Occupational therapist Jen DeFeo has a special interest in helping stroke patients recover strength and mobility.

How do you approach a stroke patient with lack of strength, mobility, and function in an upper extremity?

 

Loss of upper extremity function following a stroke is detrimental to performance of Activities of Daily Living (ADLs).

 

Something as simple as pulling your hair up into a ponytail, cutting your food, opening a container, or managing your clothing becomes extremely difficult for someone with only one functioning upper extremity. Try to button a shirt or tie your shoes using only one hand.

 

It is important to maintain joint mobility and movement in the upper limb following a stroke. Treatment focuses on having the patient attempt to move the arm, and if they are unable to, then stretching and facilitation of normal movement is started.

 

There are so many aspects that can affect upper extremity function, from lack of ability to initiate movement, to decreased ability to perform full movements, to decreased coordination of movements including speed, smoothness, accuracy, and the ability to sustain movements, which all become part of a patient’s individualized treatment plan.

 

Is the issue of dominance a factor?

 

If the affected limb is the person’s dominant hand it makes ADLs even more difficult. One handed compensation for self-care skills is taught and practiced, regardless of hand dominance. Most ADL tasks are bimanual tasks, meaning normally performed using both hands or arms. If a patient has some use of the hemiparetic limb and it’s their dominant arm then we work on getting them to use that arm as functionally as possible. Whether or not the hemiparetic limb is the dominant extremity, the person is taught how to use that limb despite how much movement they currently have in it.


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