The most common problems in movement improvements of the paralyzed upper limb for patients after cerebral stroke

Stanisław Kijowski
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Instytut Fizjoterapii Politechniki Opolskiej w Opolu, Polska

Abstract

In the process of rehabilitation of cerebral stroke patients, the biggest problems are encountered during restoration of the lost activity in the upper limb. This emerges from complex arm activity control in neuropathological conditions, caused by localized damage to the nervous system. Nursing-care omissions and physiotherapeutic errors can exacerbate this condition. This is especially critical during the limpness period, when damage of dynamical elements of the arm joint are possible. This in turn can result in shoulder sprains and pain and, in effect, lead to a painful shoulder disorder or even a frozen shoulder. The upper limb swelling is another disadvantage impeding the process of rehabilitation. The swelling is caused by insufficient shoulder exercise, poor posture with regard to shoulder placement, and use of continuous drip injections into paralyzed limbs. The restoration of normal shoulder functions, in the spasticity period, is impeded by increased muscular tonicity. The muscular tonicity can be mitigated by exercises, relaxing positions and by some electro-physical treatment. However, the electro-physical intervention should not be used for patients with diabetic neuropathy. The most complex and the most precise movements, ie. those most needed in normal life, are unfortunately restored at the latest stages, and are the ‘most difficult to recover. The forearm, wrist and fingers muscles, as well as supported and balanced movements, can be stimulated through exercise in isolated positions.

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