User:Tmly/Stroke - Prevention of Upper Limb Muscular Contracture

Case study
At age 46 the patient, a male, suffered a right-brain hemorrhagic stroke. Post-stroke, the patient currently experiences slight spasticity in his left upper limb. The stroke was caused by thinning of blood vessels due to his use of prescribed corticosteroids to treat the rheumatoid arthritis (RA) he experiences in his right hand. The RA affected joints include the carpal metacarpal, metacarpal-phalangeal as well as his proximal and distal inter-phalangeal joints.

As it is too uncomfortable and painful to use his right hand for long periods, the patient is required to use his stroke-affected left hand to grip his walking aid and enable ambulation. The patient presently receives botulism toxin treatment to prevent and reduce muscular contracture however, to maintain function of his left hand the patient has been recommended by his general practitioner to attempt using an upper limb orthosis.

Written information

 * Equivalent to 1500 words
 * This will be marked on the level 4 marking matrix.

Evidence
Write this section based on “Orthotic Treatment of (insert your pathology/case study here) in the Upperlimb”. Anatomy and Pathology: give an outline of the area and specific muscle groups affected. A summary of the pathology with specific reference to the upper limb. Don’t forget to reference.

Orthotic treatment options
(this may include post-surgery)

Comparison of orthotic treatment options
(or orthotic treatment vs surgical intervention)

Functional Aims and Goals
Give a detailed description of the goals outlining the specific movements/activies that your orthosis is required to provide use the evidence described above to support this.

Design
Outline the design of your orthosis, this should include but is not limited to: technical drawings, force system diagrams (3 planes), materials of choice, attachment methods, trimlines and manufacturing procedure. Within this section, if you would choose to make your device from something other than LTT explain why and how this may affect the function of the device you manufacture.

Manufacturing process
Document the manufacturing process of your device. This should be a step by step “how to guide” including photographs, patterns, fittings, adjustments etc.

Critique of fit
You should base this critique on the your understanding of the critique process and the lecture you will receive in week 8. You will need to provide photographic or video evidence of the fit, function and operation of the force systems. Written support for your critique is fine if you choose to not video this.

Outcome measures
There are a variety of outcome measures available for the upperlimb functional ability. Choose an appropriate measure (if you are having trouble finding some the TAC website for clinical resources here may be useful.

Complete this for your client (using your clinical knowledge and judgement) for before and after the client receives the orthosis. Choose activies that you believe the client would have improved on and video your client undertaking these whilst wearing their orthoses. Outline your finding. Provide images of the completed Outcome measure on your wikipage.

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