[BLOG SPOT] Home After a Stroke: Tricks for Stretching a Tight Hemiplegic Hand

Tricks for Stretching a Tight Hemiplegic Hand

I am haunted by a client who had her fingernails grow into her palm because the nurses couldn’t open her tight hemiplegic hand until after I treated her.  Facilitating active hand movement requires a deep understanding of how the 18 hand muscles work together, but passive stretching is less complex. Here are tricks that make opening a tight hand easier.
Trick # 1) Using force strengthens spastic muscles. The instant you feel resistance slow down so movement is barely visible.  Patience pays off.

Trick # 2) Avoid touching the palm because it elicits the palmar grasp reflex that closes the hand.

Trick # 3) To open the hand start by bending the wrist slightly 1st.  Bending the wrist stretches tendons that cross over the wrist and go to the ends of your fingers. Caution: Aim for a few degrees of wrist motion to protect these tendons (see angle in photo).  As the tendons stretch, the fingers will move away from the palm so you don’t have to dig fingers out of a tight fist.

Trick # 4) A fist will relax more if you straighten the thumb first.  The thumb has half the muscles in the hand so it is a bully.  Here is a good video for people who have a caregiver.  The trick is to wrap several fingers around the base of the thumb rather than grab the thumb close to the fingernail with the bony ends of your fingers.

Always keep the fingers in a straight line with the palm.  Clients should NOT passively straighten their fingers farther like in the photo on the left.  Caution:  Overstretching the fingers at the first joint (MPs) can damage muscles you need for active movement (lumbricals and interossei).
Initially it’s better to aim for partial finger extension when stretching the wrist (photo on left).  I can get my wrist all the way back now, but I always keep my fingers in line with my palm.

Source: Home After a Stroke: Tricks for Stretching a Tight Hemiplegic Hand

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