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Hemiplegia
ALISON
Posted: Thursday, April 10, 2008 4:39 PM
Joined: 3/31/2008
Posts: 50


Does anyone know of a good intervention to do with a patient you has hemiplegia, severely limited AROM in all areas, and needs to increase his independence with upper extremity dressing?

 


Anonymous
Posted: Thursday, April 10, 2008 4:43 PM
I have a patient with a minor subluxation and I don't want to resort to taping. Any suggestions for some good stabilization techniques?
Posted by: OT-Advantage at 4/9/2008 9:02 AM



jenniferm.craig
Posted: Thursday, April 10, 2008 9:57 PM
Joined: 4/10/2008
Posts: 2


You are right, I would not resort to taping. If the patient has hemiplegia, most likely, he/she has weakened/loss of pelvic/trunk, rib cage, and scapula control. As a result, the glenohumeral joint has become weakened, causing the humeral head to become subluxed. My suggestion would be to start with trunk stability and move distally from there. Try doing some weight bearing exercises: have him/her sit on a mat and lean forward onto a stability ball. Have them weight bear through the affected side and do different activities with the other. The key to subluxation is to start proximally with the trunk, and work distally until the patient has good trunk control and correct scapular alignment. This will bring the head of the humerus back into the glenoid fossa.
Loc
Posted: Tuesday, April 22, 2008 12:26 AM
Joined: 4/12/2008
Posts: 3


Alison regarding your posted msg., I am facing a similar dilemma with my patient.  Also, does anyone know of any good strategies to increase a hemiplegic patient's grasp/release hand motion?

OT-Advantage
Posted: Wednesday, April 23, 2008 8:42 PM
Joined: 11/9/2007
Posts: 15


Have you tried changing the surface level?  Having the client stand up to pick something up from off the table or pick something up from off of the floor in sitting is good, as a start (they could also release a 1-2# wt onto the floor).  Also, stabilizing an object at the top, by the therapist, and then having the client attempt to grasp various sized objects is good.  Have you tried any force modulation?  Also, you can have the client hold onto a dowel rod, with both hands, and have the client do a crossover pattern (like a grapevine). 


NeuroOT
Posted: Sunday, August 03, 2008 1:07 PM
Joined: 8/3/2008
Posts: 7


It all starts at the scapula when trying to increase AROM and functional use.  If the scapula becomes fixed or even imbalanced than the dynamics of the arm will be off creating an orthopedic disadvantage.  Check out "Functional Stroke Rehabilitation" by Glen Gillen.  This book has helped me out considerably over the years.
AshSallee
Posted: Tuesday, March 09, 2010 2:20 PM
Joined: 3/9/2010
Posts: 1


Hi, I'm a OTA student and I just stumbled across this site, very impressed with it!! I to have question with R CVA as well, most of my current qurestions yall have already answered in your conversations. My Pt is an elder who had her CVA almost 15yrs ago and I'm working with her as part of a "best friends" program at the nursing home. She doesn't have left neglect but she refuses to use her left side, "says it doesn't work!" My actual question is how do I open her hand back up? Her hand is in a constatant fist but the rest of her arm is not contracted? Can one part be contracted and the other not?
OT-Advantage
Posted: Wednesday, March 10, 2010 2:35 PM
Joined: 11/9/2007
Posts: 15


Have you tried a cone, finger separator splint or a type of volar resting hand splint?  If she is only contracted in the hand, and not the wrist, that is a bit odd.  However, everyone is different! 

If it is just in the hand, the cone splint can be introduced for a minimal period of time per day to progress to a longer wear schedule or nighttime wearing.  If there is increased tightness or contracture in the wrist, you may want to look into volar splinting options that include the hand/wrist/forearm.  This will increase support and address the hand contracture.

Any type of splint you introduce will need to be complemented with a good preparatory program, rom/exercise program, pt/nursing education, among other areas.  I would talk to your supervising COTA or OTR and ask their thoughts as well. 

 

Good luck!


 
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