The Neurological Hand

Question 1

common diagnoses associated with the neurological hand (8)

Answer 1

1. CVA 2. TBI 3. CP 4. MS 5. Parkinson’s disease 6. SCI 7. dystonia 8. hemiplegia/hemiparesis

Question 2

neurological hand: spasticity

Answer 2

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

Question 3

neurological hand: pain

Answer 3

obvious barrier in client’s ability to effectively incorporate affected hand in meaningful tasks *can be at hand or shoulder

Question 4

neurological hand: edema

Answer 4

utilize edema control techniques *severe cases may need to be referred to lymphedema therapist

Question 5

neurological hand tips: addressing spasticity

Answer 5

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

Question 6

neurological hand tips: sensory reeducation (10)

Answer 6

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

Question 7

neurological hand tips: edema (8)

Answer 7

1. compression glove 2. kinesiotaping 3. contrast bathing 4. soft-tissue mobilization 5. positioning 6. fist pumps above heart 7. caregiver education 8. continuous passive motion and e-stim are potentially more effective treatments for hand edema than intermittent pneumatic compression

Question 8

neurological hand tips: increase attention to the affected UE (7)

Answer 8

1. proprioceptive feedback 2. blend of AAROM and resistance 3. resistance 4. vibration 5. perturbations 6. visual regard 7. mirror box therapy

Question 9

neurological hand tips: hand dominance

Answer 9

with an ipsilateral brain injury, RH dominant individuals prefer to use R UE, whereas LH dominant individuals prefer more bilateral UE involvement

Question 10

neurological hand tips: weight bearing

Answer 10

incorporation of UE WB activities is an important and common practice for normalizing muscle tone in clients following a brain injury

Question 11

neurological hand tips: CIT/mCIT

Answer 11

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

Question 12

neurological hand tips: bilateral training

Answer 12

theoretically the use of the intact limb helps to promote functional recovery of the impaired limb through facilitative coupling effects between the upper limbs

Question 13

neurological hand tips: NMES/FES/TENS

Answer 13

often used with the neurological hand FES refers to the application of NMES to help achieve a functional task

Question 14

neurological hand tips: hand/palmar shaping (5)

Answer 14

it is important to consider positioning and shape of the hand when assessing and treating reach-to-grasp movements 1. open/closed kinetic chain exercises 2. positioning to support distal movement 3. grading the force of movement 4. closing the sensory loop 5. working in/out of synergistic patterns

Question 15

neurological hand tips: adaptive movements

Answer 15

1. pre-grasp: no terminal extension of digits, disproportionate opening of the hand to compensate for muscle imbalance, and/or decreased wrist control 2. grasping: if client has ability to extend digits, excessive force can be observed due to difficulty gauging force needed to grasp 3. releasing objects: clients may attempt to utilize grasp driven by tenodesis

Question 16

neurological hand tips: mirror box therapy

Answer 16

can assist in reducing unilateral neglect because it brings attention to the affected UE *requires ability to maintain sustained attention

Question 17

neurological hand tips: SaeboFlex

Answer 17

dynamic custom-fabricated wrist, hand, finger orthosis designed to strengthen grip and assist in release as needed highly repetitive task-specific training “distal to proximal” recovery concept

Question 18

neurological hand tips: Bioness H200

Answer 18

an advanced FES system intended to provide clients with a mechanism to regain function an movement of their affected UE allows precise delivery of patterned FES to selected muscles to facilitate various grasp and release patterns

Question 19

neurological hand tips: TheraTogs

Answer 19

an elasticized orthosis garment and strapping system which can be used to position the hand and wrist for grasp and release

Question 20

neurological hand tips: robotics/VR/telerehabilitation

Answer 20

robotics can be used for ROM VR may enhance cortical reorganization telerehab programs are remote retraining of arm movement using software that records and analyzes participant performance

Question 21

neurological hand tips: complementary medicine

Answer 21

focuses on noninvasive and stress-reducing techniques that can supplement or be used in conjunction with more conventional treatment methods, such as acupuncture

Question 22

indications for orthosis in the neurological hand (4)

Answer 22

1. soft tissue restrictions into digit flexion or extension 2. joint contractures 3. decreases ROM, muscle weakness, tendon laxity, and decreased coordination causing difficulty with functional grasp 4. hygiene issues due to spasticity and contractures