Upper Limb Flashcards
Difference in motor control/ function between the upper and lower limb: anatomy (form)
Greater variety of joint movements - shoulder and hand
Greater number of smaller more precise muscles
Difference in motor control/ function between the upper and lower limb: function
Greater variety and more complex
Interlinking of multiple body segments - open chain
Hand-eye coordination
Strength
Stabilisation
Precision
Shoulder subluxation
Rotator cuff muscle weakness - joint instability; inferior subluxation of humeral head related to the GH join, humeral head drops inferiorly, can fit your fingers between the acromion and the humeral head
Stroke 34% early patients
Important consideration in care and rehabilitation - support to shoulder where handling and positioning
Shoulder pain
39% at 12 months post-stroke
Causes - weakness, traction-related injuries; muscle tears, nerve damage, overstretching ligaments and capsule, spasticity; rotator cuff tear, bursitis, malalignment; impingement, frozen shoulder; pain and loss of ROM
Influencing shoulder pain - neuropathic pain; hypersensitivity, allodynia and burning pain, referred pain; cervical spine
Risk factors - poor motor control, spasticity, sensory impairment, diabetes, previous history of shoulder pain
Perceptual impairment: unilateral neglect/ inattention
More likely in right sided stroke (left hemiplegia)
Failure to report, respond or orient to stimuli in the space contralateral to the site of the brain lesion
Focus attention to the right o have no understanding/ awareness of the left side
Functional effect - less engagement in left side during treatment sessions and active daily living, associated with lower functional ability and slower recovery
Outcome measures for upper limb
9-hole peg test - precision, move pegs into the slots, time recorded
Motor assessment scale - impairment level, can they do movements, functional
Fugl Meyer assessment - used in research, impairment level
Action research arm test - activity level
Chedoke arm and hand activity inventory
Wolf motor function test - activity level
Motor activity leg - patient report measure, self-report, how well do they think they’re doing
Key treatment techniques
Re-education of movement through therapeutic handling and functional exercise
Strengthening
Passive movements/ stretching
Weight bearing
Static splinting/ positioning
Dynamic splinting
Electrical stimulation
Sensory stimulation
Positioning
Chair - on a pillow or table so its elevated and supported
Bed - raised on a pillow
Managing shoulder pain and subluxation
Thorough assessment and monitoring of pain
Handling - avoiding mechanical stress/ trauma, educate careers and nurses
Positioning with support to promote neutral alignment, change position regularly
Move shoulder through range - flex, abduct and laterally rotate daily
Improve muscle activity and strengthening
Treat pain - regular simple analgesia/ corticosteroid injection
Adjuncts to treatment of shoulder pain and subluxation
Strapping/ tapping
Electrical stimulation
Upper limb orthosis for transfers and mobility
Sensory training
Tapping, brushing, ice
Specific to the task being practices
Consider with the ability of the patient to interpret the meaning and relevance of sensory input
Training of a functional task will promote their sensory inputs that are normally utilised on the control of those movements
Designing a treatment programme
Specificity - identifies which impairments are specifically contributing to the problem
Functional
Repetition and practice - group work/ rehabilitation technologies/ independent task practice
Vary practice
Use feedback to optimise learning - shows that they’re improving
Enhance self-efficacy and motivation - joint goal setting and treatment planning; see the changes, make it interesting/ meaningful/ competitive
Outcome measures
Applying ICF to treatment of the upper limb
Impairments - e.g. spasticity, decreased range of motion, weakness. stretching, mobilising, strengthening
Activity limitations - e.g. holding, manipulating object. Stabilise object, reach and grasp object
Participation restrictions - e.g. restricted social life. Write letter to a friend; stabilise paper with affected hand, have a coffee out; hand to mouth using affected hand
