Upper extremity orthoses for stroke patients.

The painful shoulder in the paralysed stroke patient, is a great problem in the field of physical medicine. Certain pathological changes are taking place in the patients with extensive paralysis in the upper limb. These changes are: (1) lesions or rupture of the rotatorcuff, (2) displacement of caput humeri in a caudal direction, (3) neuropathy of plexus brachialis with peripheral paresis. Careless handling of the patients' arm and the passive pull of the heavy, paralytic arm are claimed to be the main cause for these lesions. Correct handling of the patient and support of the shoulder is necessary to prevent these injuries from taking place. The different arm-slings used for this purpose, are not good enough. The article describes an orthosis which supports the shoulder joint and reposition caput humeri (if this has been luxated). It also gives the patient a better balance by straightening the trunk and letting the arm hang extended and slightly abducted along the side of the body. The orthosis is only tested in a few patients. Further development and testing on several patients are now being planned.