week 3 Flashcards
What are the potential problems of the shoulder post neurological event
hemiplegia/hemiparesis
abnormal tone
neurological deficits with sensation, proprioception and/or coordination
impingement
sift tissue injury
subluxation
immobility
hemiplegic shoulder pain
brachial plexus or peripheral nerve injury
in what stage of a post-stroke does subluxation of the shoulder occur
occurs initially in the flaccid stage post stroke
what are some of the potential causes of hemiplegic shoulder pain
glenohumeral subluxation
spasticity
impingement
rotator cuff tear
adhesive capsulitis
reflex sympathetic dystrophy
bursitis
tendonitis
what are the impacts of hemiplegic shoulder pain
reduced functional outcomes
interference with hygiene
depression/low mood
increased risk of secondary shoulder complications (impingement, adhesive capsulitis)
increased length of stay
prolonged rehabilitation
interferes with ADL’s
impedes balance
difficulty with transfers and mobility
how do you reduce the risk of hemiplegic shoulder pain
careful positioning with weight of the limb supported
appropriate support for the affected limb when against gravity
careful and correct handling of the affected limb in transfers and bed mobility
avoid mechanical stress and excessive ROM of the affected limb
what are some upper limb problems for neuro patients
flaccidity
weakness
spasticity or rigidity
pain
change of sensation
ataxia
shoulder subluxation
loss of co-ordination
tremors
reduced dexterity
what is subluxation
weakness of the upper limb, combined with the weight of a dependent arm, can cause a downward displacement of the humeral head from the shallow glenoid fossa
what is an inferior subluxation caused by
rotator cuff weakness
weakness also present around the shoulder girdle means the scapula loses stability on thorax
what is anterior subluxation due to
tight pecs and latissimus dorsi
what is superior subluxation due to
due to tight supraspinatus or deltoid
what is the typical pattern of post stroke
shoulder medial rotation/adduction
elbow flexion/pronation
wrist/fingers flexed
name some techniques for managing spasticity
passive and active stretching
soft tissue mobilisation
positioning
active movement/strengthening/function
splinting/serial casting
focal spasticity management - Botulinum toxin injections
anti-spasmodic medication
hydrotherapy
what does tapping do
tapping over the muscle belly to stimulate reflex contraction
sensory input to encourage motor output
what are some positive indicators of UL recovery
early UL strength
intact sensation
motivation
what are some negative indicators of UL recovery
severity of paresis
cognition
pain
subluxation
flaccidity
visual inattention
neglect/inattention
receptive dysphasia
name some possible reasons for poor UL recovery
complexity of UL function compared to lower limb
emphasis on lower limb rehab
less time spent on UL rehab
focus on unilateral activity
pain
hemiplegic shoulder pain
cognition and engagement in therapy
lesions affecting CST
spasticity
flaccidity
learned non-use
name some problems neurological patients may have that impacts their UL function
weakness/flacidity
spasticity or rigidity
contractures
loss of function
pain
change of sensation
poor postural control
tremors
reduced proprioception
ataxia/loss of coordination
name some things to consider when rehabilitating sensation
focus on different textures
use of vision/without vision
stereognosis
proprioceptive input
weight bearing
following and placing
functional handling
name some things to consider when rehabilitating motor output
repetition of goal orientated task
functional
maximise relevance
accessibility
achievability - build complexity
realistic
keep it interesting to encourage motivation and compliance
What is CMT
constraint-induced movement therapy (use a glove or plaster cast to stop them using their good hand)
How do you rehabilitate someone with no or limited UL movement?
focus on sensory stimulation
facilitation
mirror box
mental imagery
functional electrical stimulation
What are the uses of FES
strengthen and/or maintain muscle bulk
facilitating voluntary muscle contraction
gaining/maintaining ROM
increase sensory awareness
reducing spasticity
as an orthotic substitute to produce functional movement
What are some contraindications of FES
patients who don’t comprehend the physiotherapists instructions or who are unable to co-operate
patients with pacemakers
skin allergies to electrodes, gel or tape
dermatological conditions - dermatitis, broken skin, eczema
area of tumor or suspected malignancy
abnormal skin sensation
current or recent bleeding
compromised circulation
area of tuberculosis
area of devitalised skin
Name some precautions for FES
abnormal skin sensation - choose another area
epilepsy
abdominal electrodes used in labour may interfere with foetal monitoring
