Abstract
Upper Limb After Effects of an Upper Motor Neuron Syndrome
Highlights
According to Lance’s classical definition, spasticity is only one of a number of positive signs and phenomena that emerge in patients with an Upper Motor Neuron Syndrome (UMNS) [1]
From a different perspective that reflects a net balance of forces generated by the interaction of ‘positive’ signs and ‘negative’ signs acting across joints, the after effects of UMNS such as skin problems, musculoskeletal deformity and movement impairment are of great concern to patients [5]
Skin problems commonly occur in patients with UMNS who develop musculoskeletal postures resulting from a net imbalance between voluntary agonist and involuntary antagonist forces acting across joints [6]
Summary
To identify and illustrate a variety of skin, musculoskeletal and movement impairment after effects that are problematic for patients with an upper motor neuron syndrome. Observation, videography, dynamic polyelectromyography (polyEMG) and clinical analysis were the basic tools used to identify a variety of after effects. Clinical case material is presented that identifies skin lesions, problems of access, grasp dysfunction, restraint of reaching, object transport, release and problematic postural configurations. Chemodenervation with botulinum toxin, serial casting and newer types of dynamic splinting are discussed in relation to identified after effects. “Spastic hemiparesis” as a term may be a useful diagnostic classifier for clinicians but, from a patient perspective, it falls short in pointing to the after effects of UMNS including many skin, musculoskeletal and dysfunctional movement findings that are of considerable concern to patients. Mentioned after effects in order to broaden the concept of UMNS management
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