Stroke Upper Limb

8/6/2019 Stroke Upper Limb

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STROKE MANAGEMENT UPPER LIMB



�65 years old woman has been

referred to you by her

physical therapist fororthotic evaluation. She comes

to you with this clinical

presentation.



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.



� 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



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



� Shoulder : retracted, depressed and int.rotated

� Elbow : flexed� Forearm : pronated� Wrist : flexed�

Hand : fingers flexed� Hip : internally rotated, extended



� 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



� Aim of rehabilitation team :

Regain maximum function

Improve quality of life Put the limbs in anatomical position



� Doctor : surgery and medication

� Physical therapist : exercise

� Occupational therapist : improve daily living� Family :

� Prosthetis & Orthotist : provide brace /

device

� Speech therapy



� DIP extention� PIP flexion� MCP flexion� Elbow flexion� Glenohumeral subluxation



� 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



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)



2 . Elbow wrist hand orthosis

� Fuction

Preventing contracture

Control elbow motion

For the functional position same

with rigid or static resting wrist

hand orthosis



� Function

Prevent subluxation of the shoulder joint

Prevent rotation of the shoulder

Support shoulder from depression



THANK YOU

Stroke Upper Limb

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