UE Dysfunction Flashcards
Grasp dysfunction behaviors (5)
anticipatory hand shape impaired grip force inappropriate precision grip premature/delayed finger closure delayed/labored release
Manipulation allow u to do what?
interact with your environment on a fine motor level
Functional performance scales (outcomes measures) for UE
motor activity log
wolf motor function test
*however, most PTs address UE impairments by observation alone, not formal testing…
how many ppl have shoulder pain post CVA?
70-84% of pts
what happens to shoulders Post CVA
gravity slowly pulls arm into subluxation
what are reasons that shoulder pain develops post CVA
> rotator cuff musculature paralysis, incoordination or weakness
adhesive capsulitis
scapular position is off (tone, tightness)
scapulo-humeral rhythm is off
repeated trauma (multiple falls, neglect, loss of sensation)
Complex regional pain syndrome affects what percentage of ppl post stroke?
10-25%
components of CRPS
hypersensitivity, swelling, warmness, redness, glossy skin
how to help/prevent shoulder subluxations
wt. bearing, sling, strengthen mm, FES
treatment for reduced scapular mobility
soft tissue scapular mobs, sidelying strengthening/stretching, progress to AROM, then with perterbations, etc. PNF diagonals, massge to tight tissues
why is edema a common problem in post CVA pts?
lack of mm pumping in UE
what can edema in the hand lead to?
impaired grasp
impaired release
treatments of hand impairments
prevent/treat edema
facilitate or inhibit flexor/extensor mm
hand positioning splints
task oriented training
treat hand/UE impairments with functional tasks that the patient would do everyday, grasping objects, picking things up, reaching, manipulating, hand-eye coordination, etc.
is unilateral or bilateral a better technique to facilitate fxnl tasks ?
bilateral!
what is the misnomer with the “uninvolved side” of a stroke pt
there really is no “uninvolved side” both sides are involved, one just more than the other
Why are both sides actually involved in a stroke
bc of bilateral cortical control, component of corticospinal tract that does not decussate, general cognitive deficits, visual-perceptual deficits
CIMT
constraint induced movement therapy… works great, no nobody uses it…
does CIMT work?
yes! changes brain mapping, effects last 2 years post study
What do u do in CIMT?
restrict the “good arm” so that the pt has to use the involved side for all waking hours for 2 weeks
What is the limiting factor for whether or not CIMT will work?
must be able to extend wrist and fingers 10-20 degrees, have to be at least Brunnstrom stage 5
CIMT length of tx
14 days
CIMT amount of time in contraint amount
90% of waking hours
CIMT PT
6 hours each session x2 weeks
CIMT frequency of PT
5 days/week
mCIMT length of tx
10 weeks
mCIMT amount of constraint
5 hours/day, 5 days/week
mCIMT session times
1/2 hour at a time, 3 days/week
frequency of sessions for mCIMT
3 days/week
has there been success with mCIMT at home?
yes, with increased grip strength and decreased time on the WMFT
functional roles of the UEs (6)
reaching grasping manipulation balance/arm swing pointing/gesturing weight bearing
UE dysfunction/impairments
> abnormal tone: UE synergies, Brunnstrom stages, >abnormal voluntary movements, strength and coordination
impaired vision/perception
impaired sensation
examples of reach dysfunction
timing problems, multiple joint coordination, weakness, vision
