Test 2: UE Management Flashcards
UE screen vs assessment
Screen = strength, power, endurance, fatigue, tone, coordination
assessment = all of the above + pain, sublux, functional ability, outcome measures, participation
what factors contribute to GH sublux
weakness
weight if heavy arm = downward RT of scapula
unlocking mechanism of capsule is lost and humerus subluxes inferiorly with IR
superiorly capsule and coracohumeral ligament are taut due to passive distraction and vulnerable to stretch and tear
2 main categories that cause shoulder pain
spasticity - can cause secondary tightness of ligaments/tendons/capsule causing adhesive capsulitis
flaccidity - loss of proprioception and support from RTC = reduced stability
what causes pain with sublux
malalignment during mobility causes impingement of soft tissue structures during shoulder ROM
pain with overhead reach and shoulder flexion over 90
do not use shoulder pulleys
what is FIM
functional independent measure
measures disability for variety of populations
18 items
some subsets relate to functional use of UE
what is the purpose of reach and grasp with patients
gives info on pts ability to move, anticipatory posture control, functional UE mobility
shows grip formation, hand shaping
can choose task to emphasize shoulder or elbow motion, hand opening/closing, individual finger motion, or combo of movements
what measures does the strokeEDGE task force recommend students have competence in prior to graduating
9 hole peg test
action research arm test
box and block test
Fugl-Meyer assessment of motor performance
wolf motor function
what is the action research arm test (ARAT)
examines UE function
19 items, 4 subscales
specific to adults with neuro dysnfunction
more sensitive, but less ceiling than FMA-UE
scoring for ARAT
0 = cant perform any part of test
1=partial performance
2= completes test but takes too long/is very difficult
3= normal performance
subscales of ARAT
grasp
grip
pinch
gross movement
describe 9 hole peg test
measures finger dexterity
ICF = body structure/function and activity
pegs moved and put in 9 pegs, then returned to container; time is measured
describe the box and block test
measures manual dexterity
ICF = body function/structure and activity
box with central divider; move as many blocks as possible over divider to other side of box
count number of blocks moved in 60 sec
what is Fugl-Meyer assessment
stroke specific outcome measure
full test = subsets for UE, LE, balance, sensation, ROM, and pain
ICF = body structure and function
based on observation of sequential recovery of motor function
used for reasearch
describe the UE subsection of the Fugl-Meyer
assesses body structure and function
high score = better outcomes
max score 66
used for reasearch but not clinical
what is the wolf motor function test
standardized UE assessment for adults post stroke
ICF = body structure/function
15 timed tasks and 2 strength measures
tasks arranged in order of complexity
high interrater reliability, internal consistency, and test-retest reliability
6 point rating scale; 0 no use, 5 normal
max 75 points
reasons a pt may not use affected limb following stroke that contribute to learned nonuse
weakness/paresis
altered force production
sensory loss
spasticity
stroke related pain
what is learned bad use
compensatory movements used to complete task
become habit
i.e. using trunk flexion rather than elbow extension to reach
what to be mindful of when patients forget to use their affected arm
use it or lose it
repitition matters
out of sight out of mind- forget about limb
pt isnt cued to use limb so they compensate even more
attention is needed to relearn to use the limb
chronic phase of stroke rehab often focuses on
reducing secondary impairments to improve compensatory patterns of function
intervention for flaccid UE
WBing posiiton with therapist stabilizing
describe the task oriented approach
focus on performance of normal ADLs with paretic hand
encourages neuroplasticity
salience- meaningful and feasible
describe the facilitation approach to intervention
provide assistance during functional activities as needed but no more than needed
physical demands can be altered to enhance performance
when is STM, joint mobilization, and ROM recommended
indicated early to encourage AROM and prevent contracture
what to be mindful of at the shoulder with PROM
in ranges of 90 deg of shoulder flexion be careful not to perform distraction of humerus
scapula should be mobilized with emphasis on upward RT and protraction
dont use shoulder pulley with neuro pt- dont facilitate proper scapulohumeral rhythm
what are 2 ways upper limb can be used with UE intervention
stabilizer - increase WBing and approximation of joint
manipulator - reaching and grasping
describe the use of the UE as a stabilizer
extended arm and stabilized hand in WBing on support surface
promote posture shift to more affected side
promotes proximal stabilization, decreases flexor hypertonicity, allows approximation of joint, and tapping cues can increase extensor muscle activity
describe the use of the UE as a manipulator
introduce grasp
need finger ext
later stroke intervention- can be frustrating
perform bimanual activities and ADLs
when/how to use CIMT with UE intervention
sub acute, do not use in acute - need more distal function
restrain unaffected arm for 90% of waking hours
therapy focuses on intensive/repetitive task training 6-8 hours a day
can be very restrictive and long hours of therapy can be quite burdensome
describe the ideal shoulder sling
maintains normal angular alignment with allowed freedom of movement
decreases tendency of humerus to IR
takes some weight of arm off of trunk
general rules for slings
therapist should minimize use during therapy
slings may be useful for initial transfer and gait training
traditional slings that position UE in flexion are less desirable should be used only for select upright sctivities and only for short periods
effective alternatives to slings
taping/strapping - KT tape to facilitate/inhibit periscapular muscles
electrotherapy - to reduce shoulder sublux and enable active support via own muscular contraction
effectiveness of support trough
arm trough overcorrects sublux vs shoulder sling
what is a resting hand splint and the pros/cons
semiflexible orthotic to prevent extreme wrist flexion which limits grasp function
for night use only
pros: limits contractures/spasticity return, positins wrist and hand in position that minimizes potential development of undesirable flexion contractures q
con: enforces learned nonuse
pros and cons of unilateral devices for mobility
pro = use of bilateral with a pt with significant UE involvement requires therapist; can be more independent
con: compensatory gait pattern encouraged, use of step to gait pattern, non-normal pattern can impact neuroplasticity, goal is to encourage pt to use affected limbs
what is the algorithm for UE interventions
Upper limb intervention algorithm
clinician guides to determine appropriateness of UE intervention
based on acuity of stroke and CLOF
algorithm based on shoulder abduction finger extension (SAFE) model
