Secondary Impairments After Stroke (Week 3)

Question 1

Prevalence of contracture after strokje

Answer 1

Within 6 months, about half of all patients develop contracture

Question 2

Predictors of contracture

Answer 2

No one factor predicts
Muscle strength is a significant predictor of elbow, wrist and
ankle contractures
– but cannot accurately predict development of contractures
in these joints

Question 3

Muscles at risk of contracture after stroke

Answer 3

• Gastroc/soleus
• Shoulder internal rotators
• Elbow flexors
• Wrist flexors, long finger flexors
• Forearm pronators
• Thumb web space

Question 4

Prevention of contracture

Answer 4

No additional benefit of routine stretching. 
- Use positioning and active practice. 
30 mins positioning at EOR ER 
Daytime: 
Lap trays
Arm troughs on wheelchairs
Night time:
Supine or sidelying on unaffected side

Question 5

Prevention and treatment of swelling after stroke

Answer 5

Pressure garments
Electrical Stimulation (reciprocal flexion and extension)

Question 6

Shoulder subluxation associated with

Answer 6

– associated with poor UL function

– associated with reflex sympathetic dystrophy

Question 7

• For people with extreme weakness who are at
risk of developing shoulder subluxation,
management should include:

Answer 7

– Electrical stimulation – level B
– Firm support devices – GPP
– Education and training – GPP

Question 8

key
components in counteracting downward pull of the
humerus and maintaining normal alignment of GHJ

Answer 8

– supraspinatus and posterior deltoid

Question 9

Shoulder pain associated with

Answer 9

Subluxation, spasticity, sensory impairment, decreased ROM, adhesive capsulitis, impingement, CRPS