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Physical deficits

5) Care of the affected arm video

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In this film you will see how to assist the person to move their arm after a stroke. Some people will have a very high tone or stiff arm and some will have a very low tone or floppy arm.
These tips are only guidelines and you should ask to speak to a physiotherapist for individual advice.

  • Ask for how long and how often these exercises should be done.
  • When you are helping with the movements you should aim to make them smooth and controlled.
  • Always start at the shoulder and work down the arm to the hand.
  • Take care not to force or over stretch the muscles and joints.
  • If the person has a painful arm extra care may be needed.

The high tone or stiff arm.

The physiotherapist first supports Bills affected arm by placing her hand firmly but comfortably on the inner part of his upper arm. This gives the affected shoulder support and helps to reduce some of the effects of gravity which tend to pull the arm downwards.
She places her other hand over his shoulder blade or scapula. The scapula has to be able to move against the chest wall to enable the arm to be raised.
Bill also helps by holding his affected hand and forearm while it is being moved.
Start with small circular movements at first. If this is comfortable for the person try making the circles a little wider. As you work with the arm you should feel the movements getting easier with less resistance and tightness.

Next the physiotherapist changes hand position to support the upper arm and wrist. This allows movement at the shoulder and elbow. She moves the arm forward and back. Next moving across the body from side to side.

Once the muscles and joints in the upper arm and forearm have been moved, the therapist works on Bills hand and fingers. She gently stretches and bends the fingers. Never over stretch as this can be painful and may cause further damage to joints, ligaments or tendons.
The thumb is then gently stretched in all directions of movement.
Finally the hand can be positioned on Bills knee with the fingers and thumb in a comfortable and natural position.

Bill can now practice some of these movements and stretches by himself at home. He supports his affected arm by holding onto the wrist. He follows the same movements as before.

After a few moments he is able to almost fully straighten his affected arm. It is important not to force any movement and to stop if the joints become painful. Keep movements smooth and controlled. Bill can now place his hand is a natural position on his knee.

This is Greg. His arm tone is the opposite of Bills. Greg’s arm is low toned and floppy. You can see that he is not really aware of where his arm is or that it is hanging down unsupported. Notice how awkwardly and unevenly he is sitting in the chair. His back is twisting and the whole weight of his arm is pulling his body on his affected side.

The Physiotherapist uses pillows to help place Greg’s arm in to a more natural and supported position.
She very carefully lifts the affected arm by placing her hands at his elbow and hand in order to give full support to the arm.
She adjusts the pillows so that his elbow and shoulder are supported. This brings both shoulders back in line at the same level and allows Greg to sit symmetrically in his chair
She carefully spreads Greg’s fingers on the pillow in front of him where he will be able to see his hand. She also encourages him to relax and sit back in the chair once he is in a more natural and comfortable sitting position.

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