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Neuro Eval > Profound UE > Flashcards

Profound UE Flashcards

1
Q

What is a profoundly affected UE?

A

When a stroke survivor has no movement in the affected arm or when movement is not functionally useful

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2
Q

do most people who have a profoundly affected UE recover full dexterity in the arm at 6 mo?

A

nope

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3
Q

what can occur secondary to profoundly affected UE

A
  • shoulder pain
  • spasticity
  • arm contracture
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4
Q

risk factors of spasticity and contracture

A

weakness and reduced motor control

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5
Q

risk factors for developing arm pain

A

reduced sensation, shoulder subluxation, weakness, and stroke severity

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6
Q

what does the arm primarily function to do?

A

to place the hand in an appropriate position and with the appropriate orientation in space to interact with the environment

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7
Q

single unit for reaching/manipulation 3 steps

A

*The hand starts to open for grasp at the start of a reaching action
*Grasp aperture increased throughout the transport phase, reaching a maximum before contact and around the time the transport movement start to decelerate
*The grasp size then decreases as the hand nears the object

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8
Q

what does tactile and pressure sensory give us?

A

information that helps us identify objects, classify them according to the properties of the object, and gauge potential for slippage/loss of control

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9
Q

what plays a critical part in enabling a coordinated movement to take place

A

eye and head movement

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10
Q

what is vision important for?

A
  • to determine distance from the body and orientation
  • enables precision of movement and grasping
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11
Q

arm/hand function

A

*Arms are connected with the postural control system
*Most commonly performed tasks are bimanual tasks
*Two upper limbs function in concert

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12
Q

reaching to grasp an object

A
  • transportation phase: hand moves quickly to the vicinity of the target
  • thumb plays a role in guiding the transport component of reaching
    *Manipulation Component
    *Under visual control
    *Final adjustment to the grasp aperture is made just prior to grasp
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13
Q

essential components of reaching portion of reaching to grasp an object

A
  • Function of the arm enable hand to be positioned in space for manipulation
  • Shoulder abduction
  • Shoulder flexion
  • Shoulder extension
  • Elbow Flexion/Extension
  • Pronation/Supination
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14
Q

essential components to the rest of reaching to grasp and object

A
  • Grasping
  • Control of the hand for fine grasping movements- consideration of location, size, shape of object
  • Can have difficulties with power or precision
  • Poke
  • Pinch
  • Clench
  • Palm
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15
Q

major function of the hand:

A

-grasp, release, and manipulate objects for a specific purpose

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16
Q

essential components of the grasp

A
  • Major function of hand is to grasp, release, and manipulate objects for a specific purpose.
  • Radial deviation combined with wrist extension.
  • Wrist extension and flexion while holding object.
  • Palmar abduction and opposition at the CMC joint of thumb.
  • Flexion and opposition of fingers
  • Flexion and extension of MCP and ICP joints
  • Supination and pronation of forearm while holding an object
17
Q

Training of UE

A

*Repetitive exercise/practice to activate weak/paralyzed muscles
*Task related training to improve strength/coordination
*Opportunity to practice intensively
*Prevention of soft tissue adaptations- muscle shortening, loss of extensibility, and stiffness
*Prevention of a painful shoulder and UE

18
Q

adaptive motor behavior following stroke

A
  • Persistent posturing
  • Abnormal patterns of movement
19
Q

Glenohumeral subluxation following stroke

A
  • stiffness
  • pain
  • occurs in majority of patients who have sustained CVA
  • Can occur as soon as 2 weeks post CVA
20
Q

what is integrity of GH joint maintained by?

A
  • Position of scapula on rib cage
  • Tension in the joint capsule
  • Tendons and ligaments connecting the bones of the arm to each other and to the trunk
  • Inferior support for the humeral head
    • Resting position of the scapular
    • Angulation of the glenoid fossa with its cartilage lip
21
Q

what population does inferior subluxation occur in?

