Management of the Hemi UE Flashcards
Which artery is the most commonly affected in a stroke?
MCA (which supply UE)
Prognosis of UE recovery following CVA
early use (amount @ 1 month) = further recovery
lesion location, size and type
Can the FIM score be used to rate UE recovery?
no, FIM score may be high b/c they learned how to use the unaffected arm for all tasks.
Should PT teach the patient to compensate following stroke? What are the factors?
Yes if:
- long time since injury
- go home alone, safe to do so with both hands?
- behavior (low tolerance)
- pt goal
On a neural level, explain learned non-use
cortical remapping occurs and the unaffected arm will take over the area of the unused arms
Why is there less recovery in the UE compare to LE following a stroke?
Patient does not use it because:
- it is weak
- decrease attention to the UE in rehab
- early remapping on both sides of the brain => learned nonuse
Which body region becomes a frequent problem following CVA? Why?
Shoulder
- Weak RTC mm => sublux => impingement
- immobility => adhesive capsulitis
- spasticity & immobility => shorten mm
- trauma
- impact of stroke severity
How is the shoulder subluxation quantified in CVA?
Finger Breath (FB#)
where # = the number of finger fitting into the sublux
Edema of the UE is common in patients with _____ UE, why?
flaccid UE
dependent position, loss of muscle pump
When is a sling commonly used in patient with CVA?
flaccid limb
Types of slings used with CVA patients
Regular arm sling
Cuff sling
Giv-Mohr sling
Ottobock Sling
Cuff Slings
pro/con
Hold humerous up into the glenoid fossa
hard to get on/off
GivMohr Sling
pro/con
easy to put on/off
arm is place in flexion with arm into the fossa
Why should we not put an arm into a traditional sling? When should we consider using it?
b/c it puts the arm into a position of disuse
used for pain management & far out when no active motion present
Which shoulder mm are FES in pt with CVA?
surpraspinatus
deltoid
When does research suggest using FES to reduce sublux?
during the acute stage only b/c during chronic stage, the tissues might be too stretch out
Is FES commonly used in hemiplegia of UE? Why? or why not?
No b/c most protocols use 6 hours a day at patient tolerance.
also setup takes a long time.
Functional interventions of the hemiplegic UE includes
ADL training/task based training
bimanual practice
manipulation & dexterity
mirror therapy
CIMT
Bioness
Mental imagery
ADL training with hemiplegic UE involves
prevent compensation with less affected extremity
dressing bathing etc
KP > KR by using hand over hand assist
Bimanual practice of the hemiplegic UE includes
Don’t let the less affected UE lead unless necessary
Gross motor activities (towel folding, catch, UBE, reaching tasks)
Brain mapping studies show same remapping b/w bimanual and CIMT training
Dexterity Practice includes
Picking up small objects, large objects
functional tasks requiring dexterity
mirror therapy
protocol/physiology behind how it works
Protocol: bilateral mirror motor tasks performed with distal affected arm blocked by mirror, 30 min/day x4 weeks
Physiology: brain perceives visual imagery as affected arm movement => sensorimotor cortical activation in lesioned hemisphere
Protocol for CIMT
6 hours/day for 2 weeks
General inclusion criteria for CIMT training
typical: 20 deg wrist ext, 10 degress finger ext
new: 10 degree wrist ext, 10 thumb abd, 10 fingers ext for 2 digits
In short u still need some active motion
CIMT is effective with
chronic CVA
subacute CVA
Acute CVA
gage by stroke impact scale (measure activity/participation)
Bioness holds wrist where?
10-20 deg of ext
