The Hemiplegic (paralysed) Shoulder:
Now a days Hemiplegia / paralysis has become a common condition. The cause can be Stroke or Spinal cord injury or traumatic skull injury. In my practice, i have seen most of the rehabilitation programms are gait (walking pattern) oriented in my area. But we need to work out the upper limbs too, so this article comprises of the upper limb exercises in hemiplegia.
*To improve the muscle tone, we have to start with weight bearing exercises. Weight bearing improves the proprioceptive input of the joint which in turn improves muscle tone.
As the muscle tone improves, you have to approch the nearer physiotherapist who will teach you the functional reeducation exercise. After reaching to a physio, you may not enter to the next phase-
Spasticity phase: Here there is hypertoina of the muscles with exaggerated reflexes. (muscles become tight) This phase should be controlled earlier. Start working lots of weight bearing exercise as given above. Go to your physio he will start with anti pattern proprioceptive nuromuscular facilitation exercises, before starting work out of elbow or wrist-fingers we have to stretch the shoulder capsule if its tight[ gentle auto stretches are recommanded] then go for shoulder retracion which will cure the protraction pattern of shoulder, which in turn reduces other factors of pattern like internal rotation-adduction- pronation-wrist flexion. This is the most important part of upper limb rehabilitation. As the shoulder becomes properly movable, the other activites we can start are shoulder pulley, theraband exercises to improve control,forearm supination exercise, Dynamic cock-up splint to induce finger flexor activity & later on PNF principle- Transfer of action for the individual finger movements.
This all process takes 1-2 months & sometimes more but here patients co-operation, confidance can reduce the time periode.
[sometimes it will be difficult for the non-medico to understand the medical words, i have given some simple language in the brackets & you can use the www.onlinemedicaldictionary.com )
After getting an admission for a Stroke/ CVA , we have to wait for the vitals (Blood presure, pulse etc.) to get stable. It may take a time period of 7 days to 1 month. After settlement of these things a phase of no movement comes called as -
Flaccid phase:
Here you will not see any movement [Lets speak more on upper limb], reflexes can be brisk or not elicited. Here the commonly getting injuered joint is Shoulder.
The common cause is Shoulder dislocation due to improper transfers of the patients. 
First few days only, we have to prevent the dislocation by means of using the figure of 8 bandage--->
*To improve the muscle tone, we have to start with weight bearing exercises. Weight bearing improves the proprioceptive input of the joint which in turn improves muscle tone.
As the muscle tone improves, you have to approch the nearer physiotherapist who will teach you the functional reeducation exercise. After reaching to a physio, you may not enter to the next phase-
Spasticity phase: Here there is hypertoina of the muscles with exaggerated reflexes. (muscles become tight) This phase should be controlled earlier. Start working lots of weight bearing exercise as given above. Go to your physio he will start with anti pattern proprioceptive nuromuscular facilitation exercises, before starting work out of elbow or wrist-fingers we have to stretch the shoulder capsule if its tight[ gentle auto stretches are recommanded] then go for shoulder retracion which will cure the protraction pattern of shoulder, which in turn reduces other factors of pattern like internal rotation-adduction- pronation-wrist flexion. This is the most important part of upper limb rehabilitation. As the shoulder becomes properly movable, the other activites we can start are shoulder pulley, theraband exercises to improve control,forearm supination exercise, Dynamic cock-up splint to induce finger flexor activity & later on PNF principle- Transfer of action for the individual finger movements.
This all process takes 1-2 months & sometimes more but here patients co-operation, confidance can reduce the time periode.
[sometimes it will be difficult for the non-medico to understand the medical words, i have given some simple language in the brackets & you can use the www.onlinemedicaldictionary.com )
Comments