January 28, 2014
PTs do not start gait training by asking clients to lift their hemiplegic (paralyzed) leg in the air and then move their ankle and toes. Yet classic hand evaluations like the Fugl-Meyer Assessment tell OTs to ask stroke survivors to sit and lift their hemiplegic arm up to table top height to pick up an object resting on the table. There is a problem with evaluating early hand function this way. When a stroke survivor struggles to lift a paralyzed arm, high muscle tone can cascade down the arm and make the hand too tight to open to grasp an object.
Hand-to-hand transfers can promote early hand use because the hemiplegic hand is held close to the body as it opens to accept an object from the sound hand. Notice how small the shoulder angle is when objects are close to the body. This angle is similar to the angle PTs expect from the hip when clients walk. Finally letting the thigh take some of the weight of the bottle promotes early success. The hemiplegic hand only has to keep the bottle still as the sound hand takes the cap off and puts it back on. Modifying tasks so clients can succeed is a good way to change everyone's expectation of what is possible. On the first day in rehab I walked the full length of the PT gym with the help of three people. I did not dismiss this early attempt because it was a modified version of my end goal. See
Small Motions Make My Hand Useful for more ways to use hand-to-hand transfers.
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