Upper Limb Flashcards
UMN negative upper limb features
- weakness/ loss of AROM
- Impaired motor control / manual dexterity
- fatigue
UMN positive upper limb symptoms
- spasticity
- co-activation
- associated reactions
- spasms
- clonus
UMN secondary adaptive upper limb symptoms
- contractures
- stiffness
hypertonus
- Neural – overactive stretch reflex / coactivation/ associated reaction (positive features)
- Non-neural - contracture (loss of passive range) / stiffness (secondary features)
shoulder subluxations
- 34% of early stroke patients sublux
- rotator cuff muscle weakness–> joint insability –> infeerior sublux of humeral head related to G/H joint
- important consideration in care and rehab - support to shoulder when handling/positioning
shoulder pain
- 39% prevalance at 12 months post-stroke
- weakness/sublux (traction related injurys, muscle tears, nerve damage, overstretching of ligs and capsule)
- spasticity- humerus internal rotated and adduction, shortening/contracture, loss of rom
- subacromial pain syndrome, rotator cuff, bursitis, supraspinatus tendinopathy or biceps tendonitis malalingment –> impingment between humerus head and coracoacromial arch
- frozen shoulder - pain and gradual loss of rom
neuropathic pain
- centeral post stroke pain
- hypersensitivity, allodynia and burning pain
risk factors of other factors influencing shoulder pain
- poor motor control
- spasticity
- sensory impairment
- diabetes
- previous Hx of shoulder pain
perceptual impairment - unilateral neglect
- attention disorder in stroke - R sided stroke (L hemi) more likely than L sided stroke
- A failiure to report, respond or orient to stimuli in the space contralateral to the site of brain lesion (heilman 1993) - eg. shave only one side of face, put only one arm into a top/ dressing
- associated with lower functional ability and slower recovery
Outcome measures for UL
- 9- hole peg test (Heller et al 1987)
- Motor assessment scale (Carr & Shepherd, 1985)
- Modified Rivermead Assessment (Collen et al 1990)
- Action Research Arm Test (Lyle et al, 1981)
- Wolf Motor Function Test (Morris, 2001)
- Motor activity log (Uswatte et al, 2006)
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Hollistic key treatment
re-education of movement through therapeutic handling and functional exercise
treatment techniques
- Strengthening
- Passive movements/ stretching
- Weight bearing
- Static Splinting / positioning
- Dynamic splinting
- Electrical stimulation
- Sensory stimulation
EDUCATION
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manageing shoulder pain and sublux
- Thorough assessment and monitoring of pain
- Handling: Avoiding mechanical stress/trauma – educate carers
- Positioning with support to promote neutral alignment, change position regularly
- Move shoulder through range of flex / abd/ Lat rot. daily
- Improve muscle activity / strengthen
- Strapping /taping
- Electrical Stimulation
- UL orthosis for transfers and mobility
- Treat pain (regular simple analgesia / Corticosteroid injection)
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Ajuncts to treatment of shoulder pain/sublux
- strapping/taping
- electrical stimulation
- UL orthosis for transfers and mobility
sensory training
e.g - taping, brushing, ice
- needs to be specific to the task being practised
- consider the ability of the individual to interpret the meaning and relevance of sensory input
- training of a functional task will provide the sensory inputs that are normally utilised on the control of those movements (carr and shepard 1998)
