Comments for Flaccid Stage Treatment in Stroke

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Codman’s Pendulum Exercises
by: Anonymous

Would pendulum exercise be contraindicated on a flaccid UE? Have client who sustained a shoulder fracture when he fell resulting from a R CVA. Has very low tone but also restricted due to recent break. MD wants pendulum exercise, but our staff fears the exercise may cause increased risk of subluxation of shoulder. Any input greatly appreciated.

Answer from stroke-rehab.com: Normally you would support a flaccid/hemiplegic arm due to weak musculature around the shoulder. I would discuss the unique circumstances of the arm being flaccid from stroke with the orthopedic MD as maybe the MD isn't aware of exactly what is going on and may just being following their normal protocol. If on the other hand, there is return of muscle tone to the arm and no subluxation, then it may not be an issue. I would evaluate the shoulder/arm and amount of tone then discuss any concerns you had with the MD.

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Speechless after Stroke
by: Spish

My father is 84 yrs old. Last month he had a stroke and his right Side is paralyzed. In the hospital they said there was nothing they could do. He doesn't talk, move or eat himself. He's always crying when he sees his siblings. Our prayer is to regain his speech. Is there any chances at his age? Now his appetite is very low and we don't know what can we do as family. Thanks.

Response from stroke-rehab.com: You would need to talk to his doctor regarding his prognosis. If you are not satisfied with what they are telling you or the care provided, you could ask for a second opinion and also look into having him transferred to a different facility that works with him more. Sometimes people don't improve, but I have no way of telling you if that is the case for your father or not. The best indicator you can get is probably from your father's neurologist.

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Flaccid stage
by: Anonymous

My sister is 9 weeks post stroke should she have her bad arm supported when walking? She does whilst sitting, she can walk a short distance slowly with a stick ! Thankyou

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flaccid parlysis
by: Anonymous

Since stroke is an upper motor neuron lesion, why is it that some stroke patient still present with flaccid paralysis instead of spastic paralysis?

Answer: According to Dartmouth.edu, damage to the precentral gyrus or isolated damage to the medullary pyramid produces can produce a rather pure corticospinal tract lesion. This results in severe weakness of distal muscles with little appearance of other findings, such as spasticity and hyperreflexia that are hallmarks of most UMN lesions. Also, initial flaccidity may occur with strokes that later turns into spasticity as the brain experiences neuroplastic changes after the stroke.

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Excellent summary of flaccidity
by: Anonymous

My left side was flaccid for several weeks after a hemorrhagic stroke. I cannot emphasize the importance of supporting flaccid upper extremities enough. I had some fabulous nurses who tenderly positioned my arm on a pillow, but I was not alert enough to thank them at the time. I was mad at that useless thing.

Unfortunately, my arm hung heavily too much. I couldn't understand how I could have burning pain down the side of my neck and across the top of my shoulder from the drag of my arm but not feel a loving touch or deep massage. My brother was rubbing my shoulder from behind. I thanked him, saying how good it felt and asked him if he could rub my left shoulder as well as the right. There was a stunned silence -- he'd been vigorously rubbing both shoulders.

Gradually, I became able to move on the left but I still had NO sensation or propioception. I "lost" my hand or foot regularly. To find my hand, I had to feel down, starting at the shoulder. My foot was easier -- I could use vision to find it but I needed reminders to look for it. It was often tucked away, where putting weight on it might cause a sprain or a fall.

When I started having some feeling, I realized I was trashing my elbow, hitting the bed rail or arm of the wheelchair many times each day. I didn't know where my arm was, so it kept banging things.

Last month, I told my therapists that my next goal is to be able to pass a field sobriety test stone sober. Don't know if I can ever do that, but I'm working on it. Hopefully, I'll be able to drive, but I hope never to need to pass a field sobriety test. People have said that they wouldn't notice my issues if they weren't looking for them.

I am getting better with the help of skilled and experienced therapists, but I'm like a puppy -- I know when I've done wrong. It doesn't always stop me from doing things that could cause me to fall or hurt myself. I'm still getting stronger and more coordinated. I've typed all this with two hands. That is remarkable!



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Study
by: Anonymous

Can you site studies that show weight bearing in a flaccid arm promotes neuro ed?
Thanks for your help

Answer: The research studies below show how weight bearing improved functional outcomes. Weight bearing is important for many reasons including preventing loss of bone density, providing sensory input to joints/skin, producing co-contraction of muscles around a joint (especially hip/shoulder) that is needed for functional activities, and for strengthening to support body weight. In fact, there are many more studies in the orthopedic realm that talk about the importance of closed chain exercises. This can be carried over to neuro patients especially those that do not have the strength to move a limb yet against gravity but that can do some easier weight bearing exercises that activate muscles for strengthening. In fact, weight bearing with the arm on something like a ball provides sensory input and allows the patient with very little to no movement the opportunity to start co-contracting muscles and produce active assisted movements.

https://www.researchgate.net/publication/263399298_The_Effects_of_Weight-Bearing_Exercise_on_Upper_Extremity_Activities_Performance_in_the_Female_Stroke_Patients

http://www.jospt.org/doi/abs/10.2519/jospt.2003.33.3.109

http://www.jptrs.org/journal/view.html?uid=50&&vmd=Full

http://lermagazine.com/article/inserts-improve-symmetry-velocity-in-stroke-patients

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Flaccidity
by: Anonymous

I'm a IV year Occupational therapy student and this answers you are giving are so simple, but they make Soooo much more sense than my notes!!

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weight bearing exercises
by: Anonymous

What are the physiological effects of the weight bearing exercises on the muscles and joints?

Answer: Weight bearing helps maintain bone density. It applies tension to muscle and bone, and the body responds to this stress by increasing bone density. Weight-bearing exercise can also help reduce the risk of fractures by improving muscle strength and balance, thus helping to prevent falls.

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Flaccid Arm
by: Anonymous

Question: Can you muscle test a flaccid arm?

Answer: Manual muscle testing is considered to be inaccurate with stroke patients that have tone disorders due to the problem originating with the brain rather than the muscles. You can test someone with flaccidity, but obviously if someone has a truly flaccid arm with no noticeable contraction, their MMT score would be 0.

When I have a patient with a flaccid arm, I do check for movement at all joints in the arm as there can be flaccidity in one part of the arm and not in the other.

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excellent
by: DR. SAAD

I like your way of teaching the treatment criteria for flaccid Arm

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Some Treatments
by: Anonymous

This is some of treatment in flaccid Stage :
1- positioning (very important)
2- weight bearing on joints (very important)
3- Having patient to gait (with support of effected side & knee/knees if needed)
4- Movements in middle line
5- Rotational movements (trunks,?)

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