UE Overview Flashcards
what is a stroke?
Interruption of blood flow to the brain; inadequate supply of oxygen /
nutrients.
where can a stroke appear?
Can occur in any part of the brain
what are the 2 main types of stroke?
- ischemic
- hemmhoragic
what is thrombosis?
Blockage of blood vessel
what is an embolism?
Dislodged platelets, cholesterol, or other material that travels in
bloodstream and blocks a vesse
what does a hemorrhagic stroke occur from?
Results from rupture of blood vessel
effects of a stroke are determined by what?
location and how much brain tissue is damaged
what are some common symptoms of a right sided stroke?
contralateral weakness
contralateral sensory loss
hemispatial neglect of inattention
left visual feudal neglect
impulsive or overestimation of abilities
what are common symptoms of a left sided stroke?
contralateral weakness
contralateral sensory loss
aphasia, Alexia, agraphia
slow and cautious behaviour
what are the bones of the shoulder?
scapula
clavicle
humerus
what are the shoulder joints?
- Sternoclavicular
- Acromioclavicular
- Glenohumeral
what is the “pseudo joint” of the shoulder?
articulation
between the scapula and
the thorax
what makes the glenohumeral joint?
Humeral head + glenoid fossa of scapula
what direction does the head of the humerus face?
faces medially, posteriorly, and superiorly
what direction does the glenoid fossa face at rest?
laterally, superiorly, and anteriorly
what direction does the glenoid fossa face when the arm is in the dependent position?
inferiorly and posteriorly
how much surface area of the humeral head does the glenoid fossa cover?
1/3 to 1/4
why does the glenoid fossa cover such a small surface area on the humeral head?
to allow mobility with little articular stability
what are the functions of the glenohumeral joint?
-spreads joint loading
-allows movement of 2 opposing surfaces
what structures provide static stability to the shoulder joint?
-labrum
-joint capsule
-joint cohesion and geometry
-ligamentous support
when is contact between the humeral head and glenoid fossa significantly reduced?
when the humerus is positioned in:
-adduction, flexion, and internal rotation
-abduction and elevation
-adducted at the side, with the scapula rotated downward
less contact between humeral head and glenoid fossa =
less stability
what provides dynamic stability to the shoulder?
supraspinatus
rotator cuff
deltoid
serrates anterior
what is the function of the supraspinatus?
maintains the humeral head in the glenoid fossa
what is the function of the rotator cuff?
keeps/steers humeral head in glenoid
externally rotates the humerus
what is the function of the serrates anterior?
moves scapula forward on ribcage (important for reach)
what is the function of the deltoid?
> 90 degree compressive:pulls humeral head into glenoid
<90 degrees superior shear: pulls humeral had superiorly
what does dynamic stability of the shoulder complex rely on?
- Optimal alignment of the scapula
- Correct Glenohumeral orientation
- Length-tension relationship of
* scapula pivoters
* rotator cuff
* biceps & triceps
* static restraints (the G-H ligaments
and the joint capsule)
what does arm elevation require?
- Scapulothoracic motion
* This significantly decrease the shearing effect between the humeral head and the glenoid - Scapulohumeral motion
what is scapulothoracic motion?
Rotation and translation about three axes of motion embedded in the scapula
what does scapulohumeral motion allow?
the glenoid fossa to be positioned directly under the humeral head during the end ranges of abduction to increase joint stability
what is the ratio of motion between the scapula and humerus during full ROM?
- early abduction (0-80 degrees) involving more humeral motion
- midrange (80-140 degrees) involving more scapular motion
- end ranges (140-170 degrees) involving motion at neighbouring joints
what is a shoulder subluxation?
a partial dislocation of the shoulder joint
what is the mechanism for a shoulder subluxation due to an ABI?
-muscles supporting the shoulder are not ‘working properly’
-This causes INSTABILITY in the glenohumeral joint
what does glenohumeral stability require?
- angle of glenoid fossa (forward, upward and outward)
- scapula properly aligned on ribcage
- seating of the humeral head in the glenoid fossa
- function of supraspinatus and ligamentous structures
what are the types of subluxation?
- inferior subluxation
- anterior subluxation
- superior subluxation
what are the key elements of upper extremity function for tool use?
