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).  homeafterstroke.blogspot.com

Walking in a Barren Environment

Walking in wide, empty spaces did not prepare me for tasks that force me to stop concentrating fiercely on my hemiplegic leg while I am walking.  In-patient PTs walked me in gyms with equipment and people sitting around the periphery.  When two clients who are walking approach each other the PTs look at each other and decide who will stand still while the other person moves first.  Home health PTs walked me around the block in the middle of the day when nobody was outside.  PTs work in a barren environment that does not make them aware of cognitive demands.

Stroke survivors need to walk sideways between tables at a restaurant and go down stairs that have a railing only on their affected side.  At a store - walk in circles around racks of clothing and stop for people who are not watching where they are going.  At a hair salon - sit down in the chair without tripping over the big metal footrest.  Using a public toilet - turn around to sit on the toilet regardless of which side the grab bar is on.   Clients and family members need to understand that walking requires problem solving as well as physical mobility.  

Football coaches do more than have players throw and catch footballs and do foot agility drills.  Football players eventually have to stop concentrating on their body and start thinking about their opponents' strategy as they move.  Athletes and musicians have rehearsals to make the transition from practice to function.  Why are stroke survivors not getting the same kind of help?  homeafterstroke.blogspot.com

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.  homeafterstroke.blogspot.com

The Whacky Grasp That has No Name

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.  

homeafterstroke.blogspot.com