The affected limb post Stroke

After a stroke you may experience changes to the side impacted by the stroke. This could either cause the arm to be weak and ‘floppy’ (low tone) or very stiff (high tone). This in itself may fluctuate as tone increases and decreases.

Always following the advice of your physiotherapists and occupational therapists

Low Tone

  • When the arm is unable to move this means that the muscles are not working properly causing the arm to hang at a person’s side. This can cause shoulder subluxation (LINK) as the muscles are not able to keep the joints together.
  • The arm can often become swollen including the hands and fingers, this in addition can cause pain when the fingers are moved. Resting your arm on a pillow or table will assist in both supporting the shoulder and helping to prevent further swelling (LINK oedema) (LINK Bexhill/tray)
  • If you have little movement in the hand then hand rolls or palm protectors (LINK) may be used. This will help further encourage a reduction in swelling, help extend the fingers to reduce breakdown and encourage good hygiene.

High Tone

  • In order for our limbs to move we require one set of muscles to bend and the other side to relax. When one set of muscles doesn’t work the limb will be pulled in one direction. Following a stroke the brain may lose some control over the muscle movements causing an increase in stiffness (high tone).
  • If this high tone occurs it can cause difficulty moving the arm and subsequent pain and discomfort, this can reduce the ability to complete day to day tasks. Due to a lack of muscle activity in your arm this can cause the muscles to shorten, resulting in contractures. Your therapist may recommend and help you complete some ranging exercises for your arm.
  • If you have high tone in your hand your fingers may curl towards the palm, this can cause a risk of skin breakdown on the palm, inability to use the hand functionally and difficulty cleaning the skin on the palm. A palm protector (LINK) can be used to reduce the risk of skin breakdown and increase comfort as recommend in NICE guidelines.

Splinting
There is conflicting evidence in relation to the effectiveness of splinting (Lannin & Herbert 2003), this decision will be made by your health professionals and based on their clinical reasoning. Splinting is often used to reduced pain, aid hygiene, improve functional ability r.e by improving grasp and help maintain joint alignment and range.

References:
http://www.stroke4carers.org/?p=381
https://www.stroke-rehab.com/spasticity.html
https://www.nice.org.uk/guidance/cg162/chapter/1-recommendations
Lannin N, Herbert R (2003). Is hand splinting effective for adults following stroke? A systematic review and methodological critique of published research. Accessed 04.09.18 at https://doi.org/10.1191/0269215503cr682oa

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