gaining finger extension post-stroke

[clarett]

Hi
I'm treating a woman with a 5 week old right hemi. She has active movement in all UL joints, has full ROM and has no subluxation. She is progressing well but I'm looking for inspiration for what else I can do to stimulate finger extension. She has limited extension in all digits - not enough to be functional. We are using sweeping as sensory stim., active & active - assisted exercises, weight-bearing....
Got any more ideas to stimulate extension as there has been no progress over the last week? There is a slight increase in flexor tone but it is not inhibitory and when it is inhibited she doesn't gain any extension.
All suggestions welcome.

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[Nabarun]

Hi oc1dean

i'll definetlly agree with you about the assumption that the area controlling finger extension is dead ( but it might have not been damaged, in case the site of injury may be away from the point).

usually a considerable amount of molecular and cellular changes take place in surrounding area of infarct. Such changes occur at a greater than normal level, persist chronically, and in many cases have been interpreted as important to poststroke recovery.

Neuroplasticity is the changing of neurons, the organization of their networks, and their function via new experiences. (also referred to as brain plasticity, cortical plasticity or cortical re-mapping).
Thus if neuroplasticity needs to take place it requires NEW EXPERIENCES which has to be provided through rehabilitation measures to the patient. No one should sit back for spontaneous recovery, which may or may not take place in 6-12 months.

"Motor Learning" is very much important. thus rehabilitation measures always tries to get the very best for maximal recovery after any brain insult.

Unless we try we never succeed. i always tried to be optimist.
anyway thank you.

Nabaroon

[bsgandhi01]

do any one has idea of shockwave treatment and high level laser therapy ???

is there any manufactor in india who offer shockwave and high level laser instrument made in india???

the impoted instruments are very costly both for therapist and patient as we have to chage much higher because of high investment....................................

[Judith Mollet]

Re Hand rehab in Stroke: The hand is basically a "hands on" organ which is used to feel objects, manipulate and peform doing actions, express oneself with gestures etc. Certain suggestions like "training in weight bearing" and "hands off is giving bessser results" must be reconsidered and explained. Hands are not for walking. Certainly as much hands on as needed but as much hands off as possible is OK but a hand needs sensory input in all sorts of ways to raise the input on neural structures to activate lets say the "telephone connection to the brain" to faciltate movement. Work with: active assisted movements of thumb EXt/Fl, Ab/Ad, Thumb to Index finger, away from index finger; Stimulation of thenar and hyperthenar muscles with various objects, Assisted Lumbrical movement, patterns of movement are all important. Try (suitable stable supported enough sitting position so she can see the hand) tapping her end pad of thumb with a not too sharp point like a blunt pencil, the same to the index finger, move them together then apart. "mark" the borders of the thenar and hypothenar eminance with your finger firmly enough, or with some blunt object. And do it for more than just a few seconds. And as someone has already mentioned what is the rest of the body doing? A stable thorax and activated stimulated setting of the scapula is very important. Shoulder/Ellbow etc has already been mentioned. The proximal upper limb/thorax must be "stable" bt also mobile enough to place the hand distally to where we need to use it. I understand what you mean with "sitting back and not doing anything" you have experienced but HALLO! ; the patient may have concentration problems reduced tonus and very reduced endurance (among other problems)post stroke but you have to find the happy medium with encouraging enough stimulating input to get output without exhausting the patient. I'd say a hand has to be touched enough because that is what a hand is for. Without forgetting the rest of the body.......

[Nabarun]

Thanks Judith

for the concern about 'concentration problem, reduced tonus, reduced endurance' and bringing to notice.. psychological well being and counseling should be among the priorities in overall development

the point raised during the initiation of the tread was specific to "gaining finger extension". Functional use of hand is mobility and doing various activities requiring precision and priority wise if finger and wrist extensors should initiate. I believe that the training in weight bearing as mentioned in previous posts are pointing toward its beneficial effect in reducing hypertonicity (as in reflex inhibiting posture)

[dkosnik]

Hi everyone! I just signed up this morning and I'm looking for some answers. I've had multiple strokes. The first at the age of nine. I'm turning 40 on November 4th. While I have learned to walk and talk again. My right arm lacks any fine motor skills. Basically, it's a paper weight at best. Since so much time has past is it still possible to retrain the brain at all so my arms can do more?