Week 6 - Upper limb Ax and Rx Flashcards
Should Rx strategies for the upper limb post stroke be remedial or compensatory?
Mainly remedial, as improvements are possible. However compensatory strategies can be in-corperated when working on specific skills and enable function.
What are some factors that may cause increase in tone?
- Temperature (particularly cold)
- Time of day
- A sneeze or yawn
- Fatigue
- Increased effort in lower limb function
What are physical signs that a client is experiencing difficulty during an upper-limb task?
- Elevating the affected shoulder excessively during an activity
- Fixing the affected UL against the body
- Abducting the shoulder before flexing the shoulder when reaching
What does the Brunnstrom scale do?
It measures the recovery of voluntary movement in the upper extremity and hand.
Describe stage I (1) of the Brunnstrom scale of the upper extremity.
Flaccidity - there is no voluntary movement
Describe stage II (2) of the Brunnstrom scale of the upper extremity.
- Spasticity developing
- Reflex movements in synergy
- Flexion developing before extension
Describe stage III (3) of the Brunnstrom scale of the upper extremity.
- Spasticity increasing
- Developing voluntary movement in synergy
Describe stage IV (4) of the Brunnstrom scale of the upper extremity.
- Some movements deviating from synergy
a. hand behind back
b. arm to forward horizontal
c. pronation/supination of forearm when elbow flexed in 90 degrees - Spasticity decreasing
Describe stage V (5) of the Brunnstrom scale of the upper extremity.
- Independence from basic synergies
a. arm to side horizontal position
b. arm forward and overhead
c. pronation/supination of forarm when elbow fully extended - Spasticity waning
Describe stage VI (6) of the Brunnstrom scale of the upper extremity.
- Isolated joint movements freely performed with near normal coordination
- Spasticity minimal
What is synergy?
Instances of associated reactions. When movement is initiated at a joint, all muscles that are linked in synergy with that movement will automatically contract
Describe what happens with UL flexor synergy
- Scapular retraction and/or elevation
- Shoulder abduction
- Elbow flexion (strongest component)
- Forearm supination
- Position of the wrist and fingers are variable
Describe stage I (1) of the Brunnstrom scale of the hand.
Flaccidity
Describe stage II (2) of the Brunnstrom scale of the hand.
Little or no finger action
Describe stage III (3) of the Brunnstrom scale of the hand.
- Mass grasp or hook grasp with no voluntary finger extension or release
- MCP joints in extension
Describe stage IV (4) of the Brunnstrom scale of the hand.
- Semi-voluntary finger extension in a small ROM
- Lateral prehension with release by thumb movement
Describe stage V (5) of the Brunnstrom scale of the hand.
- Palmar prehension
- Cylindrical grasp (emerging)
- Spherical grasp (emerging)
- Voluntary mass finger extension (variable ROM)
Describe stage VI (6) of the Brunstromm scale of the hand.
- All types of prehension with improved skill
- Voluntary finger extension (full ROM)
- Individual finger movements
What is mass flexion of the hand?
Making a fist
What is a hook grasp?
MCP extension, PIP and DIP flexion. Like holding a shopping bag
What is lateral prehension?
Grasping an item (like paper) between the thumb and the side of the index finger
What is palmar prehension?
The tip of the thumb, index finger and middle finger come together to grasp an item (like holding a pencil)
What is cylindrical grasp?
Taking hold of a cup
What is spherical grasp
Taking hold of a tennis ball (fingers abducted)
What do clients need to be taught how to self-regulate their tone?
A good level of cognition and sensation
What might UL function be impacted by?
- Scapula movement
- If movement is possible at the shoulder joint
- ROM of UL joints (both active and passive)
- Muscle tone (high or low?)
What are benefits of maintaining ROM?
- Maintenance of joint lubrication
- Prevention of impingement
- Maintenance of soft tissue length
- Reduction in tone
- Prevention of contractures
