Test 2: UE Management

Question 1

UE screen vs assessment

Answer 1

Screen = strength, power, endurance, fatigue, tone, coordination

assessment = all of the above + pain, sublux, functional ability, outcome measures, participation

Question 2

what factors contribute to GH sublux

Answer 2

weakness

weight if heavy arm = downward RT of scapula

unlocking mechanism of capsule is lost and humerus subluxes inferiorly with IR

superiorly capsule and coracohumeral ligament are taut due to passive distraction and vulnerable to stretch and tear

Question 3

2 main categories that cause shoulder pain

Answer 3

spasticity - can cause secondary tightness of ligaments/tendons/capsule causing adhesive capsulitis

flaccidity - loss of proprioception and support from RTC = reduced stability

Question 4

what causes pain with sublux

Answer 4

malalignment during mobility causes impingement of soft tissue structures during shoulder ROM

pain with overhead reach and shoulder flexion over 90

do not use shoulder pulleys

Question 5

what is FIM

Answer 5

functional independent measure

measures disability for variety of populations

18 items

some subsets relate to functional use of UE

Question 6

what is the purpose of reach and grasp with patients

Answer 6

gives info on pts ability to move, anticipatory posture control, functional UE mobility

shows grip formation, hand shaping

can choose task to emphasize shoulder or elbow motion, hand opening/closing, individual finger motion, or combo of movements

Question 7

what measures does the strokeEDGE task force recommend students have competence in prior to graduating

Answer 7

9 hole peg test
action research arm test
box and block test
Fugl-Meyer assessment of motor performance
wolf motor function

Question 8

what is the action research arm test (ARAT)

Answer 8

examines UE function

19 items, 4 subscales

specific to adults with neuro dysnfunction

more sensitive, but less ceiling than FMA-UE

Question 9

scoring for ARAT

Answer 9

0 = cant perform any part of test
1=partial performance
2= completes test but takes too long/is very difficult
3= normal performance

Question 10

subscales of ARAT

Answer 10

grasp
grip
pinch
gross movement

Question 11

describe 9 hole peg test

Answer 11

measures finger dexterity

ICF = body structure/function and activity

pegs moved and put in 9 pegs, then returned to container; time is measured

Question 12

describe the box and block test

Answer 12

measures manual dexterity

ICF = body function/structure and activity

box with central divider; move as many blocks as possible over divider to other side of box

count number of blocks moved in 60 sec

Question 13

what is Fugl-Meyer assessment

Answer 13

stroke specific outcome measure

full test = subsets for UE, LE, balance, sensation, ROM, and pain

ICF = body structure and function

based on observation of sequential recovery of motor function

used for reasearch

Question 14

describe the UE subsection of the Fugl-Meyer

Answer 14

assesses body structure and function

high score = better outcomes

max score 66

used for reasearch but not clinical

Question 15

what is the wolf motor function test

Answer 15

standardized UE assessment for adults post stroke

ICF = body structure/function

15 timed tasks and 2 strength measures

tasks arranged in order of complexity

high interrater reliability, internal consistency, and test-retest reliability

6 point rating scale; 0 no use, 5 normal

max 75 points

Question 16

reasons a pt may not use affected limb following stroke that contribute to learned nonuse

Answer 16

weakness/paresis
altered force production
sensory loss
spasticity
stroke related pain

Question 17

what is learned bad use

Answer 17

compensatory movements used to complete task

become habit

i.e. using trunk flexion rather than elbow extension to reach

Question 18

what to be mindful of when patients forget to use their affected arm

Answer 18

use it or lose it

repitition matters

out of sight out of mind- forget about limb

pt isnt cued to use limb so they compensate even more

attention is needed to relearn to use the limb

Question 19

chronic phase of stroke rehab often focuses on

Answer 19

reducing secondary impairments to improve compensatory patterns of function

Question 20

intervention for flaccid UE

Answer 20

WBing posiiton with therapist stabilizing

Question 21

describe the task oriented approach

Answer 21

focus on performance of normal ADLs with paretic hand

encourages neuroplasticity

salience- meaningful and feasible

Question 22

describe the facilitation approach to intervention

Answer 22

provide assistance during functional activities as needed but no more than needed

physical demands can be altered to enhance performance

Question 23

when is STM, joint mobilization, and ROM recommended

Answer 23

indicated early to encourage AROM and prevent contracture

Question 24

what to be mindful of at the shoulder with PROM

Answer 24

in ranges of 90 deg of shoulder flexion be careful not to perform distraction of humerus

scapula should be mobilized with emphasis on upward RT and protraction

dont use shoulder pulley with neuro pt- dont facilitate proper scapulohumeral rhythm

Question 25

what are 2 ways upper limb can be used with UE intervention

Answer 25

stabilizer - increase WBing and approximation of joint manipulator - reaching and grasping

Question 26

describe the use of the UE as a stabilizer

Answer 26

extended arm and stabilized hand in WBing on support surface promote posture shift to more affected side promotes proximal stabilization, decreases flexor hypertonicity, allows approximation of joint, and tapping cues can increase extensor muscle activity

Question 27

describe the use of the UE as a manipulator

Answer 27

introduce grasp need finger ext later stroke intervention- can be frustrating perform bimanual activities and ADLs

Question 28

when/how to use CIMT with UE intervention

Answer 28

sub acute, do not use in acute - need more distal function restrain unaffected arm for 90% of waking hours therapy focuses on intensive/repetitive task training 6-8 hours a day can be very restrictive and long hours of therapy can be quite burdensome

Question 29

describe the ideal shoulder sling

Answer 29

maintains normal angular alignment with allowed freedom of movement decreases tendency of humerus to IR takes some weight of arm off of trunk

Question 30

general rules for slings

Answer 30

therapist should minimize use during therapy slings may be useful for initial transfer and gait training traditional slings that position UE in flexion are less desirable should be used only for select upright sctivities and only for short periods

Question 31

effective alternatives to slings

Answer 31

taping/strapping - KT tape to facilitate/inhibit periscapular muscles electrotherapy - to reduce shoulder sublux and enable active support via own muscular contraction

Question 31

effectiveness of support trough

Answer 31

arm trough overcorrects sublux vs shoulder sling

Question 32

what is a resting hand splint and the pros/cons

Answer 32

semiflexible orthotic to prevent extreme wrist flexion which limits grasp function for night use only pros: limits contractures/spasticity return, positins wrist and hand in position that minimizes potential development of undesirable flexion contractures q con: enforces learned nonuse

Question 33

pros and cons of unilateral devices for mobility

Answer 33

pro = use of bilateral with a pt with significant UE involvement requires therapist; can be more independent con: compensatory gait pattern encouraged, use of step to gait pattern, non-normal pattern can impact neuroplasticity, goal is to encourage pt to use affected limbs

Question 34

what is the algorithm for UE interventions

Answer 34

Upper limb intervention algorithm clinician guides to determine appropriateness of UE intervention based on acuity of stroke and CLOF algorithm based on shoulder abduction finger extension (SAFE) model