rehab therapy which forces the use of the limb affected by stroke and reduces the use of the unaffected limb

Question 26

what is mirror therapy ?

Answer 26

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