hemiplegic upper limb Flashcards
(26 cards)
what is the combined action of the RC muscles?
to stabilise the head of the humerus in he glenoid cavity
briefly describe the scapulohumeral rhythm?
-2 degrees of GH movement for every 1 degree of scapular movement
ratio is 2:1
what are the consequences of UL dysfunction?
-pain
-recovery and outcome of rehab
-interferes w. rehab
-interferes w. transfers
-ADLs
-depression
-sleep disturbance
what are the causative factors of post stroke UL dysfunction?
-paralysis / loss of mvt post stroke
-muscle weakness
-muscle imbalance
-abnormal tone
-sensory loss
-dependent limb
-forced ROM
-poor handling
- trauma
what are examples of secondary impairments/ effects on patient post stroke in hemiplegic UL?
-immobility
-weakness
-abnormal tone
-adaptive soft tissue changes
-degenerative changes
-restricted joint ROM
what are the 3 types of shoulder dysfunction after stroke?
-hemiplegic shoulder pain HSP- very common
-subluxation
-shoulder hand syndrome - chronic pain, changes in skin, swelling etc in affected area
describe HSP
-common post stroke -
may get it in acute stage or later on
-there can be a presence of abnormal tone and or subluxation
-sharp pain at end of ROM
-night pain
what are examples of causes of hemiplegic shoulder pain?
-loss of co-ordination joint motion eg abnormal scapula-humeral rhythm, loss of external rotation
-muscle imbalance
-forced / passive ROM
-incorrect handling / trauma eg fall
what is subluxation? discuss it with regards to the shoulder
partial dislocation of the joint
-scapula is depressed or retracted and there is an impaired locking mechanism
what are examples of factors that can cause subluxation of the shoulder in neuro patients?
-paralysis of RC muscles
-abnormal tone
-gravity
-weight of limb
-loss of locking mechanism
how does subluxation present in neuro patients?
-may or may not be painful - due to loss of sensation
-could be inferior, superior or anterior subluxation
-they could describe a dragging
-mal alignment of shoulder
relieved by passive elevation
-there is a palpable dip
how do you check for a hemiplegic shoulder subluxation?
-patient should be in sitting
-palpate from the SC joint along the clavicle to the AC joint
-check for a gap
- a gap of 1-2 fingers indicates subluxation
what are the signs of stage 1 shoulder hand syndrome?
-tender swollen hand
-sensitivity
-diffuse aching pain
-discolouration
-warm / moist
-loss of mvt
describe the signs of stage 2 shoulder hand syndrome
-marked pain and swelling
-progressive loss of mvt
-oedema loss of skin elasticity
describe the signs of stage 3 shoulder hand syndrome
-decreased ROM
-muscle atrophy
-soft tissue changes
-joint contracture
-deformity - eg flexion
-resolution of pain and oedema
how is shoulder hand syndrome managed?
-normalise tone
-normalise alignment
-sensory re -education
-handling and positioning
-facilitate normal motor control and muscle activity
list examples of approaches for management of hemiplegic shoulder dysfunction
-positioning NB - if supine - keep arm up and away and not in high tone position
-education
-normalise tone and alignment
-posture
-mobilise scapula
-restore function
-strapping and taping
-external rotation rehab
how is subluxation managed?
-correct position of scapula - eg slings and position
-minimise trauma
-facilitate muscle handling
what are good positions for care of the hemiplegic UL?
-NB SUPPORTED IN ALL POSTURES
eg lying on hemiplegic sides, sitting in bed with pillows supported hemiplegic limb
list the stroke arm position tool
-sit up straight
- stroke shoulder slightly forward
-stroke elbow away from the body
-stroke forearm slightly forward
-palm down and finger straight
how should you support a hemiplegic limb during transfers and mobility?
-slings should only be used for transfers and walking
-when in bed / chair - sling should be removed and arm should be positioned appropriately
what are the factors to consider if using NMES?
-sensation of area
-tissue viability - what kind of condition is it in?
what are the aims of NMES?
-reduce pain
-reduce atrophy
-reduce risk of subluxation
-increase ROM
-assist w/ muscle activation
what does GRASP stand for?
graded repetitive arm supplementary program
ready made exercise program w/ 3 levels
