Profound UE Flashcards
What is a profoundly affected UE?
When a stroke survivor has no movement in the affected arm or when movement is not functionally useful
do most people who have a profoundly affected UE recover full dexterity in the arm at 6 mo?
nope
what can occur secondary to profoundly affected UE
- shoulder pain
- spasticity
- arm contracture
risk factors of spasticity and contracture
weakness and reduced motor control
risk factors for developing arm pain
reduced sensation, shoulder subluxation, weakness, and stroke severity
what does the arm primarily function to do?
to place the hand in an appropriate position and with the appropriate orientation in space to interact with the environment
single unit for reaching/manipulation 3 steps
*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
what does tactile and pressure sensory give us?
information that helps us identify objects, classify them according to the properties of the object, and gauge potential for slippage/loss of control
what plays a critical part in enabling a coordinated movement to take place
eye and head movement
what is vision important for?
- to determine distance from the body and orientation
- enables precision of movement and grasping
arm/hand function
*Arms are connected with the postural control system
*Most commonly performed tasks are bimanual tasks
*Two upper limbs function in concert
reaching to grasp an object
- 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
essential components of reaching portion of reaching to grasp an object
- Function of the arm enable hand to be positioned in space for manipulation
- Shoulder abduction
- Shoulder flexion
- Shoulder extension
- Elbow Flexion/Extension
- Pronation/Supination
essential components to the rest of reaching to grasp and object
- 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
major function of the hand:
-grasp, release, and manipulate objects for a specific purpose
essential components of the grasp
- 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
Training of UE
*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
adaptive motor behavior following stroke
- Persistent posturing
- Abnormal patterns of movement
Glenohumeral subluxation following stroke
- stiffness
- pain
- occurs in majority of patients who have sustained CVA
- Can occur as soon as 2 weeks post CVA
what is integrity of GH joint maintained by?
- 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
what population does inferior subluxation occur in?
patients with severe muscle weakness and low tone
inferior subluxation
- Scapula downward rotation
- Glenoid fossa vertical
- Humerus internally rotated
amount of subluxation
- distance between top of the shoulder and humerus
- often described as number of fingers
to reduce inferior subluxation:
- 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
how does anterior subluxation occur?
- 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
anterior subluxation
- Downwardly rotated scapula
- Elevation and forward tilt of scapula
- Humerus hyperextension and internal rotation
- Increased tension elbow biceps causing elbow flexion and supination
to reduce anterior subluxation:
- 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
how does superior subluxation occur?
- Humeral head lodged under the coracoid process in a position of elevation and internal rotation
- Patients with muscle cocontraction and hypertonicity
Superior subluxation
- Scapula abducted and elevated
- Humerus internally rotated and abducted
- Forearm adducted across body with flexion at elbow and supination
what is superior subluxation associated with?
inappropriate muscle firing in the middle
deltoid, pectoral muscles, and biceps
to reduce superior subluxation
- Treat unbalance muscle firing and co contraction
- Restore normal alignment to the trunk and scapula
preventing subluxation
*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
another way to help reduce shoulder subluxation
- FES Functional Electrical Stimulation to the post deltoid and supraspinatus
more training for profoundly affected UE
- 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
treatment progression
*Weightbearing
*Isometric Activity
*Eccentric Activity
*Concentric Activity
Rehabilitation of motor function - Acute
- 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)
rehabilitation of Motor Function - Subacute
- 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)
Rehabilitation of Motor Function - Chronic
- > 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
