gaining finger extension post-stroke

[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)