Jodanna enjoyed a nice visit from her mother, Anne, her Aunt Carla and her Uncle Duane. They drove out from Idaho Falls to celebrate Anne’s birthday. It was understandably a very emotional visit. They are currently driving home, so travel safely.
Today, August 23d, two months after her stroke, Jodanna used the treadmill in physical therapy. She performed three sessions on the treadmill. The last one went for an impressive 408 feet. She burned eight calories. She’s progressing markedly in her walking and her gait. Jo is able to navigate the house, assisted, but unsupported. That is to say that she still needs assistance, but she generally carries her own weight. She is clearly determined to meet the six week goal set by her PT.
In occupational therapy, they worked on Jodanna’s shoulder and arm. Post-stroke arms are stubborn. The therapists work initially on stretching the muscles to loosen them up, and then working the muscles. The muscles benefit, even when the moves are done passively. In this video, the therapist keeps Jodanna’s hand attached to the bar.
Jodanna is affected by a condition known as “shoulder subluxation.” Jodanna’s shoulder could dislocate if not properly supported. Shoulder subluxation or shoulder instability occurs when the shoulder partially dislocates. The shoulder joint by its nature allows a large range of movement which means it is likely to be less stable. No single structure is responsible for providing stability at the shoulder joint. Rather, the bones, ligaments, joint capsule and muscles are all key components in maintaining a stable shoulder joint, yet permitting a large range of movement in several directions. This is unlike the knee, which has a more limited range. If the muscles are not firing, gravity essentially pulls the arm out of the socket.
Shoulder subluxation is a common occurrence after stroke and can be due to muscle weakness or spasticity. It is characterized by the upper arm bone (humerus) dropping out of the shoulder socket. The muscles may be too weak to hold the arm bone securely into the shoulder socket or spasticity can cause subluxation by pulling the bone into an abnormal position. Both muscle weakness and spasticity can cause the shoulder blade (scapula) to be abnormally positioned as well.
Initially after stroke, one may experience a flaccid stage where the arm is limp, hangs down, and has no movement. Jodanna is currently in this stage. Soft tissue can become overstretched from the effects of gravity and improper handling of the arm. Stroke patients who have their arm unsupported and/or handled inappropriately (i.e. pulling on the arm) are at higher risk for injury. It is important that caregivers of stroke patients are properly trained in handling the affected arm especially when shoulder subluxation is present. Chris, Max and Beau are all properly trained. Lap trays or pillows can provide support when the person is seated and arm slings can be used when the person is standing or walking.
The therapists have been using KT tape on Jodanna’s shoulder to address her shoulder instability. It’s best for stroke victims to focus on using their affected arm as much as possible, and support their arm when seated, and during transfers or walking. As tone returns to the shoulder muscles, the risk of shoulder subluxation decreases.
Jo engages in each of her therapies two times per week. That’s what insurance provides. Jo is determined and would like to have therapy every day. Family and friends are exploring options to increase her therapy.