February 25, 2016

Tricks for Stretching a Tight Hemiplegic Hand

I am haunted by a client who had her fingernails grow into her palm because the nurses could not open her tight hemiplegic hand until after I treated her.  Here are tricks that make opening a tight hand easier.  Trick # 1) Using force strengthens spastic muscles. The instant you feel resistance slow down so movement is barely visible.  Patience pays off.  Trick # 2) Avoid touching the palm because it can elicit the palmar grasp reflex which closes the hand.
 
Trick # 3) To open the hand start by bending the wrist slightly 1st.  Bending the wrist stretches tendons that cross over the wrist and go to the ends of your fingers. Caution: Aim for a few degrees of wrist motion (see angle in photo) to protect these finger tendons.  As the tendons stretch, the fingers will open so you do not have to struggle to grab fingers that are in a tight fist. 


Trick # 4) A fist will relax more if you straighten the thumb first.  The thumb has half the muscles in the hand so it is a bully.  The trick is to wrap several fingers around the base of the thumb rather than grab the thumb close to the fingernail with the bony ends of your fingers.
 
Always keep the fingers in a straight line with the palm.  Clients should NOT passively straighten their fingers like in the photo on the left.  Caution:  Overstretching the fingers at the first joint (MPs) can damage muscles needed for active movement (lumbricals and interossei).
When stretching the wrist, it is initially better to aim for partial finger extension when stretching the wrist (photo on left).  I can get my wrist all the way back now, but I always keep my fingers in line with my palm.  

5 comments:

  1. I an huge offender to over stretching my right hand, it is so numb and hard to open up, but it feels so good... I will do a better job now, thanks for the reminder!

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  2. weight bearing excercises coupled with cimt helps extenion

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  3. MY MOTHER IS A STROKE VICTIM AND WE WERE TOLD THAT STANDING AT THE KITCHEN SINK WITH HAND/HANDS GRIPPING THE EDGE, THEN PROCEED TO ROCK HIPS LEFT AND RIGHT IN A MOTION OF WEIGHT SHIFTING HELPS TO RECOVER THE WALKING/STANDING DIFFICULTIES. MOM HAD A MASSIVE LEFT SIDED STROKE DUE TO BLOOD CLOT WHICH REMAINS IN HER BRAIN TODAY. ITS BEEN 2 YEARS AND 5 MONTHS AND SHE HAS WENT FROM NO SPEECH(FEEDING TUBE) NO SWALLOWING ABILITIES TO NOW SHE TRANSFERS TO WH. CHAIR ALONE, FOLDS LAUNDRY ONE HANDED AND EVEN CHANGING HER OWN BRIEF( ADULT DIAPER. SHE IS THE STRONGEST WOMAN IVE EVER KNOWN AND SHE WAKES UP EVEY MORNINTG SMILING AND HUMMING A FAV. TUNE SHE REMEMBERS.!! NEVER GIVE UP THE STROKE MAY HAVE GOTTEN YOUR BODY BUT IT CAN NEVER TAKE YOUR SOUL!

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