Transcript Recovery of the upper limb function after stroke

Recovery of the upper limb
function after stroke
Wael Alasaq PT. Ph.D.
Kuwait University
PT Dep.
Functional recovery
Reports:
 Functional recovery of UL of pt vary from 5%-52%
(irrespective of initial impairment severity)
Gowland, 1982 & Dean & Mackey, 1992
 20% of pts with flaccid UL 2 WKs after stroke
regained any functional use of the hand.
Wade et al 1983
 Absence of a measurable grip by 1 moth after
stroke indicate poor functional recovery
Sunderland et al 1989
Reports
Cont.
 +ve effects of interventions involving
repetitive exercise & practice of taskoriented & functionally relevant actions.
(Sunderland et al 1992, Butefesch et al . 1995, Duncan 1997, Kwakkel et al 1999, Perry et
al 1999b, Nelles et al 2001)
 +ve effects of intensive task-oriented
exercise of the affected limb during
constraint of non affected limb in those with
some ability to activate hand muscles
(Taub et al. 1993, Liepert et al. 2001)
Reports
Cont.
 Although most recovery occurs within the
first 3 mths, training studies have shown
improvement in functional UL performance
more than 1 year following strike.
 This suggests that functional recovery may
go on for much longer for those maintaining
active use of the limb.
 This reflects the nature of brain
reorganization as a result of use & activity.
Analysis of motor performance
UL functional performance is affected by:
1. Depressed motor output
2. Decreased rate of neural activation
3. Poor timing & coordination of segmental
movements
4. Sensory deficits
Motor analysis
Cont
Research findings:
 No evidence of proximal to distal recovery.
 Weakness of GHJ abductors, flexors &
external rotators & of supinators affect
reaching actions.
 Weakness of wrist extensors, finger &
thumb flexors & extensors, abductors &
adductors affect manipulation of objects.
Research findings
cont.
 Reaching movement generally slower after
stroke.
 Pts perform better in concrete tasks
involving meaningful interaction with an
object, compared to an abstract task with no
object.
(Van der Weel et al. 1991)
 Reflex hyperactivity, associated reactions &
co-contraction do not necessarily interfere
with function
(O’Dwyer ey al. 1996, Ada & O’Dwyer 2001)
Research findings
cont.
 Reflex hyperactivity & muscle stiffness
respond +vely with vigorous task-specific
exercise & training.
(Miller & Light 1997, Teixeira-Salmela et al. 1999)
Shoulder Pain
 84% of pt develop shoulder pain following
stroke. (Najenson et al. 1971, van Ouwenaller et al. 1986, Roy et al. 1994)
 With some pts pain start to develop as early
as 2 Wks after stroke (Brocklehurst et al. 1978)
 Decreased in the pain-free range of
movement occur within the first 2 WKs.
(Buhannon & Andrews 1990)
 Subluxation may occur within 3 WKs
(Chaco & Wolf 1971)
Shoulder Pain
Cont.
 Shoulder pain interferes with rehabilitation & has –
ve effect on functional recovery.
 Factors causing shoulder pain
– Pre-stroke factors (degeneration)
– Post-stroke factors (immobility, soft tissue changes,
disuse, trauma etc)
 Pain is mostly due to
– Development of adhesive capsulitis
– Pinching of stretched soft tissue between joint surfaces.
Management of shoulder pain
 Injection of anti-inflamatory or analgesic
substances
 TENS
 Passive joint mobilization
 Active exercises
Prevention Prevention Prevention
 Positioning
 Pain-free active exercise
 Electrical stimulation: Anterior & posterior
deltoid muscle.
 Avoid damaging activities, such as pulling,
passive ROM exercises