Spastic Upperlimb in Hemiplegia

I am currently seeing a patient with with a spastic left upper limb after a stroke, there is nil voluntary movement in the upper limb. I need recommendations on other types of management

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Originally Posted by femiojagbule

I am currently seeing a patient with with a spastic left upper limb after a stroke, there is nil voluntary movement in the upper limb. I need recommendations on other types of management

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You need to assess whether the change in tone is related to posture or not. e.g. Does the tone fluctuate between supine, sitting and standing. If so you will be able to find areas where you can work to assist the person with more 'core' stability before moving into postures that challenge this excessively, hence resulting in an increase in tone.

it is important to work on balance and supported sitting before moving to standing if there is currently a large difference between the two positions and tone/spasticity. It might be nice to work with the client sitting on a ball as a progression from stable sitting on a rigid surface before going to standing.

Thanks Physiodude,
the thing is that upperlimb is relaxed after appling a susutained stretch, but once he makes a movement the tone increases, I guess tone fluctuates between changes in position.

Quote:

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Originally Posted by femiojagbule

Thanks Physiodude,
the thing is that upperlimb is relaxed after appling a susutained stretch, but once he makes a movement the tone increases, I guess tone fluctuates between changes in position.

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You have provided your answer there. The person needs to work more in unbalanced sitting to get their trunk control better. The perhaps standing with enough support to keep the arm relaxed.

Thanks once again,
what is the place of electrical stimulation, as there is increased tone in both the upperlimb and lower limb but no active movement.
waiting for a reply

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Originally Posted by femiojagbule

Thanks once again,
what is the place of electrical stimulation, as there is increased tone in both the upperlimb and lower limb but no active movement.
waiting for a reply

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Whilst this may have a use, at this stage this should not be on your immediate plan. You need to reduce the tone before you begin to try and increase the voluntary movement. Often a reduction in tone can give light to some underlying control. Be patient and let us know what you do and how the patient progresses. :)

to reduce tone u can go for light joint compression. check for shoulder pain ,if it is there it can increase spasticity bcoz fear of pain while movement increase the spasticity