gaining finger extension post-stroke

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.

You could try some electrical stimulation while doing reaching tasks. Try and incorporate it into something functional at the same time for a better chance of functional carryover.

Hello

Im srikanth, I have been teaching and using PNF techniques on my patients for quite some time. Try using irradiation techniques, they are quite useful in initiating thumb and finger extension. If u need more details please give the stonger components in ur patients limb. Good luck

Memory exs are very good & result oriented. There is researh on this. Another exs you could try is while you do approximation in sittin, give compression downward by holding at the medial & lateral aspect of elbow. do not handle the biceps while doing this. After doing a couple of times get the patient to attempt finger extension. If you do it well you will definitly get the ext'n.

hi
how can improve hand function in hemiplegic child ( result from RTA )
and thank u

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Originally Posted by muhana85d

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how I can improve the hand and arm function in hemiplegic child ?

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Before the UL functions are embarked on, check on the trunk. If the trunk is not stable, UL will not achieve control. Think trunk first. Most often, the flexors are spastic. Hence the arm must go outwards. They are stuck in midrange & inner ranges. Hence target should be outer ranges. Do not stretch. rehablitation should be painfree. Pain increases spasticity which increases spasticity again, & a vicous circle is set. Inhibit pects & biceps;get controlled extension. Inhibit pronaters & facilitate supinators. Approximate UL & give compression at elbow downward towards wrist. do not handle biceps at this time. You'll get wrist extension.As you make child sit on a balancing disc/ ball etc, work on the trunk & get lot of functional work on childs post deltoid & ext rot's. Hope this is helpful.

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Originally Posted by psychophysio

You could try some electrical stimulation while doing reaching tasks. Try and incorporate it into something functional at the same time for a better chance of functional carryover.

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there is no evidence of improving function by electrical stimulation,it may improve only isometric strenth but not isotonic..........do u know any evidence 4 improving function by es????

I cannot speak from experience but have you looked into saeboflex therapy?

hi
my self roshan dominic
physio from india.working as cordinator for one of the finest stroke rehab centers in india
i'll give u few sugesstions for the same.plz try n u'll get good results
1.plz try functional hand splint.if its not available ready made,plz contact ur OT for that.or u may try it through SAMMONSAND PRISTON.COM
2.CONCENTRATE MORE ON WEIGHT BEARING EXERCISES
3.try giving TENS for flexors and icing for extensors simultaneosly
4.never facilitate finger flexors,even if they have some movement.
5.do quick iceing for all extensors with quick strectching
6.never do quick stretching for flexors as it stimulates flexor synergy
try this methods n get back to me
roshan
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.[/QUOTE]

Please start the constraint induced movement therapy as you may get a lot of success with improvement of hand function.

my suggestion is PNF only. PNF not only initiates the movement but also gives strengthening to the muscles.

try PNF.. it s more useful always in most neurological conditions

I totally agree with Roshan's view except with one ;) . The web site URL that Roshan gave is wrong and it should be as www.sammonspreston.com . I was just trying to help out all of you there who are in search of the website for the splint. http://www.sammonspreston.com/

Your post was really informative.

Cheers
Rahid Kader

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Originally Posted by physioforu

hi
my self roshan dominic
physio from india.working as cordinator for one of the finest stroke rehab centers in india
i'll give u few sugesstions for the same.plz try n u'll get good results
1.plz try functional hand splint.if its not available ready made,plz contact ur OT for that.or u may try it through SAMMONSAND PRISTON.COM
2.CONCENTRATE MORE ON WEIGHT BEARING EXERCISES
3.try giving TENS for flexors and icing for extensors simultaneosly
4.never facilitate finger flexors,even if they have some movement.
5.do quick iceing for all extensors with quick strectching
6.never do quick stretching for flexors as it stimulates flexor synergy
try this methods n get back to me
roshan
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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[/QUOTE]

hi,

i had tried irradiation technique and especially concentrated on the diagonal pattern of PNF.. i'd elicited the flexor synergy muscles in the begining and then concentrated on the extensor group rather than treating both together.. this i did bcoz flexor synergy is more easilly elicitable then extensors.. for a time being.. try to concentrate on a single group rather than both the groups.. this is only to get a balance.. get back in treating flexor groups when u feel appropriate.. Ur clinical judgment will help you best in this situation..

hope u can get a good result..

best of luck..

Nabaroon

Thanks very much for all your replies - she has increased activity in all her fingers, still struggling to get IP extension of the thumb (the only position she achieves this is in supine when she's reaching for the ceiling and protracting the scapula. I have tried PNF with her but she tends to do better with hands off techniques. With hands on she tends to sit back and not do anything.
Thanks again,

finger and thumb extension is always facilitated with elbow exension(similar to the position you described of reaching the ceiling). you could repeat the finger and wrist movements alongwith gradualy incorporating elbow and shoulder flexion. once the pathway of extensoin is open all that is neede is reinforcement in different joint positions. try PNF trechniques with only voice commands from mid range to end range movements the you want to facilitate

can anyone give me the reference to irradiation techniques, what is it
how is it applied, where is it applied.........
all suggestion are welcome....

you can check "PNFin pratice by ADLER"

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Originally Posted by sjsrikanth

Hello

Im srikanth, I have been teaching and using PNF techniques on my patients for quite some time. Try using irradiation techniques, they are quite useful in initiating thumb and finger extension. If u need more details please give the stonger components in ur patients limb. Good luck

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HI SRIKANTH
CAN U PLEASE EXPLAIN WHAT IS IRRADIATION TECHNIQUE,HOW IT IS PERFORMED.

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Originally Posted by sdkashif

Please start the constraint induced movement therapy as you may get a lot of success with improvement of hand function.

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HI SDKASHIF,
CAN U PLEASE EXPLAIN WHAT IS CONSTRAINT INDUCED MOVEMENT THERAPY.
UR PREVIOUS THREADS AND POSTS R VERY GOOD AND THEY R VERY HELPFUL ALSO. THANK U FOR UR RESPONSE

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Originally Posted by SURESH BABU BODDU

can anyone give me the reference to irradiation techniques, what is it
how is it applied, where is it applied.........
all suggestion are welcome....

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can u tell me how can we initiate finger extension?my patient has got flexor synergy,but she can extend the elbow n has got wrist drp
Additional Comment I forgot:
hi,
can u teach me the irradiation tecnique for my patient who has devlopd flexor synergy n has 0 finger extension?

shreeyanshi

I feel your Pt has a more of flexor tone/synergy then it's counterpart(the extensor). I hope you need to go for INHIBITION of flexor the finger.

Once you can control this you should also concentrate in facilitation of the wrist and the finger extensor's...

Good luck.. bye

can u tell me how2 do inhibition of flexors?

shreeyanshi

For Inhibition of hypertonocity there are many technique. All are based on basics of neurophysiology.

to name a few: Reflex Inhibition posture, Reciprocal inhibition. etc are wonderful.

k Best of Luck

Since I am just a survivor you don't have to listen to me but has anyone looked at the diagnosis, ie. is the area controlling finger extension dead, if so then neuroplastical modification is required first. Otherwise the assumption you all are making is that all the motor control you are expecting to recover is in the penumbra, which will spontaneously recover in 6-12 months anyway.
Dean

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

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....................................

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.......

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)

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?