Dear friends ,Hi. thans for mailing me.
Though I have very little exp. of 6 yrs to make any openion standard, but in these 6 yrs most of the time I had been working with c.v.a.. The conclusion I wd like to put is 'I found the sling can be used when the tone of mses around shoulder is flacid or is unable to prevent the elongation of the superior ligament around the shoulder'. Because we know from varrious studies that the major cause of the sh. subluxation is unsupported shoulder aginst Gravitational Force.Along with sling use of long cock up splint with wrist in ext. or functional position to prevent flexion synergy facilitation may be benifissiary.Along with this I used to be very conscious as the tone starts coming the use of sling should be minimise as far as possible by proper supported shoulder in varrious positions i.e. lying sitting etc., to facilitate the proprioceptive sensation around shoulder . Above mentio! ned splint sd be taken as positioning splint and we sd try to facilitate the extention of wrist and fingers for possible recovery.some times the finger ext. comes while the wrist remains flacil in this case i used to change the splint into short cock -up for therapeutic activities, to make hand for functional .
I found my attempt in this pattern the result was remarkable without or very minimal Sh.Subluxation .
I am an Occupational Therapist from INDIA studied and worked in NATIONAL INSTITUTE FOR THE ORTHOPEDICALY HANDICAPPED ,KOLKATA ,INDIA.&
now has been working for MINISTRY OF HEALTH , KUWAIT since last 2yrs 9 months..
This is what my experiance was which I wanted to share.
Thanks for hearing me patiently.
BINOD KUMAR BARANWAL, KUWAIT.
maria pamela palanca <[EMAIL PROTECTED]>wrote:
>From: "Suzanne Martin" <[EMAIL PROTECTED]> >Reply-To: [EMAIL PROTECTED] >To: [EMAIL PROTECTED] >Subject: Re: Slings: yes or no for treatment of the hemiplegic shoulder? >Date: Fri, 02 Aug 2002 17:08:36 -0400 > >I understand why a sling would be used with a completely flaccid arm >for the >purpose of keeping it out of the way, but I don't think I agree with >the way >my coworkers are slinging everybody with a cva. For examle, one man >came to >our SNF, 4 years post CVA, no evidence of a subluxation, and he was >issued a >sling to prevent subluxation. He is hypertonic, with some AROM, not >flaccid. In my opinion, this will only lead to a contracture. The >PT's >also agree that this man SHOULD wear the sling all day. The other >example >was a woman who transfered from a rehab hospital. She was issued a >sling >there and wore it for over a month. When she was transfered to us, >the OT >reccommended "sling when out of bed". The d/c stated no active >range of >motion, and neglect. When I evaluated her, she did have a 1/2-1 >finger >subluxation in that shoulder but she was contracted into internal >rotation >and elbow flexion (the shape of the sling!). The therapists I work >with >wanted to continue the sling. I kept taking it off her, and she >started to >show active rom within a week. I am new to the facility where I >work and >don't want to offend anybody. I have casually mentioned a few times >that >there is no evedence as far as reversing or preventing subluxation, >but they >clearly have thier oun ideas. Any more thoughts on the subject? > > >>From: Lynn Chivers <[EMAIL PROTECTED]> >>Reply-To: [EMAIL PROTECTED] >>To: [EMAIL PROTECTED] >>Subject: Re: Slings: yes or no for treatment of the hemiplegic >>shoulder? >>Date: Tue, 30 Jul 2002 20:15:31 +0100 >> >> > I always understood >> >that slings are not effective for prevention or treatment of >>subluxed >> >shoulder and only contribute to non use and abnormal gait >>patterns. >>Suzanne >>Hi Suzanne >>I've also had both sides of the argument at different places of >>work. I >>ended up using a sling when there was a flaccid arm that got in the >>way >>if not in a sling and affected gait that way, but only during >>mobilising, not all the time. Since my client group tended to be >>the >>very elderly, I feel that mobility and function were preferable to >>dysfunction waiting for "proper" techniques - an 80-odd year old >>might >>prefer to wear a sling for a short while to enable him to get >>around the >>house and do his daily tasks, and then take it off when resting. >>If the >>patient had been a twenty year old, there may have been a different >>set >>of options which would have taken longer to learn and practice but >>reduced long-term problems. Sorry not to be more clear. >> >> >>Incidentally, could I please request that you "snip" mails if you >>are >>using the reply function - I've just had literally yards of mail >>repeated from previous ones. thanks very much. >> >>Best wishes >> >>-- >>Lynn Chivers >> >>*********��*********** >> >>Unsubscribe? Send a message to [EMAIL PROTECTED] >> >>In the message's *body*, put the following text: unsubscribe OTlist >> >>** List messages are archived at: >> >>http://www.mail-archive.com/[email protected] >> >>*********��*********** > > > > >_________________________________________________________________ >MSN Photos is the easiest way to share and print your photos: >http://photos.msn.com/support/worldwide.aspx > >*********��*********** > >Unsubscribe? Send a message to [EMAIL PROTECTED] > >In the message's *body*, put the following text: unsubscribe OTlist > >** List messages are archived at: > >http://www.mail-archive.com/[email protected] > >*********��*********** >
hi Susanne!
I really do emphatized with you. In my country (Philippines), most PTs and OTs do not prescribe slings. If ever they do, it is only during certain periods of the day but generally we do not because of the problems that wearing might elicit. If we do advise use of slings, we recommends a sling that leaves the distal portion of the arm (forearm) free. It is also generally used for flaccid uppper exremity. Maybe what you can do is lessen the use of the sling and recommend incorporating the use of your affected in activities such as weight bearing or if they can move it to a certain degree to encourage using it in simple activities like putting the affected arm on the table. These are only suggestions, I think you know what is best for your patients. Good Luck!
PAM
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