Orthopedic rehabilitation of the stroke patient.

Rehabilitation of hemiplegic patients begins with setting reasonable functional goals and a treatment plan to reach them. During the initial illness an effort is made to begin range of motion exercising and positioning to prevent contractures. Transfer from bed to chair is recommended as soon as the patient's general condition permits.Upper extremity function depends on sensory and motor function as well as visual and central cerebral impairment. Spastic symptomatic contracture of the shoulder must be prevented by adequate orthopedic management of any musculoskeletal problems such as arthritis or tendinitis and the initiation of an active exercise program. Surgical release of contractures is occasionally indicated in refractory cases. Elbow flexion and pronation flexion deformity of the forearm and hand have also required surgical release on occasion. The goal of lower extremity function is ambulation. A double upright short leg brace aids stability in gait. Long leg braces are not used but a cane may be necessary for balance assistance. Contractures must be prevented by an exercise program or surgically released.