14.11.3 The hemiplegic hand
In hemiplegic patients, the hand and wrist show paresis or even paralysis with more or less pronounced
spasticity of the flexor muscles and atrophy of the extensors. This highly debilitating situation can develop
into retraction, stiening and misalignment if regular treatment is not initiated.
This specific indication is an example of using the Spasticity programme for the area most commonly
aected by debilitating spasticity.
14.11.3.1 Protocol
Spasticity
If the patient is experiencing associated pain symptoms, TENS stimulation can be performed in addition on
the other channels.
In this case, the specific practical rules for TENS (electrode placement, regulation of intensity) should be
followed for each channel used for this purpose.
14.11.3.2 Treatment frequency
One to two 20-minute sessions per day.
14.11.3.3 Electrode position
A single channel is sucient to stimulate the extensor muscles of the fingers and the wrist.
• A small electrode is placed on the fleshy part of the epicondylar muscles approximately two finger-
widths below the epicondyle.
• The second electrode, also small, is placed on the dorsal aspect of the forearm, where the lower and
middle thirds meet.
The position of these electrodes must be adjusted so as to firstly obtain extension of the fingers, and then
extension of the wrist.
Extension of the wrist alone with flexion of the proximal and distal interphalangeal joints will not produce
optimum results.
Extension of the interphalangeal joints is therefore the first objective.
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