I'm working on two stroke patients currently,one of which started coming to the clinic just a couple of days back. The other,an year old case of left hemiplegia has been coming since the last 2 months.
In the latters case, the voluntary control in the upper limb is 1. It remains in the typical synergistic posture. Spasticity being grade 3 on the Mod. Ashworth's scale, hampers passive ROM of the wrist and finger. The carpus instability adds to this problem as they remain subluxated volarly because of the unbalanced overactivity of the long flexors. This has lead to the overstretching of the long extensors, which may be a contributing factor to the weakness. A cockup static splint is required to ease the position of the hand to the functional position. There is some activity seen in the upperlimb extensors when the patient is asked to extend the arms from a 90 degree shoulder abduction and 90 degree elbow flexion toextension towards the opposite ASIS. This activity is only seen in supine position thus indicating two possibilities. Either the activity seen is due to TLR or due to the proximal stability in the supine positions which aids proper chanelisation of the tone.
There is no activity seen in the sitting position even on appropriate stabilization of the proximal structures.
The question is.whether to accept the role of TLR and continue strengthening the extensors in supine or start with some other approach. But the former looks more convenient at this moment considering the chronicity of the condition.
In the latters case, the voluntary control in the upper limb is 1. It remains in the typical synergistic posture. Spasticity being grade 3 on the Mod. Ashworth's scale, hampers passive ROM of the wrist and finger. The carpus instability adds to this problem as they remain subluxated volarly because of the unbalanced overactivity of the long flexors. This has lead to the overstretching of the long extensors, which may be a contributing factor to the weakness. A cockup static splint is required to ease the position of the hand to the functional position. There is some activity seen in the upperlimb extensors when the patient is asked to extend the arms from a 90 degree shoulder abduction and 90 degree elbow flexion toextension towards the opposite ASIS. This activity is only seen in supine position thus indicating two possibilities. Either the activity seen is due to TLR or due to the proximal stability in the supine positions which aids proper chanelisation of the tone.
There is no activity seen in the sitting position even on appropriate stabilization of the proximal structures.
The question is.whether to accept the role of TLR and continue strengthening the extensors in supine or start with some other approach. But the former looks more convenient at this moment considering the chronicity of the condition.
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