A

patients with severe muscle weakness and low tone

22
Q

inferior subluxation

A
  • Scapula downward rotation
  • Glenoid fossa vertical
  • Humerus internally rotated
23
Q

amount of subluxation

A
  • distance between top of the shoulder and humerus
  • often described as number of fingers
24
Q

to reduce inferior subluxation:

A
  • Correct trunk position
  • Upwardly rotate the scapula to neutral and lift humerus into the glenoid fossa
  • Rotate the humerus from internal rotation into slight external rotation
25
Q

how does anterior subluxation occur?

A
  • Humeral head separates from glenoid fossa in an anterior direction
  • Distal end of the humerus moves posteriorly into hyperextension
  • Patients with hypertonicity and unbalanced muscle return
26
Q

anterior subluxation

A
  • Downwardly rotated scapula
  • Elevation and forward tilt of scapula
  • Humerus hyperextension and internal rotation
  • Increased tension elbow biceps causing elbow flexion and supination
27
Q

to reduce anterior subluxation:

A
  • Correct trunk position
  • Take humerus out of internal rotation and hyperextension
  • Depress and upwardly rotate the scapula
  • Glide the humeral head back into the fossa
28
Q

how does superior subluxation occur?

A
  • Humeral head lodged under the coracoid process in a position of elevation and internal rotation
  • Patients with muscle cocontraction and hypertonicity
29
Q

Superior subluxation

A
  • Scapula abducted and elevated
  • Humerus internally rotated and abducted
  • Forearm adducted across body with flexion at elbow and supination
30
Q

what is superior subluxation associated with?

A

inappropriate muscle firing in the middle
deltoid, pectoral muscles, and biceps

31
Q

to reduce superior subluxation

A
  • Treat unbalance muscle firing and co contraction
  • Restore normal alignment to the trunk and scapula
32
Q

preventing subluxation

A

*Positioning procedures
*Avoid certain handling methods- DO NOT PULL ON ARM
*Support the arm in sitting
*Exercises to regain active muscle contraction, increase strength, and increase control of the muscles of shoulder region
*Taping, FES, Slings, and supports

33
Q

another way to help reduce shoulder subluxation

A
  • FES Functional Electrical Stimulation to the post deltoid and supraspinatus
34
Q

more training for profoundly affected UE

A
  • Forced use of the affected limb with constraint of unaffected limb
  • Avoidance of slings (when appropriate) and hand splints that promote immobility
  • Activities that provide motivation, incentive to increase repetitions
  • Activities that encourage flexibility
  • Practice of concrete, interesting tasks
  • Feedback
35
Q

treatment progression

A

*Weightbearing
*Isometric Activity
*Eccentric Activity
*Concentric Activity

36
Q

Rehabilitation of motor function - Acute

A
  • less than 1 month
  • Muscle strengthening activities
  • Constraint induced movement therapy
  • Mirror therapy
  • Passive NMES
  • Repetitive transcranial magnetic stimulation
  • SSRI and NARI antidepressants
  • Botox (if spasticity)
37
Q

rehabilitation of Motor Function - Subacute

A
  • 1-6 months
  • Muscle strengthening activities
  • Constraint induced movement
  • Mirror therapy
  • Mental practice with motor imagery
  • High frequency transcutaneous electrical stimulation
  • Repetitive transcranial magnetic stimulation
  • SSRI and NARI antidepressants
  • Botox (is spasticity)
38
Q

Rehabilitation of Motor Function - Chronic

A
  • > 6 mo
  • Muscle strengthening activities
  • Constraint induced movement
  • Mirror therapy
  • Mental practice with motor imagery
  • High frequency transcutaneous electrical stimulation
  • Repetitive transcranial magnetic stimulation
  • Transcranial direct current stimulation
  • SSRI and NARI antidepressants
  • Botox (if spasticity)
  • Virtual Reality

Neuro Eval (18 decks)

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