Improving Function & Awareness

Question 1

What are the Therapeutic Benefits of this Approach?

Answer 1

1. Increased awareness of the involved side
2. Decreased fear and neglect
3. Improved use of the involved upper extremity.
4. Improved joint range of motion of the involved side.

Question 2

What are the 5 Basic Treatment Principles?

Answer 2

1. Encourage Weight shift over the Hemiplegic Side
2. Encourage Trunk Rotation
3. Put Muscles on Length
4. Encourage Forward Flexion
5. Encourage Scapular Protraction

Question 3

What are the advantages to supporting the involved arm on a surface while sitting?

Answer 3

1. It helps to support the trunk in a more symmetrical position, reducing flexion of the trunk.
2. The arm is in their visual field, helping to reduce neglect.
3. They are more likely to spontaneously use the hand, even as an assist or stabilizer.
4. It helps to prevent dependent edema of the hand.

Question 4

What are the advantages to positioning a patient on their weak side?

Answer 4

1. They become more aware of this side due to weight bearing and increased sensory stimulation.
2. They become less fearful of putting weight on the weak side.
3. It can help to prevent painful shoulders as well as reduce the increased tone in upper extremity flexion synergies, which often occurs during recovery.
4. It allows the strong side to be free to reach for objects from the nightstand.

Question 5

What are the 3 ways to include a Nonfunctional UE into a task?

Answer 5

1. Weight bearing/Stabilizer
2. Guided Movement
3. Bilateral

Question 6

What are the benefits of incorporating the nonfunctional UE in weight bearing or as a stabilizer?

Answer 6

1. Facilitates weight bearing over the involved side.
2. Encourages use of the involved side.
3. Improves awareness.

Question 7

What are the benefits of guiding the involved UE?

Answer 7

1. Promotes normal sensory information.
2. Facilitates normal patterns of movement.
3. Encourages compensation for visual-field cut.

Question 8

What are the benefits of bilateral use of both upper extremities?

Answer 8

1. Allows the patient to incorporate the involved side without assistance from the therapist.
2. Promotes symmetry.
3. Facilitates dynamic trunk control.

Question 9

What is important to remember when standing with fearful patients during function?

Answer 9

Provide a wide base of support.

Question 10

HEP - what are the three general rules?

Answer 10

1. Start with a good base of support, feet flat on the floor and trunk forward (out of a posterior pelvic tilt) with arms resting on the table.
2. Work proximal to distal, beginning with the trunk and shoulders before working with the wrist and fingers.
3. Do the exercises in the same sequence, 10 repetitions each. This makes it easier for patients to remember.

Question 11

In all stroke patients, what is a general rule?

Answer 11

Exercises should never be painful.

Question 12

What are the steps of the HEP?

Answer 12

1. Stretching Forward with Scapular Protraction
2. Scapular Protraction with Weight Bearing
3. Shoulder Flexion in Sitting
4. Shoulder Flexion in Supine
5. Forearm Supination and Pronation
6. Wrist Flexion and Extension
7. Finger Extension