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
we want at least ___ degrees of wrist extension to be maintained
25
what do we mean by proper transfer techniques for protective handling post stroke?
avoid pulling or lifting on the affected limb during mobility or transfers (educate fam, staff, nursing)
how can we protect and maintain jt integrity?
ensuring good GH jt alignment and scap mobility on the thorax
avoiding passive or active shoulder flexion beyond 90 degrees
avoiding overhead pulleys
why should we avoid passive or active shoulder flexion beyond 90 degrees post stroke?
it can cause impingement and CRPS
when is the only time it may be acceptable to flex the shoulder beyond 90 degrees post stroke?
if the scap is gliding towards upward rotation and has sufficient ER available
how can we mobilize and protect the UE with transfers?
tuck the involved extremity into a pocket, gait belt, or under your arm
if higher level of fxn-can use uninvolved extremity to support the involved extremity (b/l clasp)
WB
how can we mobilize and protect the UE in gait?
WB on a moving cart or table (make sure the humeral head doesn’t move up)
can use urself as the AD and use your fingers for directional cues
b/l engagement
what is the problem with slings?
they promote non-use and assymetry of the trunk and extremity
they prevent normal mov’t from occuring
put the arm in a synergistic patterns
no sling does anything to realign the scap
t/f: slings are a tool to be used while gaining proximal stability and should not be used long term
true
what three types of slings support the GH jt?
Bobath sling
Give-Mohr sling
hook hemi harness
what is the Give-Mohr sling?
elastic fabric sling that has a hand device for the pt to hold onto
every mov’t gives input to the shoulder
leaves the arm free for normal mov’t in gait
what is the hook hemi harness?
intends to keep the humerus from downward subluxation
what is the problem with the Bobath, Give-Mohr, and hook hemi harness slings?
the pt can’t put them on independently
if a pt demonstrates active shoulder abduction WITHOUT finger extension, what interventions are appropriate?
motor imagery/mental practice
strength training
task specific training
ESTIM-NMES
mirror therapy
robot assisted training
video gaming
sensory retraining
if a pt demonstrates active shoulder abduction WITH finger extension, what interventions are appropriate?
modified CIMT
motor imagery/mental practice
sensory retraining
video gaming
when is there strong evidence for mental practice/imagery?
when used in conjunction with PT
t/f: there is good evidence for mental practice/imagery as an individual intervention
false
what are the 3 techniques for active recruitment and facilitation/strengthening of motor responses in the UE?
1) critical to maintain a proper scap and GH positioning
2) UT relaxation
3) facilitation of active response
what muscles are critical to keep the scap against the trunk?
rhomboids
MT
LT