Lecture 10: Upper Extremity Assessment + Management Flashcards
do impairments of the upper extremity only happen on the contralateral side
no, they can happen in both upper extremities
what are the 3 levels of the chedoke McMaster stroke assessment
low level arm (stages 1-2) - severely impaired
Intermediate level arm (3-5) - moderately impaired
High level arm (6-7) - mildly impaired
is the chedoke McMaster stroke assessment for the arm and hand a functional assessment?
no it looks at motor control during different movements
is the chedoke arm and hand activity inventory a functional assessment?
yes, looks at activity the client views as meaningful
should be used alongside chedoke McMaster stroke assessment for the arm and hand
what would a Chedoke arm and hand stages 1 – 2 look like
severely impaired
no or very little active movement (flaccid)
primarily used for stabilization/weight bearing
what would a Chedoke arm and hand stages 3 – 5 look like
moderately impaired
Some functioning – some active but limited selective movement due to tone
Transitioning from stabilization to manipulation tasks
what would a Chedoke arm and hand stages 6 – 7 look like
mildly impaired
Fairly high functioning – some problems with dexterity, strength, or coordination
Primarily used in manipulation tasks with emphasis on speed, accuracy, quality of movement
what is the most important thing to keep in mind when a client has Low Functioning UE (Category 1)
ALWAYS have the arm supported. It should never be hanging
what 4 interventions might you do with someone with the Low Functioning UE (Category 1)
use a sling for transitional movements
gentle weight bearing
Active-assisted ROM
Scapular mobilizations
what 4 interventions might you do with someone with the Moderate Impaired UE (category 2)
Stabilizing activities
Task-oriented training
Facilitation in weight bearing
mental imagery
what 4 interventions might you do with someone with the Mildly Impaired UE
(Category 3)
Task-oriented training
Fine motor training
Strength training
Constraint-Induced Movement Therapy (CIMT)
what is original Constraint-Induced Movement Therapy
Therapy for 6 hours per day, 5 days per week for 2-3 weeks
Less affected limb constrained for 90% of waking hours
what is modified Constraint-Induced Movement Therapy
Dose varies considerably to make it more appropriate for clients
- 30 mins-3 hours therapy per day, 5 days per week
- Less affected limb constrained for < 6 hours per day
what is the 10-10 eligibility criteria for constraint induced movement therapy
10 degrees active wrist extension
10 degrees active finger extension
Intact cognition and minimal spasticity
what is the Recovery – Intervention guideline
Stage 3 or less Chedoke-McMaster:
minimize pain and joint contractures
Stage 4 or higher Chedoke-McMaster:
aggressive restorative therapy
if someone has Hemiplegic Shoulder Pain & Subluxation, what should be avoided
No shoulder ROM >90 unless humerus lateral rotation & scapula upward rotated
can Shoulder Subluxation always be avoided
No technique could effectively reduce the subluxation and facilitate the upper limb recovery even if all precautions are taken
what is the number 1 thing to prevent shoulder pain and subluxation
prevention positioning:
always support arm
reminder to others about careful positioning of arm
avoid sitting on it (impaired sensation) and overhead pulling
when are slings used
ONLY recommended for people with flaccid shoulders (stage 1 and 2)
ONLY recommended during transitional movements
