After experiencing a stroke or neurological event such as a TBI, many survivors are often left with residual deficits that affect their upper extremity. These deficits can vary from increased muscle tone, often called spasticity, or decreased muscle tone, often called flaccidity. Some survivors may also experience what is known as a shoulder subluxation. Care for and proper positioning are important for a multitude of reasons, including pain management, injury prevention, and to prevent worsening spasticity and/or flaccidity.
General Care
Some general care techniques include using elevation as needed for edema (swelling) management, maintaining proper hygiene, performing skin checks especially if sensation is impaired, and performing any stretches that have been recommended by a physician or therapist. When transitioning from lying to sitting or sitting to standing, it is important to remember that the upper extremity should be supported as needed but never pulled on. Pulling on the arm can result in a new or worsening subluxation.
Positioning
Upper extremity positioning can vary based on the person’s needs and whether they are in a lying, seated, or standing position. When lying or sitting, a pillow can be used to provide elevation and support, especially if there is pain or discomfort. When lying or sitting, the arm should be positioned to the person’s side instead of in the person’s lap for optimal shoulder placement. It is important to provide support in all positions if experiencing low tone to prevent new or worsening shoulder subluxation.
Positioning Aides
Some survivors may find that positioning aides can be beneficial. These aides can be used when sitting, standing, and walking. If the survivor is a wheelchair user, a lap tray or arm trough can be used to provide support. For standing and/or walking, certain braces and slings can be used for shoulder support, especially if a subluxation is present. However, it is important to pick the proper brace as some can worsen spasticity.
Occupational therapists are experts in care for post-neurological event upper extremity deficits. They can help educate and train patients and caregivers on proper positioning and care, and if positioning aides would be beneficial. Reach out to your neurologist or Sage Outpatient Rehabilitation for more information on how to care for and position your affected upper extremity.
