UE recovery post-stroke Flashcards
What is hemianesthesia
Partial or complete loss of somatosensation
Why do we care about motor overall?
If you can’t move, your other impairments hardly matter
What is the most important predictor of motor recovery?
Initial grade of paresis is #1
Rln b/t # of impairments and amount of recovery?
More impairments, less likelihood of recovery
What are indicators of POOR PROGNOSIS 20-30 days post CVA
No/min grip strength
No/min shldr flexion
assistance needed for sitting –> not independent later
What is different about UE Motor recovery, esp of the hand (compared to LE)
For hand movement, you need ALL 3 joints to function (shoulder, elbow, wrist) whereas for LE function, you can get by w/o all joints working properly
How long is the lag of recovery of function vs neuro impairments post stroke
1-2 weeks + require a lot of practice
What are predictors of UE recovery?
Active finger extension and shoulder abduction (SAFE)
ARAT Scores 3 mo post stroke and predictor for recovery
0-12 = poor = not useful
13-33 = limited = limited helper hand
34-49 = good = useful helper hand w/ADLs but not dexterity
50-57 = return to normal or almost normal dexterity
How does SAFE score predict UE prognosis?
- add together shldr abd and finger extension
> 5 on day 3 & less than 80 = excellent (>8) to good prognosis (>5)
<5 w/low MEP = limited to poor prognosis
What should the focus of therapy be on if pt has excellent prognosis?
Promote normal function w/self-directed hand and arm HEP
What should the focus of therapy be on if pt has good prognosis?
Promote function overall w/repetitive practice of movement and everyday tasks
What should the focus of therapy be on if pt has limited prognosis?
Promote movement w/focus on improving strength, AROM, and joint flexibility w/adaptations to ADLs
What should the focus of therapy be on if pt has poor prognosis?
Promote compensation w/focus on preventing secondary complications
How to deliver bad news?
- clear
- honest
- listen
- emphathize
What are some compensations for UE that we can teach?
- one handed techniques (ex. dress affected arm first and undress affected last)
- adaptive aids
What should we NOT do w/a flaccid shoulder
Use overhead pulleys or have pt perform self ROM
What are some ways to prevent further injury to UE?
- careful positioning (abd, ER, flexion) w/continous support
What does the evidence say about arm slings?
The evidence is limited and does not show that it helps prevent subluxation
What sling would be better to use?
- GivMohr sling or hemi-arm sling as these help to improve symmetry, stabilize humeral head, and do not promote a flexion synergy
What is the incidence of hemiplegic arm pain?
High (48-84%)
What is shoulder subluxation?
- anterior/downward displacement of humeral head + 2 deg rot of scapula w/flaccid UE
How do you measure shoulder sublux?
w/finger width
List ways to manage shoulder sublux
UE support
Gentle ROM (*** NO PULLEY)
Taping
NMES
Mirror therapy if CRPS is present
Evidence for tapping and sublux?
- conflicting
- mod evidence says it does not help
- better if only a light sublux
Evidence for NMES and sublux?
- may help to dec. sublux and improve ROM
(NO PAIN AFFECT)
What are the keys to the UE Rehab?
- hand shapes activation of entire UE
- use meaningful tasks
- lower the physical demands (grav elim position, support at trunk and prox to focus on one jt mvmt)
- functional tasks (hand open, coord, finemotor)
What does evidence say about static hand splinting?
It does not improve motor function or reduce contracture formation
What does research say about CIMT?
It may be beneficial for UE rehab in the chronic phase following stroke
What does literature say about EMG/biofeedback?
- alone it is mixed
- in combo, may not be beneficial
What does literature say about FES for UE?
Mixed
