Recovery of the upper limb function after stroke

1
Recovery of the upper limb function after stroke

• Wael Alasaq PT. Ph.D.
• Kuwait University
• PT Dep.

2
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

3
Reports Cont.

• ve effects of interventions involving repetitive
  exercise practice of task-oriented
  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)

4
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.

5
Analysis of motor performance

• UL functional performance is affected by
• Depressed motor output
• Decreased rate of neural activation
• Poor timing coordination of segmental movements
• Sensory deficits

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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.

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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
• (ODwyer ey al. 1996, Ada ODwyer 2001)

8
Research findings cont.

• Reflex hyperactivity muscle stiffness respond
  vely with vigorous task-specific exercise
  training.
• (Miller Light 1997,
  Teixeira-Salmela et al. 1999)

9
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)

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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.

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Management of shoulder pain

• Injection of anti-inflamatory or analgesic
  substances
• TENS
• Passive joint mobilization
• Active exercises

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Prevention Prevention Prevention

• Positioning
• Pain-free active exercise
• Electrical stimulation Anterior posterior
  deltoid muscle.
• Avoid damaging activities, such as pulling,
  passive ROM exercises