Many people who have a stroke are left with problems with one of their arms. Proper arm care after a stroke can help treat these problems. It can also help prevent new problems. Arm care after a stroke includes techniques such as proper positioning.
A stroke happens when part of the brain is deprived of oxygen. This can happen if a blood vessel to the brain gets blocked, or if there is a bleed in your brain. This causes some of the cells in your brain to die.
Stroke often causes paralysis (hemiplegia or hemiparalysis) or weakness of one or more of the muscles in your arm or shoulder. The muscles might feel tight instead of weak (spasticity). In general, stroke might increase or decrease the normal tension (muscle tone) in these muscles. You may also have numbness or limited feeling in your arm.
The shoulder is a key problem area after a stroke. The shoulder blade (scapula) and the upper arm bone (humerus) come together to form the shoulder joint. This joint is shaped like a ball and socket. Problems with the shoulder muscles can cause this joint to partly dislocate due to the weight of your arm. This partial separation (subluxation) makes your shoulder droop down.
Subluxation can cause pain with movement and a sensation that your shoulder is out of joint. Muscles, tendons, and ligaments can become overstretched. These muscle problems can lead to other problems with your shoulder as well, such as reduced range of motion. Some of the muscles may also be permanently shortened. This is called contracture.
Proper arm care after a stroke helps prevent and treat these problems. Arm care may include placing the arms in the proper position, using devices such as a sling or brace, and taking care to prevent further injury during rehabilitation.
If you have had a stroke, you may need arm care treatment while you recover function. Some people who have a stroke need treatment for trouble with the muscles of their arm or shoulder, and shoulder pain is common. This treatment often begins right after a stroke. Even if you only have minor harm from your stroke, proper arm care can help keep future problems from occurring.
For example, proper positioning of your arm is important, since you may not have proper feeling in your arm and shoulder. It is easy to damage your arm without knowing it if you don’t keep your arm in the correct position. Some people continue to have shoulder pain and arm problems months after a stroke. This may need specific rehabilitation and treatment.There are no risks associated with arm care after stroke.
Learn everything you can about your treatment plan. Your healthcare team will work with you to design a treatment plan specific to your needs. You may work with a physiatrist. This is a doctor who specializes in rehabilitative medicine. You will likely work with a physical therapist. This is a therapist who can teach you safe exercises to improve the strength, endurance, and range of motion in your arm, shoulder, and hand. An occupational therapist can help you learn to regain skills needed for everyday living using your arm. This may include using assistive devices, such as braces or arm rails.
Expect your treatment plan to change as you recover. Talk with the members of your medical team about how things are going. If an exercise causes pain, stop the exercise and let someone know right away.
Preventing partial separation or subluxation is one of the most important goals of arm care after a stroke. To prevent this problem, you must protect your arm at the shoulder joint.
You will need to control the shoulder joint during movement. It is important that all of your caregivers know about the proper ways to assist you. No one should pull on your arm. Damage can result from getting underarm support to stand or walk. Instead, support your affected arm and use your strong arm to help pull yourself up.
Support devices may also be part of your treatment. You may need to have your arm in a sling or harness after your stroke. This will support your arm and help prevent more damage. If you’re in a wheelchair, the chair’s arm support may also help. Other devices include special lap trays or pillows. You may need to use these for weeks or longer.
Other types of proper positioning after stroke include:
- When lying on your unaffected side, use one or two pillows for your head. Your affected shoulder should be forward with your arm supported on a pillow.
- When lying on your affected side, use one or two pillows for your head. Your affected shoulder should be positioned comfortably.
- When sitting up, sit fully back into the chair. Place your arms forward onto two pillows on a table. Your feet should be flat on the floor.
- When lying on your back, place 3 pillows supporting both your shoulders and your head. Place your affected arm on a pillow.
- When sitting in bed, sit upright, well supported by pillows. Place both arms on pillows. (Usually only recommended for limited periods.)
Your physical therapist will make other suggestions about positions that are safe and comfortable for you. He or she may also begin physical therapy exercises with you. These are to help you regain strength and flexibility in your affected muscles. This might include muscle stretches, strengthening exercises, and range-of-motion exercises.
Some people regain full use of their arm in the weeks after a stroke. Many others still have some weakness, pain, or other problems with their arm. You may continue to benefit from arm therapy. Your medical team can tailor your treatment plan to your needs.
If you continue to have arm problems, your healthcare team might try other treatments such as:
- Constraint-induced movement therapy. This involves using your affected arm a lot and not using your unaffected arm. A therapist might help you with this. Or it could be robot-assisted.
- Botulinum toxin injections. This can help to reduce tightness in the arm muscles.
- Electrical stimulation of muscles. The weakened muscles in your arm or shoulder may be treated with electricity. This can help to help strengthen your weakened arm.
- Electrical stimulation of the brain. This may be done during rehab exercises, and may help increase mobility.
- Motor imagery. This method may help improve arm use.
- Biofeedback exercises. These may help you regain mobility and reduce pain.
- Pain medicine. These may be needed to decrease shoulder pain if subluxation has occurred.
Depending on your situation, these treatments might be used early or late in your therapy. Ongoing physical therapy may also help you reduce chronic pain as you regain your strength and flexibility.
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January 11, 2018
Kang, Steven, MD,Turley, Ray, BSN, MSN