The document discusses postoperative rehabilitation for spastic hands. It covers:
1. Postoperative rehabilitation starts with preoperative evaluation and aims to integrate gained function into daily life.
2. The outcome depends on the surgeon defining a realistic rehabilitation goal that can likely be achieved.
3. Understanding the patient's individual situation and the development of their cerebral palsy is important.
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Funcional capacity
• Mano hábil
• Mano estable
• Mano de soporte
• Mano de desplazamiento
A
U
T
O
N
O
M
I
A
To be or not to be
Toma de decisiones…
the spastic, hand postoperative rehabilitation Doll 2003
• Postoperative rehabilitation starts with preoperative evaluation
• The outcome of rehabilitation measures is strongly dependent on
the surgeon's ability to define a realistic rehabilitation aim, i.e., a
goal the patient can achieve with a high degree of probability.
• knowledge of the patient's individual basic situation and status as
well as of the autonomic development of the different categories of
cerebral palsy is of great importance.
• The decisive question is to whom they are offered.
• Physiotherapy plus occupational therapy is offered after primary
cast immobilization. This period is finished when the specific aim
has been achieved, integration of the gained function into everyday
life.
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Toma de decisiones…
the spastic, hand postoperative rehabilitation Doll 2003
• Postoperative rehabilitation starts with preoperative evaluation
• The outcome of rehabilitation measures is strongly dependent on
the surgeon's ability to define a realistic rehabilitation aim, i.e., a
goal the patient can achieve with a high degree of probability.
• knowledge of the patient's individual basic situation and status as
well as of the autonomic development of the different categories of
cerebral palsy is of great importance.
• The decisive question is to whom they are offered.
• Physiotherapy plus occupational therapy is offered after primary
cast immobilization. This period is finished when the specific aim
has been achieved, integration of the gained function into everyday
life.
Toma de decisiones…
the spastic, hand postoperative rehabilitation Doll 2003
• Postoperative rehabilitation starts with preoperative evaluation
• The outcome of rehabilitation measures is strongly dependent on
the surgeon's ability to define a realistic rehabilitation aim,
goal the patient can achieve with a high degree of probability.
• knowledge of the patient's individual basic situation and status as
well as of the autonomic development of the different categories of
cerebral palsy is of great importance.
• The decisive question is to whom they are offered.
• Physiotherapy plus occupational therapy is offered after primary cast
immobilization. This period is finished when the specific aim has
been achieved, integration of the gained function into everyday life.
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Toma de decisiones…
the spastic, hand postoperative rehabilitation Doll 2003
• Postoperative rehabilitation starts with preoperative evaluation
• The outcome of rehabilitation measures is strongly dependent on
the surgeon's ability to define a realistic rehabilitation aim, i.e., a
goal the patient can achieve with a high degree of probability.
• knowledge of the patient's individual basic situation and status as
well as of the autonomic development of the different categories
of cerebral palsy is of great importance
• The decisive question is to whom they are offered.
• Physiotherapy plus occupational therapy is offered after primary
cast immobilization. This period is finished when the specific aim
has been achieved, integration of the gained function into everyday
life.
Toma de decisiones…
the spastic, hand postoperative rehabilitation Doll 2003
• Postoperative rehabilitation starts with preoperative evaluation
• The outcome of rehabilitation measures is strongly dependent on
the surgeon's ability to define a realistic rehabilitation aim, i.e., a
goal the patient can achieve with a high degree of probability.
• knowledge of the patient's individual basic situation and status as
well as of the autonomic development of the different categories of
cerebral palsy is of great importance.
• The decisive question is to whom they are offered.
• Physiotherapy plus occupational therapy is offered after primary
cast immobilization. This period is finished when the specific aim
has been achieved, integration of the gained function into everyday
life.
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5
Toma de decisiones…
the spastic, hand postoperative rehabilitation Doll 2003
• Postoperative rehabilitation starts with preoperative evaluation
• The outcome of rehabilitation measures is strongly dependent on
the surgeon's ability to define a realistic rehabilitation aim, i.e., a
goal the patient can achieve with a high degree of probability.
• knowledge of the patient's individual basic situation and status as
well as of the autonomic development of the different categories of
cerebral palsy is of great importance.
• The decisive question is to whom they are offered.
• Physiotherapy plus occupational therapy is offered after primary
cast immobilization. This period is finished when the specific aim
has been achieved, integration of the gained function into
everyday life.
Spastic hand
Stages of Motor Recovery of the Chedoke McMaster Stroke Impairment Inventory (Gowland et al. 1993)
Stage Characteristics
1.- Flaccid paralysis is present. Phasic stretch reflexes are absent or hypoactive. Active
movement cannot be elicited reflexively with a facilitory stimulus or volitionally.
2.- Spasticity is present and is felt as a resistance to passive movement. No voluntary
movement is present but a facilitatory stimulus will elicit the limb synergies reflexively.
These limb synergies consist of stereotypical flexor and extensor movements.
3.- Spasticity is marked. The synergistic movements can be elicited voluntarily but are
not obligatory.
4.- Spasticity decreases. Synergy patterns can be reversed if movement takes place in
the weaker synergy first. Movement combining antagonistic synergies can be
performed when the prime movers are the strong components of the synergy.
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Spastic hand
Stages of Motor Recovery of the Chedoke McMaster Stroke Impairment Inventory
(Gowland et al. 1993)
• Stage Characteristics
5.- Spasticity wanes, but is evident with rapid movement and at the extremes of
range. Synergy patterns can be revised even if the movement takes place in the
strongest synergy first. Movements that utilize the weak components of both
synergies acting as prime movers can be performed.
6.- Coordination and patterns of movement can be near normal. Spasticity as
demonstrated as resistance to passive movement is no longer present. Abnormal
patterns of movement with faulty timing emerge when rapid or complex actions
are requested.
7.- Normal. A “normal” variety of rapid, age appropriate complex movement patterns
are possible with normal timing, coordination, strength and endurance. There is no
evidence of functional impairment compared to the normal side. There is a
“normal” sensory-perceptual motor system.
Functional Assessment
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Post surgical hand
• Artrodesis
Post surgical hand
• Tenotomia
– Protección de la sutura
– Recorrido muscular
• Zona de sutura….
• Cuantos centrímeros de recorrido?
• Para cuantas articulaciones?
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Post surgical hand
• Tenodesis
– Reconstrucción ligamentosa
– Rigidez relativa
Post surgical hand
• Trasposiciones
– Sutura tendinosa
– Riesgos: Rotura vs adherencia
– Necesidades: desplazamiento
– Reconocimiento muscular
– Control muscular
– Gestión del recorrido
