Complex challenge with chronic R. Hemiplegia (Full Version)

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LynnOTR -> Complex challenge with chronic R. Hemiplegia (April 5, 2007 9:53:00 PM)

Hi,

I would very much appreciate some advice as I have been scouring the net looking for assistance with a 68 year old woman I have been treating in her home. She suffered a L.CVA in October and had undergone rehab for 28 days at a rehab hospital. On the 29th day she underwent surgery for a bloodclot they located and remained localized in her leg.

A couple of weeks after the surgery she apparently had a mini seizure that very briefly affected her speach, but resolved within 24 hours post.

My concern is that she has R. UE hemiplegia with very little restored movement. She can at the most flex her fingers 6-7* with no ability to extend her wrist or digits. She can contract her bicep and to approx 10* flexion with again no ability to extend, pronate, supinate. I have to really try hard to establish a trace level for any extension most of which is wisfull thinking on my part.

She also has a shoulder subluxation of 2 fingers which her husband has taped together with duct tape so she can sleep through the night.

She does complain of pain mostly in her biceps during exercises and her R. scapula is winging.

On the upside, another therapist is treating her lower extremities and she has regained approximately 50% not any foot movement.

The concern I have is how to approach this chronic hemiplegia and subluxation. I just started working with her and have begun repetitive assisive movements and am using an e-stim to elicit wrist extension, but, I am not sure how to approach the most effective protocol or exerciese for eliciting any UE movement.

Also, I am not sure about the taping that her husband is using. He seem to be committed to grabbing her shoulder, pulling it tight and taping her like a christmas package, of which I have asked him to discontinue until I research proper positioning. His methods seem a bit barbaric to say the least.

I would appreciate any advice on protocols and exercises for treatment, realistic expectations, if recovery is even at all possible at this point (as I believe that she should regain at least some). Also what is the best approach and which part of the extremity should I focus on. Shoulder movemnt first vs. wrist movement, etc.

Thank you in advance as I know this is a lot of information, but it is very much appreciated as I believe she can regain some movement with the right treatment protocol and regain at least a little function out her dominant UE.

Forever the optimist
Lynn




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