The Neurological Hand Flashcards
common diagnoses associated with the neurological hand (8)
- CVA
- TBI
- CP
- MS
- Parkinson’s disease
- SCI
- dystonia
- hemiplegia/hemiparesis
neurological hand: spasticity
one of the most common barriers for the neurological hand
- can be managed by oral medication or injections
- spasticity changes over time
- not uncommon to go untreated
neurological hand: pain
obvious barrier in client’s ability to effectively incorporate affected hand in meaningful tasks
*can be at hand or shoulder
neurological hand: edema
utilize edema control techniques
*severe cases may need to be referred to lymphedema therapist
neurological hand tips: addressing spasticity
spasticity in the hand may assist a client to achieve a functional grasp, and if reduced/removed, the client’s grasp may be too weak to continue its role in functional tasks
*regardless of function, spasticity has the potential to lead to other barriers such as deformities, pain, and inadequate hygiene
neurological hand tips: sensory reeducation (10)
no protocol identified as being superior over another 1. contrast baths 2. thermal stimulation 3. intermittent pneumatic compression 4. sensory training using robotics 5. brushing 6. WB 7. TENS/NMES 8. stereognosis 9. vibration 10 tactile input
neurological hand tips: edema (8)
- compression glove
- kinesiotaping
- contrast bathing
- soft-tissue mobilization
- positioning
- fist pumps above heart
- caregiver education
- continuous passive motion and e-stim are potentially more effective treatments for hand edema than intermittent pneumatic compression
neurological hand tips: increase attention to the affected UE (7)
- proprioceptive feedback
- blend of AAROM and resistance
- resistance
- vibration
- perturbations
- visual regard
- mirror box therapy
neurological hand tips: hand dominance
with an ipsilateral brain injury, RH dominant individuals prefer to use R UE, whereas LH dominant individuals prefer more bilateral UE involvement
neurological hand tips: weight bearing
incorporation of UE WB activities is an important and common practice for normalizing muscle tone in clients following a brain injury
neurological hand tips: CIT/mCIT
proven effective at improving UE function in clients but if not supervised properly, poor compliance with the protocol can result, yielding less than desirable outcomes
neurological hand tips: bilateral training
theoretically the use of the intact limb helps to promote functional recovery of the impaired limb through facilitative coupling effects between the upper limbs
neurological hand tips: NMES/FES/TENS
often used with the neurological hand
FES refers to the application of NMES to help achieve a functional task
neurological hand tips: hand/palmar shaping (5)
it is important to consider positioning and shape of the hand when assessing and treating reach-to-grasp movements
- open/closed kinetic chain exercises
- positioning to support distal movement
- grading the force of movement
- closing the sensory loop
- working in/out of synergistic patterns
neurological hand tips: adaptive movements
- pre-grasp: no terminal extension of digits, disproportionate opening of the hand to compensate for muscle imbalance, and/or decreased wrist control
- grasping: if client has ability to extend digits, excessive force can be observed due to difficulty gauging force needed to grasp
- releasing objects: clients may attempt to utilize grasp driven by tenodesis
