Occupational Therapy
From an OT standpoint you normally are working with the upper body, arm and hand therapies. Also, you will be addressing your daily needs (ADL’s/Activities of Daily Living) such as bathing, brushing your teeth, dressing and transferring (i.e. moving from a wheelchair to a commode).
Normally the arm/hand recovery comes last in the healing process. In Barb’s case this is true. After one year she is able to demonstrate some flexion and grip with her weak right arm and hand. She has had to manage her abnormal tone (muscle contractions that are outside the norm) with a muscle tone-reducing drug.
Many stroke victims also experience a subluxed/dislocated shoulder because of abnormal tone on their affected side. This is also the case with Barb and her rehab issues. The biggest problem with this situation is the threat of a frozen shoulder that can be extremely painful and uncomfortable for the patient. Therefore, this situation needs to be addressed quickly if it’s applicable to you.
A frozen shoulder is very difficult to loosen up. Thus, daily maintenance and exercise are important. Barb has addressed this component with basic range of motion and daily exercise on her exercise bike. Consequently, she maintains a very comfortable arm. The mission is to keep the arm supple to maximize recovery.
Creative Bracing Concept
You need to use your imagination based on your need for bracing, if necessary. This obviously is applicable to the affected side of the body with regard to your ankle and arm situation. Hopefully, you have a good hand therapist and/or prosthetic organization that can assist in this regard. If you don't, find one! Barb pushed the envelope in these areas to give her better functionality and quality of life.
Bracing Over Injectable Neuromodulators
Barb's right arm presented challenges for recovery. It is extremely important through the recovery process that you keep the arm supple to maximize this opportunity. The drug, an oral muscle tone reducing medication, helps with the abnormal tone to a certain extent. Because of many individuals’ discomfort, Injectable Neuromodulators becomes an alternative. A few physicians discussed this option with Barb. More specifically, they suggested injecting limited amounts of this drug in various parts of her arm and hand region.
Barb and her family analyzed the effects of the drug which stays in your system for approximately 60 days. Because of Barb's exercise regimen she pushed back on this option to look at other alternatives. The primary reason is that, although effective in reducing muscle tone and making the arm more comfortable, the negative effect was that it would make her arm flaccid. Thus, it was taking away too much muscle tone for the rehab exercises that she was doing.
It was discovered that Barb had a “significant trigger point” in her right thumb that created additional tone and spasm in her right arm. Therefore, she decided to work with her hand therapist/OT with bracing options to address this area. As illustrated in the bracing section, you will see various thumb splints/braces that are used by Barb. These provide the relief that is necessary to keep Barb's arm comfortable.