Dylan Crake RMT & R.KIN

Communication: Pre-Treatment

• Approach non-affected side and walk towards client’s mid-line
• Ask client to tell you when they can’t see you any more
  • Let them know you’ll angle their head towards you when working on affected side
• Place their arm into flexed position, shoulder adducted and internally rotated, elbow flexed, wrist flexed, fingers and thumb flexed
• Slowly take them out of the position, and state that this is to decrease spasticity
• Place bolster over hand to keep it weighted down

Specific Treatment

• Start with posterior-lateral neck. Avoid the anterior lateral neck
• Check in with client that they can feel your hand
• Tell the client where you’re touching and what you’re doing
• Perform simple neuromuscular techniques
• Pectoralis Muscle will be spastic
  • Double check with client you can work in this area
  • Move their head towards you
  • Perform slow palmar kneading, and 3 neuromuscular techniques
  • Check in that they can feel you and let them know what you are doing
• Release and stabilize arm to perform range of motion of their shoulder
  • Ask if they can feel their arm move away from their body
    • Use visual feedback if they cannot
• Biceps Brachii will be spasctic
  • Perform muscle approximation for about 30 seconds, GTO, O+I, fingertip kneading.
  • Ask if client can feel what your fingers are doing
• Forearm Flexors will be spastic
  • Ask ” Do you feel my fingers moving down your arm?” ” Do you feel any tension or pain?”
  • Slowly extend wrist
  • Perform neuromuscular techniques, slowly
  • Perform range of motion at elbow, wrist and fingers.
  • Ask “Do you feel your joints moving?”
  • Put into spastic position, then bring out

• Deltoids will be flaccid
  • Stimulating techniques: jostling, tapotement, vibration
  • Ask them to bring arms towards you. ” Imagine your arm is moving toward you head”
  • You can use an ice cube and ask if they feel the cold

• Triceps will be flaccid
  • Ask if they feel what you are doing
  • Ask client to extend arm into hand
  • Perform pincement, tapping, vibration, jostling
  • Quick stretch : have elbow extended then bring flexed 3 x. Assist for the 2nd and 3rd repetition
  • Perform joint approximation
• Wrist extensors will be flaccid
  • Similar techniques to other flaccid muscles
  • Ask client to extend wrist
  • Perform a quick stretch with wrist in neutral than flexed position 3 times. Assist them on the 2nd and 3rd repetition
  • Perform joint approximation for about 5 seconds
  • Ask them to imagine opening a heavy door as a motor engram

Communication

• Assist client up after treatment
• Ask if they feel dizzy and need assistance off the table