Subacute rehabilitation of the trunk and UL

Question 1

low tone handling

Answer 1

in lying- keep shoulder away from gravity pulling ot down- one hand underneath and round scapula- feel for tone and tightness and winging scap- do all scap movements
in sitting- support elbow with folded pillow- sensory input (stroking, tapping, squeezing), get patient to look- may need to do prep work (soft tissue mobs)- work through flex and ext and grabbing object

Question 2

prognostic indictators

Answer 2

positive= early UL strength, spasticity, some voluntary finger extension and shoulder abd on day 2= high probability regarding some dexterity at 6 months
negative= severity of paresis, flaccidity, visual inattention

Question 3

possible reasons for poor recovery

Answer 3

complexity of UL function compared to lL, emphasis tends to be on LL rehab, less time spend in rehab of UL, therapy focus on unilateral activity- most ADLs bimanual, neuroanatomy= limited potential for neuroplasticity following lesions affecting CST, learned non use

Question 4

subacute treatment options

Answer 4

motor imagery/ mental practice, care of UL, supportive devices, hand oedema- AROM/PROM, mirror therapy, FES, CIMT, spasticity management, strength training/task specific, robot assisted therapy, video gaming

Question 5

constraint induced movement therapy (CIMT)

Answer 5

unaffected arm wears mitt, forces affected arm to carry out daily activities.
use mitt for 90% of waking hours, shaping- specific training task- patient orientated, 6 hours a day (2-3 weeks), modified CIMT= 3 hours a day 2/3 weeks,

Question 6

increased tone

Answer 6

tends to develop over time, worse on effort, feels stiff and static, patient may be embarrassed
secondary changes= soft tissue shortening, joint stiffness, skin changes, pain, loss of function

Question 7

what is GRASP

Answer 7

graded repetitive arm supplementary program, for people with chronic stroke- community based/ self directed/ supervised by therapist, includes strength, ROM, weight bearing and functional exercise

Question 8

how to achieve GRASP?

Answer 8

use of active hand, self management- in gym. setting, adaption of task, adaption of the environment, assistance, independent task practice

Question 9

strength training/ task specific

Answer 9

repetition of goal oriented tasks is key, maximise relevance, motivate, make it easy for them to practice, include family, start easy and build complexity

Question 10

motor control

Answer 10

any patient with persistent motor impairment should be taught exercises or activities that will increase voluntary motor control and strength, emphasis on repetitive task training

Question 11

arm re-education

Answer 11

patients who have some arm movement should be given the opportunity to practice activities within their capacity. Bilateral arm training involving functional tasks and repetitive arm movement to improve dexterity and grip strength should be used in any patient with continuing limitation on arm function

Question 12

self efficacy

Answer 12

all patients should be offered training in self management skills, to include active problem solving and individual goal setting