Chapter 12: Upper Extremity in Stroke

For the Instructor Guide and Worksheet Key please contact user services at userservices@mheducation.com

OUTLINE

Objectives:

The student will:

1. Demonstrate appropriate verbal instruction and manual skills to prepare for a task-oriented intervention.

2. Describe, demonstrate, and teach at least three upper extremity (UE) weight-bearing activities and describe the appropriate indications/precautions for each activity.

3. Select, demonstrate, and teach an appropriate task for retraining UE reaching and an appropriate progression, providing sound rationale for his/her task selection.

4. Accurately demonstrate and teach at least one task-oriented intervention and a progression, and an exercise for the shoulder, elbow, wrist, and hand for a client with hemiplegia.

Activity 1. Movement Analysis of Open Chain Reach

Activity 2. Management of Abnormal Tone in the UE and Benefits of UE Weight Bearing

Students will practice techniques to reduce the effects of spasticity and promote weight bearing through the UE in people with stroke.

Activity 3. Outcome Measures for Further Assessment

Students will practice outcome measures for arm function.

Activity 4. UE Exercises and Activities

Students will practice specific strengthening exercises for the UE.

Activity 5. Case Work

Students will complete an assignment for one of three cases.

WORKSHEET

Evidence-based points to keep in mind across interventions:

1. Arm and hand movements must be trained early to prevent learned nonuse.

2. Focus contracture prevention on the shoulder adductor/internal rotator, and elbow, wrist, and finger flexor muscles.

3. Upper extremity (UE) movement throughout the chain is driven by what the hand is doing.

4. The goal of the activity should be clear to the client.

5. Activity should be elicited at first in the position of greatest mechanical advantage to the muscle (eg, client in supine with arm at 90 degrees for the deltoid).

6. If a muscle does not contract, vary the conditions (ie, eliminate gravity, use closed chain exercise vs. open chain, use external focus feedback vs. internal focus) to elicit a contraction.

7. Do not hold the limb too firmly since it may prevent the client from activating muscles.

8. Do not overuse passive movement to teach a pattern or movement.

9. Tasks involving both arms should be introduced as soon as possible (ie, clasp hands together and lower and raise arms or go side to side; push or pull objects with both arms).

Activity 1. Movement Analysis of Open Chain Reach: Examination Skills

Watch the video (Video 6-1) and analyze the client's affected UE movement. Describe the movement strategy or components observed. Hypothesize as to which impairments in body structure or function may be leading to the observed movement strategy: