4.1 riconoscimento dita video guida emiplegia sinistra PRESA
Summary
TLDREl guión detalla un ejercicio terapéutico progresivo diseñado para ayudar a los pacientes a reconocer el movimiento y distinguir los distintos dedos de la mano. Comienza con la simple detección del inicio y finalización del movimiento de un dedo, y avanza gradualmente hacia el reconocimiento de qué dedo se mueve y en qué dirección. El ejercicio se lleva a cabo en varios niveles de dificultad creciente, con el objetivo final de preparar al paciente para ejercicios más avanzados de recuperación de la función de la mano y la capacidad de agarrar objetos. El terapeuta ofrece retroalimentación constante y adapta el ejercicio según las necesidades del paciente.
Takeaways
- 👥 El ejercicio es crucial para preparar al paciente para mover su mano, enfocándose en la conciencia del movimiento y la presencia de los dedos.
- 🪑 El paciente debe estar sentado frente a una mesa con las manos sobre la superficie para facilitar los movimientos delicados por parte del terapeuta.
- 🖐️ En casos de hipertonía marcada, se recomienda ajustar la postura del paciente para facilitar el movimiento de los dedos.
- 👆 El primer nivel de calibración implica que el paciente reconozca el inicio del movimiento de un dedo con los ojos cerrados.
- 🔢 Los niveles de calibración avanzan de reconocer el inicio del movimiento a identificar cuál dedo se mueve y la dirección del movimiento.
- 👍 Es fundamental ofrecer retroalimentación al paciente sobre el tiempo de percepción del movimiento para mejorar su sensibilidad.
- 👉 A medida que el paciente progresa, se introducen movimientos más complejos y se incluyen más dedos en los ejercicios.
- 🔄 En niveles superiores, se agrega la identificación de la dirección del movimiento (vertical, horizontal, circular).
- 🕒 El tiempo de respuesta del paciente es un indicador de su nivel de sensibilidad y se debe tomar nota durante los ejercicios.
- 🚀 Al alcanzar el noveno nivel de calibración, el paciente está listo para avanzar a ejercicios de mayor categoría para recuperar la funcionalidad de la mano.
Q & A
¿Cuál es el propósito principal del ejercicio de reconocimiento de dedos?
-El propósito principal es preparar al paciente para mover su mano de manera distinta, ayudándolo a reconocer la presencia y el movimiento de sus dedos.
¿Cómo se debe posicionar al paciente durante el ejercicio?
-El paciente debe estar sentado frente a una mesa con las manos descansando sobre la superficie. El terapeuta puede mover los dedos del paciente delicadamente, sujetando la punta del dedo.
¿Qué ajustes de posición se recomiendan si el paciente sufre de hipertonicidad marcada?
-Si el paciente sufre de hipertonicidad marcada, se recomienda mantener el antebrazo sobre dos cojines con la muñeca flexionada, lo que facilitará el movimiento de los dedos.
¿Cuál es el primer nivel de calibración del ejercicio?
-En el primer nivel, se le pide al paciente que determine cuándo se ha comenzado a mover un dedo, con los ojos cerrados.
¿Por qué es importante ofrecer retroalimentación al paciente sobre el tiempo transcurrido entre el inicio del movimiento y su percepción?
-Es extremadamente importante ofrecer retroalimentación sobre el tiempo transcurrido para que el paciente pueda ganar confianza con las sensaciones que recibe de su mano.
¿Cuál es el segundo nivel de calibración?
-En el segundo nivel, se incluyen todos los dedos de la mano, dividiendo equitativamente el tiempo dedicado al movimiento de cada dedo.
¿En qué consiste el tercer nivel de calibración?
-En el tercer nivel, se le pide al paciente que determine no solo cuándo comienza el movimiento, sino también cuándo se detiene.
¿Cuál es el cuarto nivel de calibración?
-En el cuarto nivel, el paciente debe determinar qué dedo se está moviendo, inicialmente limitado al pulgar y el meñique.
¿Qué se agrega en el quinto nivel de calibración?
-En el quinto nivel, se incluye el dedo medio en los dedos que el paciente debe reconocer.
¿Qué nuevos elementos se introducen en los niveles superiores de calibración?
-En los niveles superiores, se introduce el reconocimiento de la dirección del movimiento (vertical, horizontal y circular) y se incluyen todos los dedos de la mano.
Outlines
🧠 Ejercicio de reconocimiento de los dedos: introducción
Este párrafo introduce la importancia del ejercicio de reconocimiento de los dedos para pacientes que tienen dificultades en mover sus dedos de manera distinta. Describe la posición del paciente, las técnicas de agarre del terapeuta y los diferentes niveles de calibración del ejercicio. El objetivo es que el paciente reconozca cuándo un dedo comienza a moverse y cuándo se detiene, brindando retroalimentación sobre el tiempo de reacción.
🤚 Niveles de calibración intermedios
Este párrafo describe los niveles de calibración intermedios del ejercicio. En el segundo nivel, el paciente debe reconocer el movimiento de todos los dedos. En el tercer nivel, el paciente debe identificar cuándo comienza y cuándo se detiene el movimiento. En el cuarto nivel, el paciente debe reconocer qué dedo se está moviendo, comenzando con el pulgar y el meñique. En el quinto nivel, se agregan los demás dedos además del pulgar y el meñique.
🖐 Niveles de calibración avanzados
Este párrafo abarca los niveles de calibración más avanzados. En el sexto nivel, se incluyen todos los dedos para que el paciente los reconozca. En el séptimo nivel, el paciente debe reconocer no solo qué dedo se mueve, sino también la dirección del movimiento (vertical, horizontal o circular). En el octavo nivel, se agrega el movimiento circular. Se enfatiza la importancia de realizar movimientos lentos y no excesivos para evitar rigidez en pacientes con hipertonicidad.
🔄 Transición a ejercicios más avanzados
Este párrafo indica que una vez que el paciente supera el noveno nivel de calibración, se puede pasar a ejercicios más avanzados para recuperar las funciones de la mano y la capacidad de agarrar objetos. Estos ejercicios incluyen el reconocimiento de superficies táctiles y el reconocimiento de bloques, que se encuentran en el Capítulo 8. Se destaca la importancia de observar el tiempo de respuesta del paciente como indicador del nivel de sensibilidad.
Mindmap
Keywords
💡Reconocimiento de los dedos
💡Calibración
💡Retroalimentación
💡Hipertonicidad
💡Posicionamiento
💡Movimiento
💡Sensibilidad
💡Corrección
💡Transición
💡Progresión
Highlights
Why is this exercise important? If the patient is unable to recognize the presence of movement in their fingers or which finger is being moved, it would be hard to imagine the patient moving them in a distinct manner. This exercise is therefore important for preparing the patient to move their hand.
In terms of positioning, the patient is seated in front of a table with their hands resting on the surface, and the therapist is able to perform the movement in a delicate manner by holding the fingertip.
If the patient is suffering from marked hypertonicity, we should use a grip that facilitates the movement, or rather keeping the forearm on two cushions, with the wrist flexed. This will allow us to move the fingers more easily.
The first calibration level: We will ask the patient to determine when we have begun moving a finger. The patient will have their eyes closed. Offer feedback to the patient regarding the time that passes between the actual start of the movement and its perception.
The second calibration level: Once the patient has gained confidence with the movement of the index finger, we can include all the other fingers as well. The patient is always informed of which finger we'll be working with each time.
The third calibration level: We will not only be asking the patient to determine when the movement begins, but also when it stops. The patient will say 'now' when they feel the movement begin, and something like 'stop' when they feel the movement stop.
The fourth calibration level: Once the patient is able to recognize the exact moments in which the movement starts and stops, we can begin to have them determine which finger is being moved. Initially, only move the two outermost fingers: the thumb and pinky.
The fifth calibration level: Once the patient is able to recognize the movement of the two outermost fingers, the thumb and pinky, at this point we can begin including the other fingers as well, in this case the middle finger.
The sixth calibration level: At this level, we finally have all the fingers at our disposal for the patient to recognize: therefore we'll also include the index finger, and the ring finger.
The seventh calibration level: The activity will also include recognizing the direction of the movement, either up and down, or left and right. The patient has to determine which finger was moved, as well as the type of movement.
The eighth calibration level: This level consists of adding an additional movement to be performed with the patient's fingers, a circular movement.
The patient must also be capable of recognizing both the finger that has been moved, as well as the direction of the movement. We must take note of the time that the patient takes to respond, as this can also be indicative of a sensitivity level that is not yet optimal.
The ninth calibration level: This is the point at which we make the transition to the more advanced exercises of a higher category, for recovering the functions of the hand, and therefore the ability to grip objects. The exercises that we will be facing once this level has been passed are the recognition of tactile surfaces and the recognition of blocks.
Whenever there's an error, we must show the patient the nature of the error itself, so that the patient has the opportunity to compare the two different sensations.
We always give the patient the opportunity to correct themselves, without prompting them ourselves. When we encounter an error, we wait for the patient to correct themselves and to give the correct answer.
Transcripts
The exercise for recognizing the fingers: introduction Why is this exercise important? I'd like
you to consider something: if the patient is unable to recognize the presence
of movement in their fingers or which finger is being moved, it would be hard to imagine the patient moving them
in a distinct manner. This exercise is therefore important for preparing the patient to move
their hand. In terms of positioning, the
patient is seated in front of a table with their hands resting on the surface, and the
therapist is able to perform the movement in a delicate manner by holding the fingertip like
this. If the patient is suffering from marked
hypertonicity, and therefore the hand looks like this, at least during the initial phases of the exercise
we should use a grip that facilitates the movement, or rather keeping the forearm on two cushions, with
the wrist flexed in this manner. This will allow us to move the fingers m ore easily.
As we the exercise progresses, you'll see that the patient's hand relaxes
and at that point we can return to having it open on the surface.
The first calibration level: at the first level, the requirements are quite simple:
we will ask the patient to determine when we have begun moving a finger. The patient will have
their eyes closed... "Okay, now I want you to tell me when you feel that
I have begun to move your index finger. This finger here, okay? Now then, in the meantime I'll
take hold of it; when you feel that I have begun to move it, let me know by saying 'there', 'now', or 'okay',
or something to that effect. What word will you use?" "Now."
"Okay, then. Now. Now get ready: From this point onward I can move it".
"Now." "Very good, very good. I have to say, however,
that it took at least three seconds." This is extremely important: be sure to offer feedback
to the patient regarding the time that passes between the actual start of the movement and its perception.
Therefore, we can mentally start counting: 1001, 1002, 1003... This can help us
count each second that passes with greater precision, so that that patient can start to gain
confidence with the sensations they are receiving from their hand.
"Let's try again... Okay, I take hold of the finger: we're working with the index finger again."
"Now." "Very good: you said it almost exactly at the same
time that I started moving it... it only took about one second. Excellent."
The second calibration level: once the patient has gained confidence with this
type of activity, involving only the movement of the index finger, at this point we can
include all the other fingers as well. Therefore, we'll equally divide the time that we dedicate to this
exercise to the movement of all five fingers. In this case the patient is always informed
of which finger we'll be working with each time. "Okay, let's start with the thumb. Let's
begin." "Now."
"Good job, good job. You practically said it at the exact moment I began
moving your finger. Excellent." Afterwards we move on to all the other fingers.
The third calibration level: at this point the activity will be slightly more complex:
we will not only be asking the patient to determine when the movement begins, but also
when it stops. Therefore the patient will say 'now' when they feel the movement begin, and might say
something like 'stop' when they feel the movement stop.
Okay, let's give it a try: we'll start with the index finger."
"Now." "No, the movement hadn't begun yet. Let me show you
how the movement
would have felt. Ready... here we go."
"Okay? Let's try again. I'll stop, and then
from one moment to the next I can begin the movement."
"Now"
"Very good. Now I want you to tell me when you feel that the finger has stopped."
"Stop". "No, I'm still moving it."
"Stop". "Very good: this time you said it right at the exact
moment." The fifth calibration level: once
the patient is able to recognize the movement of the two outermost fingers,
the thumb and pinky, at this point we can begin including the other fingers as well, in this
case the middle finger.
"Now." "Very good. Now I want you to tell me when you feel
that
the
finger
has stopped." "Stop".
"No: I'm still moving it." "Stop".
"Good: that time
you said it right at the exact moment." The fourth
calibration level: at this point the activity becomes
even more complex: once we see that the patient is able to recognize the exact moments in which the
movement starts and stops, we can begin
to
have them determine
which
finger is being moved. We should initially begin
by only moving the two outermost
fingers: the thumb and pinky. There are
certain situations in which
it is difficult the name the
finger, so you'll need to come up with a name. In these cases it is recommended to ask the patient, once
we have removed the blindfold, to indicate which finger was moved:
"Okay, we're doing the thumb and the pinky. Which finger do you think it was?"
"The thumb." "The thumb, very good. Let's move on and do
another... Did you feel that?" "The thumb."
"The thumb again, excellent. Let's do another... Which was it?"
"It was... the index finger." "Hold on, try and touch it. This one here, the
pinky? Very good."
The fifth calibration level: once the patient is able to recognize
the movement of the two outermost fingers, the thumb and pinky, at this point we can begin
to including the other fingers as well, in this case the middle finger.
"We have all three of these fingers at our disposal". "Which finger was it? The middle finger? This one here. Excellent,
good job. Here's another..." "The thumb."
"Excellent job." "The thumb."
"The thumb again, good." "The middle finger."
"That's right." "The..."
"Which one was it? This one here? The little one, the pinky? Excellent."
Now then, as long as the responses are correct, we will punctuate each response with
'Good', 'good job', or 'okay'. Whenever there's an error, on the other hand, we must show
the patient the nature of the error itself. Therefore, in this last case, for example,
if the patient had said 'the middle finger', then we would have replied: 'No, the middle finger would have been like this',
so that the patient has the opportunity to compare the two different sensations.
The sixth calibration level: at the sixth level, we finally have all the fingers
at our disposal for the patient to recognize: therefore we'll also include the index finger
and the ring finger. The seventh calibration level: at this
level, the activity becomes even more complex: up until now the patient was required
to recognize which finger was being moved; now the activity will also include recognizing the direction
of the movement. Up until now we have tended to perform the movement vertically,
with the movement being up and down. No I will perform the movement either up and down
or left and right. Therefore you have to determine which finger I move, as well as the type of movement I make:
you can respond either 'up and down' or 'left and right'. "Left and right."
"Yes. Which finger is it?" "The index finger."
"Very good, that's right." "Up and down / pinky."
"No. If it were 'up and down/pinky' it would have been like this. Do you want to try again?"
"The ring finger." "It was ring finger/up and down. Okay? This one here,
which I'm moving now." "Yes."
"Excellent. Here's another..." "The thumb... "Left and right."
"Thumb / left and right. Very good." I recommend making sure that the movement
is always performed very slowly, and not too extensively, because if there is
hypertonicity, the hand might be sensitive to these two variables: the speed and the extent of the movement.
Therefore, if you perform a movement too quickly, you might notice that
the hand starts to become rigid, which is always a sign that something is not going right during the course
of the exercise. The eighth calibration level: this level
simply consists of adding an additional movement to be performed
with the patent's fingers. Up until now we performed vertical and horizontal movements; now we
will also include this type of circular movement. "Okay? Let's give it a try..."
"Ring finger / up and down." "Ring finger / up and down, very good."
"Middle finger... No! Circular." "Circular and which finger?"
"The middle finger." "No, middle finger / circular would have been like this."
"Ah... The index finger." "The index finger." Excellent. Here, let me show you again
the index finger / circular." We always give the patient the opportunity to
correct themselves, without prompting them ourselves. When we encounter an error, we wait for the
patient to correct themselves and to give the correct answer. Another aspect to be highlighted
is that the patient must also be capable of recognizing both the finger that has been moved, as well as the direction
of the movement. But that which we must take note of and observed is also the time that the
patient takes to respond, as this can also be indicative of a sensitivity level that is
not yet optimal. The ninth calibration level: This is the point
at which we make the transition to the more advanced exercises of a higher category
for recovering the functions of the hand, and therefore the ability to grip objects. The exercises that we will
be facing once this level has been passed are the following: the recognition of
tactile surfaces and the recognition of blocks. These can be found in Chapter 8.
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