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STROKE MANAGEMENT UPPER LIMB
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�65 years old woman has been
referred to you by her
physical therapist fororthotic evaluation. She comes
to you with this clinical
presentation.
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Stroke is interruption of the blood flow to the brain
resulting in cerebraldamage.� Usually the damage only
effects one hemisphere,
each hemisphere the braincontrol the other side of thebody.
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� Ischemic : a lack of blood flow cause byobstruction, constriction or blockage of the
blood vessels� Hemorrhage : bleeding into the brain tissues
� An aneurysm, degeneration of an arterial wall or injury to the wall of an artery
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1. Initial period of ³cerebral shock´ Immediately, lasts from few days to few weeks
The muscle tone will be flaccid2 . Flaccid stage Starts between the 2nd to the 6th week after the
stroke
3 . Recovery stage Movement slowly start again
4 . Spastic stage Increase tone (spasticity) is seen in many
muscles at the same time
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� Shoulder : retracted, depressed and int.rotated
� Elbow : flexed� Forearm : pronated� Wrist : flexed�
Hand : fingers flexed� Hip : internally rotated, extended
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� sudden numbness or weakness of the face,
arm and/or leg
� sudden confusion, trouble speaking, ordifficulty understanding speech
� sudden difficulty seeing in one or both eyes
� sudden trouble walking, dizziness, loss of
balance, or loss of coordination
� sudden severe headache with no known
cause
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� Aim of rehabilitation team :
Regain maximum function
Improve quality of life Put the limbs in anatomical position
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� Doctor : surgery and medication
� Physical therapist : exercise
� Occupational therapist : improve daily living� Family :
� Prosthetis & Orthotist : provide brace /
device
� Speech therapy
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� DIP extention� PIP flexion� MCP flexion� Elbow flexion� Glenohumeral subluxation
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� G oals R educe flexor tones at finger
Avoid flexion contracture and deformity Maintain the hand and wrist in comfortable
position
Anatomically neutral position
Help correct deformities
Control the joint motions
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1. Rigid or static resting wrist hand orthosis � functional position :
20 ² 30 degree of wrist extension35 to 45 degrees of MCP joint flexion20 to 45 degrees PIP joint flexion10 to 20 DIP joint flexion
Thumb carpometacarpal joint partiallyabducted and opposed (36-38)
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2 . Elbow wrist hand orthosis
� Fuction
Preventing contracture
Control elbow motion
For the functional position same
with rigid or static resting wrist
hand orthosis
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� Function
Prevent subluxation of the shoulder joint
Prevent rotation of the shoulder
Support shoulder from depression
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THANK YOU