- Locate target (coordination of eye-head movements)
- Volitional motor control
* Reach
* Grasp
* In-hand manipulation
what is the role of the trunk while reaching for an object within arm’s length?
trunk acts as a stabilizer for postural control
what is the trunks role while reaching for an object outside of arms length?
Trunk becomes part of the kinematic chain to extend reaching distance
what are the in hand. manipulation skills?
- Shift
- Simple rotation
- Complex rotation
- Shift + rotation
what are the key elements of upper extremity function for tool use?
- Locate target (coordination of eye-head movements)
- Volitional motor control
* Reach
* Grasp
* In-hand manipulation
what is one of the most common and challenging sequelae post-stroke?
impaired upper extremity function
what is of primary importance for regaining independence?
recovery of arm and hand function
What post-stroke impairments directly impact the upper extremity?
- Impaired motor control
- Impaired sensory perception
- Shoulder pain
what is typical posture post-stroke?
Head: lateral flexed toward involved side, rotation away from involved side
Upper extremity: scapular depression and retraction, shoulder adduction and internal rotation, elbow
flexion, forearm pronation, wrist flexion, ulnar deviation, finger flexion
Trunk:posterior pelvic tilt, possible rotation, lateral flexion toward involved side
what happens to the scapula post stroke?
downwardly rotates
what happens to the glenoid fossa post stroke?
loses forward, upward and outward
orientation
what happens to the head of the humerus post stroke?
loses alignment with the glenoid fossa
why is it common to have upper extremity subluxations post stroke?
- Motor impairments cause trunk/postural changes which pre-dispose the shoulder joint to malalignment and disadvantageous glenohumeral orientation
- Motor impairments cause weakness in muscles responsible for static and dynamic stability
what are some movement pattern compensation strategies?
- lateral trunk flexion
- trunk rotation
- scapula adduction and elevation
- elbow flexion
where to movement pattern compensation patterns stem from?
1) Spasticity
2) Inability to recruit appropriate muscles
3) Weakness
4) Soft tissue tightness
what is muscle tone?
resistance to passive movement of a joint
what is the continuum of tone?
Flacidity- hypotonia- normal-spasticity-rigidity
what are some examples of increased tone in an intact
nervous system?
- Acquiring a new motor skill (riding a bike)
- Fear of falling
- Pain/expectation of pain
- Trying to do something in a hurry
define spasticity
A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes
define rigidity
Heightened resistance to passive movement of the limb,
independent of the velocity of stretch (non velocity dependent)
is rigidity unidirectional or bidirectional?
bidirectional
what is the triangle of impact of tone?
increased spasticity- immobilization and disuse- contracture
what is the impact of tone post stroke?
- Ranges from minor effects on the quality of movement to
significant difficulties for caregiving and ADL - Spasticity, contracture and weakness all contribute to loss of
function
what is the greatest contributor to tone 0-4 months?
spasticity
what is the greatest contributor to tone more than 4 months?
weakness
how many tone present?
synergy patterns
what is a synergy pattern?
- Mass movement patterns
- Not selective or isolated movement
- Can be elicited voluntarily or as a reflex response
what is an upper extremity flexor synergy?
- Retraction/elevation of the shoulder
- Abduction of the shoulder
- Flexion of the elbow
- Supination of the forearm
- Flexed wrist and fingers
what does impaired sensation post stroke impact?
- Sensory feedback
(resulting in dysthymic/uncoordinated
movement) - Response or urge to move
- Functional use even with intact motor function
what is shoulder pain post stroke correlated with?
- loss of external rotation
- lack of biomechanical alignment
- impingement syndromes
- tendonitis (overuse or traumatic)
- supraspinatus
- subacromial bursitis
- spasticity
what is the definition of hemiplegic shoulder pain?
Shoulder pain present at rest, or
during passive or active movement on the hemiparetic side after stroke with no history of trauma or injury
is hemiplegic shoulder pain a symptom of diagnosis?
symptom
whaat are contributing factors to hemiplegic shoulder pain post stroke?
- impaired motor control
- soft tissue lesions
- altered peripheral and CNS activity
initially, what percentage of stroke survivors have severe UE motor impairments?
30%
