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"The conventional treatment for RU synostosis is a rotational osteotomy of one forearm, so one forearm is in pronation and one is in neutral or supination. I have used the radial forearm adipo-fascial flap to interpose between the radius and ulna in cases of traumatic RU synostosis and congenital synostosis. The results are better in trauma than congenital, because you still need to do an osteotomy of the radius in the congenital cases and then hopefully the flap allows pronation and supination. The radial forearm flap is faster than the lateral arm free flap used by the Japanese. If you live on the east coast, the person to see would be Joe Upton MD in Boston."

Question : What is the role of ice in treatment of the flaccid condition of stroke? Please describe in detail. Also, what is the treatment for the spastic stage of stroke?

Answer : If the doctor gives the okay, ice can be used to help with swelling in the hemiplegic hand. Usually the procedure involves dipping the hand two to three times in ice/water for 5-10 seconds and repeating a few times throughout the day. You could try this technique for several days and see if swelling decreases. The key points to remember though are that you need physician approval, only leave the hand in for 10 seconds at a time, only perform the technique 3-4x throughout the day, and discontinue if there are any problems or no results are seen. One has to be careful when using ice with the hemiplegic hand because the stroke patient often has decreased sensation so close supervision is needed as well as physician approval.

Ice can also be used to facilitate muscles by briefly rubbing ice for a few seconds over the muscle you wish to facilitate (. triceps to extend the arm and back of forearm to extend the wrist/fingers). I prefer tapping as my method of facilitation rather than ice.

The best treatment for the flaccid arm and leg is weightbearing, passive range of motion, proper positioning of limbs, and facilitation techniques such as tapping, quick stretch, and electrical stimulation (physician approval required for electrical stimulation, and pt. must have no contraindications).

The spastic limb also requires weight bearing which helps with stretching and reducing tone. Scapular mobilization is important during the spastic stage to help reduce tone and increase shoulder range of motion. For more information on treating the flaccid limb, see the links below:



-/stroke-#how to improve stroke

-/shoulder- .

For information on treating spasticity, see these links:



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