Thank you for reaching out to us.
Upper limb management and facilitating recovery of the hand, arm and shoulder often requires a multi-pronged approach. There are often many layers to consider and I would encourage you to team up with the physiotherapist, your clinical supervisor and fellow colleagues to reassess your patients progress. What factors are contributing to your patient’s presentation? Muscle spasticity, weakness of extensors, pain, proprioception, overactive flexors, sensory changes or even joint changes. Together as a team, you can discuss your findings in the context of available evidence to guide how you might move forwards with your therapy.
Continue to reassess the effectiveness of your treatment. Don’t be afraid to change the direction of your therapy if the intervention isn’t leading to change.
Remember that practice of range of movement is likely to target improved range. If you are looking to building on strength, you may need to look at other intervention strategies. You may even look at ways you can tap into sensory pathways to facilitate recovery.
I like to think of movement as building blocks that have a domino effect. You can influence movement patterns from proximal to distal or vice versa. Facilitating good scapula stabilisation at the thorax can provide the postural basis for a more stable shoulder and therefore reach and grasp tasks. Building strength in the hand and lumbricals can improve neural pathways for extension of the elbow to reach.
Here are some links to clinical guidelines and articles that you may like to review to help guide your clinical judgement:
Stroke Clinical Guidelines 2017
Interventions to improve arm and hand function in people after stroke: Cochcrane review
Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery
You can also contact us on StrokeLine 1800 787 653 if you would like to discuss your patient in more depth.
Regards
Carol, Physiotherapist, Strokeline
