May 28, 2021

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 (paralyzed) hand.  Here are tricks that make opening a tight hand easier. Trick # 1.  Using force makes spastic muscles fight harder. The instant you feel resistance slow down so movement is barely visible.  Patience pays off. 
Trick # 2.  Try not to touch the client's palm.  This may stimulate the hand to close.
Trick # 3.  To open the hand, start by bending the wrist slightly 1st.  This is how police get people to open their hand to drop a weapon.  Bending the wrist relaxes tendons that cross over the wrist before they go to the ends of your fingers.
Caution: Aim for a small amount of wrist flexion (see angle in photo).  As the tendons relax, the fingers will open slightly so you do not have to pull on fingers curled in a tight fist. 

Trick # 4.   A fist will relax even further if you straighten the thumb.  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 client's thumb rather than pulling with the bony ends of your fingers.
Caution:  Overstretching the fingers can damage muscles  needed for active movement later on (lumbricals and interossei).  Always keep the fingers in a straight line with the palm.              DO NOT straighten the fingers like in the photo on the left.  
When stretching the wrist, it is better to aim for partial finger extension so muscles will relax instead of fight you.  I can get my wrist all the way back now, but I always keep my fingers in line with my palm (see green arrows).

May 21, 2021

Early Hand Use by Exploiting Normal Anatomy

It is hard to stay motivated when tests do not give you credit for the hard work you are doing.  
Fortunately, the Toronto Hand Function Test gives clients partial credit for opening their hand with tenodesis (1).  You do not have to visualize how tendons works.  To feel tenodesis, bend your sound wrist down as far as you can and try to make a fist.  Tendon action in this position keeps the hand open.  Tendon action also closes the hand when you extend you wrist (see black line below). 
The Toronto Hand Function Test gives credit for 5 different movements: reach, passive grasp by using tenodesis, active grasp, lift, and manipulate.  This creates a very sensitive basement that detects early recovery.  For example, Level 3 of 7 gives a client partial credit for reaching and grasping an object with a passive grasp without being able to lift or manipulate the object.  

When I reach for an object, I cannot open my hand with my wrist extended like able-bodied people do (black line).  My droopy wrist position leaves some slack in my flexor tendons that want to make a fist.  This allows my sound hand to place an object in my partially open affected hand.  I need my affected hand to hold objects still so my sound hand can manipulate them.  When I was able-bodied I never noticed how many times a day I needed to use both hands.

1. Kapadia N, Zivanovic V, Verrier M, Popovic 
    M. Toronto Rehabilitation Institute-Hand Function 
    Test. Top Spinal Cord Inj Rehabil. 2021 Spring; 18(2): 167-186.

May 9, 2021

Rolling Over in Bed Can Be a *****

Right after my stroke, rolling over in bed took horrendous effort when I was most tired.  When I rolled onto my sound side, my floppy hemiplegic arm would get stuck behind me.  It felt like a wrestler was pinning my upper body to the bed.  I had to remember to use my sound hand to pull my hemiplegic arm across my chest before I started to roll while pulling on the bed rail.

Seventeen years later rolling onto my sound side is still difficult.  One night when I wanted to roll over so I could sleep on my sound left side, my hand reached for the folding chair I placed next to my bed.  This chair is lower than my bed which makes it easier to lean down to tie my shoes.  With the help of the chair and a hemiplegic arm that now rolls with the rest of my body, I quickly fell asleep.  Once again serendipity made my life better.   

However, I have gotten good at rolling onto my hemiplegic right side to get out of bed.  My sound arm crosses over my chest as I swing my sound leg over my hemiplegic leg.  My sound hand reaches for the mattress as I hang both legs over the edge of the bed.  The weight of my legs dropping down helps pull my trunk and head up.  My sound hand pushes on the mattress to help me sit up.

May 4, 2021

Escaping Frustration

My sound hand can place small objects between the index and middle fingers of my affected hand so this hand can hold objects still.  As an OT I know this is a weird grasp that has no name.            As a stroke survivor it makes me really happy.

The index and middle fingers of my affected hand can hold a toothbrush so my sound hand can squeeze toothpaste on the brush.  

The index and middle fingers of my affected hand can hold a cotton swab still while my sound hand cuts it in half.  This creates smaller pieces of cotton I put in my ears before I use hair spray on my short hair. 

I use my teeth to pull a rubber glove on my sound hand.  I do not want to touch shopping carts and transfer what my hand picked up to my car key, car door, and steering wheel.  When I get my groceries to my car, I use my teeth to pull the glove off inside out.  I do not want to leave a dirty glove in the cart so I place it between the index and middle fingers of my affected hand.  
I unlock  my car door and put the used glove in a cup in my car.
Then I put my groceries on my back seat.