neuro exam 2- impairments of the neurological UE

why should OTs treat and address the hemiplegic shoulder?

shoulder function is necessary for mobility and ADLs, OTs can address positioning to manage UE function

what is an inferior subluxation

changes in the mechanical integrity of the GH causing a palpable gap between the acromion and humeral head, gravity will pull it downward and laterally due to weakness

what could an inferior subluxation cause

anterior subluxation

what happens in an anterior sublux?

head of humerus is brough forward with more internal rotation, this results in an even larger palpable gap in the front part of the shoulder, increase spasticity causes pull on subscap and pec major

what is superior subluxation?

increased tone causing the humeral head to become lodged under coracoid of the scapula, caused by increased muscle tone in the traps, deltoid, and RTC muscles

what movements of the UE result from spasticity

scap retraction and depression, and humeral IR and AD (leads to contractures in the shoulder or restricted ROM)

what must be assess before assessing the shoulder?

pelvis, trunk, scap

what are positioning techniques that could be used to prevent shortening of muscles

half lap trays, side lying, scap mobs (properly aligning the articulation of the scap in the GH joint)

right after damage to the cortex, what kind of tone do we see?

flaccid tone results from extreme trauma damag, spasticity creeps in over time

if high tone associated with LMN or UMN damage

UMN, but immediately after damage you will see hypotonicity

what are biomechanical chnages resulting from spasticity?

disuse atrophy, shortening of soft tissues in muscles, maladaptive movements, abnormal posture, pain, loss of ROM, skin breakdown

what is the impact on function from spasticity?

decrease performance bc of limited ROM and pain, increases risk of skin break down and fx’s esp if pt is not WBing

what are the two typical assessments of tone?

modified ashworth and the tardieu

what are common UE sites to screen for tone?

pec major shoulder AD (quickly stretched into AB to test, biceps flexion (quickly stretched into elbow extension, and vice versa for triceps elbow extension

what is the difference between the modified ashworth and the tardieu

the ashworth is more commonly used clinically but does not differentieate spasticity from contracture, the tardieu uses velocity at different angles of the joint to idenfity spasticity

what are direct interventions to influence tone

neuroinhibition and facilitation techniques, casting, splinting, surgery and meds and botox (however this must be OKAYed by dr)

how does botox help to decrease spasticity?

injected into the muscle so the conncection between nerves and muscles is temporarily stopped 

what is a maclofen pump

surgically implanted pump administering baclofen into spinal cord to minimize tone

what is important to remember when treating spasticity

decreasing spasticity does not automatically bring function back, somatosensory, proprioception, and perceptual impairments all must be considered too

what are the four big direct intervention approaches for spasticity OTs can use

1. neuroinhibition/neurofacilitation techniques

2. task oriented approaches

3. CIMT

   1. biomechanical interventions

what are symptoms of CRPS

changes in skin temp, color, texture (hair and nails too), burning or throbbing pain, swelling, and hypersensitivity

what is the relationship between CRPS and shoulder sublux

decrease in circulation to area or inflammation in area can cause CRPS there, which can both be caused by shoulder sublux

what is the difference between type I and II of CRPS

type I is more common and associated with hemi’s from CVA and TBI, type II is less common and associated with trauma

what is stage one of CRPS

persistent pain that is burning or aching feeling. Extremity is warm and sensitive and lasts 3 monthes

what is stage 2 of CRPS

color and texture skin changes occur, atrophy of muscles begins, lasts another 3-6 months

what is stage 3 of CRPS

soft tissue damage is more extensive, contractures occur, more irreversible effects, spreads to other body parts

what are recommended tx’s for CRPS

PROM at GH, using scapulohumeral rhythms, strengthen shoulders, reduce spasticity, and positioning