Hand Function Comes From My Gut, Part 2

Rebecca Dutton
Home After a Stroke

March 26, 2014

When you reach forward for an object that is out of reach the shoulder blade helps by sliding forward (scapular protraction). Scapular muscles are attached to the rib cage.  Abdominals keep the rib cage still so scapular muscles have a steady home base.  With weak stomach muscles, my shoulder flexors relied on help from the long head of the biceps which crosses the shoulder joint.  I repeatedly got tendonitis.  My biceps tendon used to swell so badly it made a popping sound when it slipped out of its groove.

I wonder how much faster I would have progressed if my OTs had worked on abdominal strength.  I do not blame my OTs.  As an OT I do not know of a motor theory for treating stroke that links hand function to core muscles. Yet athletes who need superior arm strength, like weight lifters and javelin throwers, know how important abdominal strength is to upper extremity performance.  Stroke survivors exert this same kind of extreme effort when they lift their arm with paralyzed muscles.   Don't believe me?   Therapists use two hands to lift a paralyzed arm so even people with normal strength are challenged when lifting all that dead weight.

Strengthening my abdominals was not enough.  Connections in my brain that link arm and abdominal movements are damaged.  The moment I focus on lifting my arm to reach for the ceiling my right hip drops lower than my left hip.  I must switch my focus to my abdominals to get my right hip back up where it belongs.   I am not discouraged.  I have beat this kind of failure before.  My hand used to drop objects.  Concentrating fiercely on keeping my hand closed was not enough.  My brain had to build new connections that make my hand stay closed when I focus on an object.*

* I have always known where my fingers are when a therapist moves them while my eyes are shut.  This traditional test of proprioception does not assess the automatic sensory awareness people need.  I cannot manipulate an object if I have to keep track of what my fingers are doing.

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Hand Function Comes From My Gut, Part 2

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Home After a Stroke