week 3

Question 1

What are the potential problems of the shoulder post neurological event

Answer 1

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

Question 2

in what stage of a post-stroke does subluxation of the shoulder occur

Answer 2

occurs initially in the flaccid stage post stroke

Question 3

what are some of the potential causes of hemiplegic shoulder pain

Answer 3

glenohumeral subluxation
spasticity
impingement
rotator cuff tear
adhesive capsulitis
reflex sympathetic dystrophy
bursitis
tendonitis

Question 4

what are the impacts of hemiplegic shoulder pain

Answer 4

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

Question 5

how do you reduce the risk of hemiplegic shoulder pain

Answer 5

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

Question 6

what are some upper limb problems for neuro patients

Answer 6

flaccidity
weakness
spasticity or rigidity
pain
change of sensation
ataxia
shoulder subluxation
loss of co-ordination
tremors
reduced dexterity

Question 7

what is subluxation

Answer 7

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

Question 8

what is an inferior subluxation caused by

Answer 8

rotator cuff weakness
weakness also present around the shoulder girdle means the scapula loses stability on thorax

Question 9

what is anterior subluxation due to

Answer 9

tight pecs and latissimus dorsi

Question 10

what is superior subluxation due to

Answer 10

due to tight supraspinatus or deltoid

Question 11

what is the typical pattern of post stroke

Answer 11

shoulder medial rotation/adduction
elbow flexion/pronation
wrist/fingers flexed

Question 12

name some techniques for managing spasticity

Answer 12

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

Question 13

what does tapping do

Answer 13

tapping over the muscle belly to stimulate reflex contraction
sensory input to encourage motor output

Question 14

what are some positive indicators of UL recovery

Answer 14

early UL strength
intact sensation
motivation

Question 15

what are some negative indicators of UL recovery

Answer 15

severity of paresis
cognition
pain
subluxation
flaccidity
visual inattention
neglect/inattention
receptive dysphasia

Question 16

name some possible reasons for poor UL recovery

Answer 16

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

Question 17

name some problems neurological patients may have that impacts their UL function

Answer 17

weakness/flacidity
spasticity or rigidity
contractures
loss of function
pain
change of sensation
poor postural control
tremors
reduced proprioception
ataxia/loss of coordination

Question 18

name some things to consider when rehabilitating sensation

Answer 18

focus on different textures
use of vision/without vision
stereognosis
proprioceptive input
weight bearing
following and placing
functional handling

Question 19

name some things to consider when rehabilitating motor output

Answer 19

repetition of goal orientated task
functional
maximise relevance
accessibility
achievability - build complexity
realistic
keep it interesting to encourage motivation and compliance

Question 20

What is CMT

Answer 20

constraint-induced movement therapy (use a glove or plaster cast to stop them using their good hand)

Question 21

How do you rehabilitate someone with no or limited UL movement?

Answer 21

focus on sensory stimulation
facilitation
mirror box
mental imagery
functional electrical stimulation

Question 22

What are the uses of FES

Answer 22

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

Question 23

What are some contraindications of FES

Answer 23

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

Question 24

Name some precautions for FES

Answer 24

abnormal skin sensation - choose another area
epilepsy
abdominal electrodes used in labour may interfere with foetal monitoring