Chair dips: Decorticate posture is a typical upper extremity issue in CVA severa…

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Chair dips: Decorticate posture is a typical upper extremity issue in CVA several weeks post onset. It is characterized by increased in muscle tone of mainly anterior musculature (shoulder IR-addiction-flexion, elbow flexion, forearm pronation, wrist flexion, fingers flexion). As an occupational therapist, we focus on functional movements/activities, hence the common practice is to teach/train patients early on into approximating hand to their mouth to eventually be able to feed self. I use to do the same, I admit, but more often than not as I observed, majority of the cases I handled over the years tend to exhibit the same pattern of posture only with different level of muscle tone. Even if I start coordination training (hand to mouth) early on, I will see improvements but still wont quality as functional (uncoordinated , overshooting, undershooting, not enough range). To therapists, when patients brag and commend you about how, with your expertise they are now able to (happily demonstrating in front of you) bring their flexed wrists and fingers to their mouths, plus the exaggerated shoulder elevation along the way, you better think twice. That is not an improvement at all. You did not make it happen, in fact made it worse. It is just a compensatory pattern and you will not get anything functional out of it unless your long term goal is just for the patient to be able to participate in the singing of the national anthem. The arm is complex, for it to function well is to have a good neuromuscular coordination, the agonist and antagonist working in unison to elicit fluid/functional movements. In this case, to improve hand to mouth approximation is to improve on all the antagonists of the muscles with hypertonicity. To manage the uncontrollable high flexor tone, you need an even stronger extensors that will help with better gross motor coordination. I find chair dips to be one effective/conservative exercise to improve on extensors for this example. With the patient sitting on the edge of the chair, I set the feet as far as the patient can tolerate. The legs were bound together to assist in keeping the affected leg in place.

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