UE recovery post-stroke

Question 1

What is hemianesthesia

Answer 1

Partial or complete loss of somatosensation

Question 2

Why do we care about motor overall?

Answer 2

If you can’t move, your other impairments hardly matter

Question 3

What is the most important predictor of motor recovery?

Answer 3

Initial grade of paresis is #1

Question 4

Rln b/t # of impairments and amount of recovery?

Answer 4

More impairments, less likelihood of recovery

Question 5

What are indicators of POOR PROGNOSIS 20-30 days post CVA

Answer 5

No/min grip strength
No/min shldr flexion
assistance needed for sitting –> not independent later

Question 6

What is different about UE Motor recovery, esp of the hand (compared to LE)

Answer 6

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

Question 7

How long is the lag of recovery of function vs neuro impairments post stroke

Answer 7

1-2 weeks + require a lot of practice

Question 8

What are predictors of UE recovery?

Answer 8

Active finger extension and shoulder abduction (SAFE)

Question 9

ARAT Scores 3 mo post stroke and predictor for recovery

Answer 9

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

Question 10

How does SAFE score predict UE prognosis?

Answer 10

• 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

Question 11

What should the focus of therapy be on if pt has excellent prognosis?

Answer 11

Promote normal function w/self-directed hand and arm HEP

Question 12

What should the focus of therapy be on if pt has good prognosis?

Answer 12

Promote function overall w/repetitive practice of movement and everyday tasks

Question 13

What should the focus of therapy be on if pt has limited prognosis?

Answer 13

Promote movement w/focus on improving strength, AROM, and joint flexibility w/adaptations to ADLs

Question 14

What should the focus of therapy be on if pt has poor prognosis?

Answer 14

Promote compensation w/focus on preventing secondary complications

Question 15

How to deliver bad news?

Answer 15

• clear
• honest
• listen
• emphathize

Question 16

What are some compensations for UE that we can teach?

Answer 16

• one handed techniques (ex. dress affected arm first and undress affected last)
• adaptive aids

Question 17

What should we NOT do w/a flaccid shoulder

Answer 17

Use overhead pulleys or have pt perform self ROM

Question 18

What are some ways to prevent further injury to UE?

Answer 18

• careful positioning (abd, ER, flexion) w/continous support

Question 19

What does the evidence say about arm slings?

Answer 19

The evidence is limited and does not show that it helps prevent subluxation

Question 20

What sling would be better to use?

Answer 20

• GivMohr sling or hemi-arm sling as these help to improve symmetry, stabilize humeral head, and do not promote a flexion synergy

Question 21

What is the incidence of hemiplegic arm pain?

Answer 21

High (48-84%)

Question 22

What is shoulder subluxation?

Answer 22

• anterior/downward displacement of humeral head + 2 deg rot of scapula w/flaccid UE

Question 23

How do you measure shoulder sublux?

Answer 23

w/finger width

Question 24

List ways to manage shoulder sublux

Answer 24

UE support
Gentle ROM (*** NO PULLEY)
Taping
NMES
Mirror therapy if CRPS is present

Question 25

Evidence for tapping and sublux?

Answer 25

• conflicting
• mod evidence says it does not help
• better if only a light sublux

Question 26

Evidence for NMES and sublux?

Answer 26

• may help to dec. sublux and improve ROM
  (NO PAIN AFFECT)

Question 27

What are the keys to the UE Rehab?

Answer 27

• 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)

Question 28

What does evidence say about static hand splinting?

Answer 28

It does not improve motor function or reduce contracture formation

Question 29

What does research say about CIMT?

Answer 29

It may be beneficial for UE rehab in the chronic phase following stroke

Question 30

What does literature say about EMG/biofeedback?

Answer 30

• alone it is mixed
• in combo, may not be beneficial

Question 31

What does literature say about FES for UE?

Answer 31

Mixed