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Evidence for normal development of linguistic but poor visuo-perceptual skills has been obtained with the neuropsychological assessment of a case of early left-brain injury. Data suggest the transfer of linguistic functions from the left to the right hemisphere at the expense of visuo-perceptual capacities for which the right hemisphere is potentially specialized.
Ten hemiplegic subjects completed 20 rapid dorsiflexions of their afflicted and nonafflicted limbs. Electrodes were attached to the tibialis anterior and the gastrocnemius muscles and electromyograms were recorded for their premotor time, motor time, and simple reaction time during ankle dorsiflexion and plantar flexion of their lower limbs. The fractionated components of reaction time, namely, premotor time and motor time, of both legs were statistically compared. It was found that the premotor time of the subject's stroke-affected limb was significantly slower than the premotor time of the nonaffected limb (control), with no differences between their associated mean motor times. These results supported the hypothesis that a stroke has a deleterious affect upon the central, premotor time processing centers and has no disruptive influence upon the peripheral motor time. Comparing the fractionated components of reaction time (premotor time and motor time), with simple reaction time, the former provided a more sensitive and valid method to detect possible injurious side effects of a stroke upon the brain's neuromotor transmission centers and subcenters, and their peripheral, stimulus, response network.
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Dynamic spirometry was examined in 23 non-smoking hemiplegic patients after the acute phase. The decrease of slow inspiratory forced capacity is related to motor impairment and does not vary with time. The forced inspiratory and expiratory vital capacities are similar to the slow inspiratory vital capacity in the first 6 months of the disease, but significantly decrease later independent of the motor impairment. The peak expiratory flow is highly variable but is clearly decreased, and is related to motor impairment. These results point to a restrictive respiratory syndrome due to mechanical limitation of thorax excursions caused by weakness, hypotonicity, and incoordination of the trunk musculature. The importance of long-term physiotherapy of the trunk is emphasized.
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Loss of the transverse arch of the hand and decreased thumb opposition has heretofore been an unreported deformity in the adult acquired spastic hemiplegic upper extremity. Based on Moberg's experience in quadriplegic patients, 11 patients underwent release of the annular ligament at the base of the thumb. This procedure allows the flexor pollicis longus tendon to bowstring and substitute for thumb opposition. All 11 had increased prehension capacity following the surgery. In carefully selected adult acquired spastic hemiplegic patients, release of the annular ligament at the base of the thumb can functionally restore the transverse arch of the hand, improve thumb opposition and improve prehensile capacity.
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Two treatment modalities for increasing active elbow extension with hemiplegic subjects were tested. Twenty subjects were randomly assigned to one of two treatment groups--an experimental treatment technique using kinesthetic biofeedback, or a control group consisting of an occupational therapy approach aimed at increasing functional use of the envolved upper extremity. The results indicate that kinesthetic biofeedback was as beneficial as conventional occupational therapy. It was also demonstrated that an individual's age, sex, or length of time beyond one-year post-CVA did not significantly affect treatment outcome. A majority of subjects in both treatment groups improved in ways not directly related to treatment, which suggests the need for long-term follow up of hemiplegic patients.
Development of a painful shoulder in the hemiplegic patient is a significant and serious problem, because it can limit the patient's ability to reach his or her maximum functional potential. Several etiologies of shoulder pain have been identified, such as immobilization of the upper extremity, trauma to the joint structures, including brachial plexus injuries, and subluxation of the gleno-humeral joint. A review of the literature explains the basic anatomy and kinesiology of the shoulder complex, the various etiologies of hemiplegic shoulder pain, and the pros and cons of specific treatment techniques. This knowledge is essential for the occupational therapist to evaluate effectively techniques used to treat the patient with hemiplegic shoulder pain. More effective management of this problem will facilitate the patient's ability to reach his or her maximum functional potential.
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OBJECTIVES: Occupationally embedded exercise is a central idea in the profession of occupational therapy. This experiment compared the effect of an occupationally embedded exercise involving a simple dice game with a rote exercise in persons with stroke with pronator spasticity. Both exercise conditions involved bilaterally assisted supination, consistent with the neurodevelopmental model of practice. METHODS: The sample consisted of 14 men and 12 women post-cerebrovascular accident with a mean age of 68.4 years (SD = 11.2) at six clinical sites in California, Texas, and Michigan. Subjects had pronator spasticity, full passive range for supination after a brief warm-up, and no functional supination. After random assignment for experimental condition, the subjects engaged in two sets of 10 repetitions of bilaterally assisted supination in either the occupationally embedded condition (dice game) or the rote condition (no game). A pen recorder electronically documented degrees of rotation of the handle that was grasped during the exercise. RESULTS: The occupationally embedded exercise resulted in significantly more handle rotation (requiring more supination) than the rote exercise, t (24) = 2.28, p (one tailed) < .05. The effect size was large. CONCLUSION: This study advances the experimental analysis of therapeutic occupation in the area of occupationally embedded exercise. Clinicians are urged to consider the multidimensional nature of occupationally embedded exercise.
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