PT and the UE Flashcards
what are some fxnal activity and performance limitations with the UE following stroke?
carrying, moving, lifting and handling objects
fine hand use (grasp, manipulate, release)
hand and arm use (pull, push, reach, throw, catch, etc)
self care (washing, dressing, drinking, toileting, eating, looking after oneself)
what is the typical position of the scap following stroke?
abd and downward rotation
t/f: with the downward pull of the scap, there is nothing stopping the downward pull of the humerus except the muscles which stretch out very quickly
true
what are the UE changes w/hemiparesis?
losses of motor and sensory fxn
varying degrees of muscle tone
mal-alignment of the pelvis and trunk
PPT and upper trunk flexion
trunk shortening and lat flexion
inf displaced humerus
ant positioned humerus
downwardly rotated scap
laterally shifted/rotated scap
change in scapulohumeral rhythm
what are the primary risks and complications limiting recovery following stroke?
ROM losses
edema
shoulder subluxation
pain
where in the shoulder can there be ROM losses?
scapulothoracic
scapulohumeral
GH
hand/finger/wrist
what should we ALWAYS inspect for post stroke at the shoulder?
for pain and subluxation
t/f: biomechanical alignment is key in interventions post stroke
true
how do we provide biomechanical alignment?
start at the base
90 deg hip and knee flex
ant tilt/neutral pelvis
symmetrical WB
may use stool on ground and arm support
what are the SAFE requirements?
visible shoulder abduction and voluntary finger extension
what happens to the prognosis when a pt meets the SAFE requirements?
the prognosis is significantly better
if the pt meets the SAFE requirements within 2 days, what is the prognosis?
98% probability of return of UE fxn
if the pt meets the SAFE requirements in >12 days, what is the prognosis?
the prognosis goes way down if it takes this long
what complications in the shoulder can dramatically change recovery?
presence of shoulder pain and/or subluxation
what are the 4 categories of recovery for the UE?
(I) no muscles activity
(II) demonstrates active shoulder abduction
(III) demonstrates shoulder and finger extension
(IV) shoulder pain and subluxation
what interventions should we focus on for pts with no muscle activity?
ESTIM for motor recovery
motor imagery/mental practice
sensory training/sensory discrimination training
what are the interventions for pts with no muscle activity?
active assisted or PROM for hand edema
assess hand edema
instruct pt in compensation techniques for fxn
ESTIM for motor recovery
motor imagery/mental practice
sensory training/sensory discrimination training
avoiding hand splinting
pt and fam ed on passive protection and care of the UE
what are the key factors to consider about the UE in supine?
need to reduce the effects of gravity on the UE by supporting the arm in light WB
make sure the humerus and scap are in good position
avoid hand edema by elevating the extremity
what are the key factors to consider about the UE in SL on the affected side?
watch the scap and humerus
make sure the shoulder is protracted and the hand is supported in WB to promote recovery
what are the key factors to consider about the UE in SL on the unaffected side?
the shoulder has a tendency to retract, so get good protraction and support the UE
want as much ER as feasible
what are the key factors to consider for the UE in sitting?
use what you have available to support the UE
WB through the elbow and forearm
check the scap
for the preservation of fxning of the hand, we have to ensure maintanance of what two things?
1) the fxnal arch of the hand
2) ROM of the hand and fingers
t/f: sometimes, if spasticity is too high, the only way to manage it is w/really strong material/surface to keep them in a fxnal hand position
true
protective handling involves what 2 things?
protective, proper transfer technique
protection and maintenance of jt integrity