Tuesday, July 16, 2024

Responses to CVA Shoulder Management

Frank Frankovitch, CPO

Apologies for delay in posting responses to Shoulder Orthoses query:

Original post:
We provide loads of Shoulder orthoses to post-CVA patients (usually < 6months) including OB's OmoNeurexa, Bauerfeind's OmoTrain, handful other manufacturers & designs. Typically PT referrals stated goal is reducing pain or reducing subluxation by "supporting shoulder." My observation is these orthoses only marginally influence undesirable movement or propensity to sublex. We are seeking experienced input to better understand shoulder treatment protocols, application & use of these orthoses, preferred products/designs. Any input welcome. Most responses referenced standard manufacturer offerings, Give-More Arm Sling featured highly, Sporlastic. Many simply stated "most not effective." --------------------------- As a PT this is an interesting area. I like to use bracing during gait and other upright function to reduce passive load on the tissues and improve symmetry. I do not find bracing effective (nor have I found any research to support use) in preventing or reducing subluxation. ------------------------- I worked as a physical therapist assistant for several years before getting into P&O (more P) & worked extensively w/fresh CVA pts. Everyone looks to try something new or interesting on these pts when what seemed to work best & had the best follow through w/nursing staff members & family was the simple arm sling. Set it up so that it firmly holds the humerus into the acetabulum (looks tighter than normally worn) AND add padding across the neck for the strap. Then during PT/OT we would work a great deal on the pt wt bearing through the affected shoulder by placing the elbow on the mat table & having the pt lean onto the elbow. Seems the more the pt got that feedback of controlled positioning, wt into the shoulder joint, the better they came around. UNLESS Left side neglect was involved....then the simple sling, positioned anyway that was comfortable for the pt to keep that arm out of harms way was the way to go. Orthotically speaking....the more complicated the more trauma the affected shoulder goes through when staff members are dressing the pt. They have a lot of work to do & generally rush through their tasks anyway...adding a complicated orthosis to the mix is not in the pt's best interest. Yes, therapy will don the device correctly when educated in the process, but they are not & cannot be there all the time. Once home, the story may or may not change. -------------- Try Give-Mor arm sling ------------------------ Spolastuc has large range of products. ------------------ Apologies again for delayed posting of responses. Many thanks to list! Frank Frankovitch M: (44) + 7470470917 [email protected]

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