Impairments of Arm Movement and Posture

Stroke can affect one or many of the areas and neural mechanisms controlling voluntary movement and posture. These include the motor cortex and associated pathways, cerebellum, basal ganglia, and brain stem. The impact on eating skills can be considerable, since weakness or paralysis affecting the arm occurs in 80% of strokes. Loss of coordination, spatial impairment, abnormal muscle tone, and sensory loss may also occur. Common problems resulting from this are difficulties manipulating cutlery, lifting/loading utensils, cutting food, inserting food in the mouth, drinking from a cup, or discerning the spatial relationships between objects.

If one arm is unaffected, then some degree of compensation is possible, particularly if this is dominant. Use of the unaffected hand is important in detecting temperatures of food and liquids where sensation is impaired. An occupational therapy assessment is necessary to identify appropriate aids to feeding. Lightweight plastic cups with molded handles and cutlery with built up indented handles may be useful, while plateguards and nonslip mats can be provided. Where upper limb impairment is severe, individuals may require continuous assistance with food preparation and ingestion.

Postural impairment following stroke can result in an inability to maintain an upright sitting position for effective food preparation, insertion, chewing, and swallowing. A physiotherapy assessment can identify the most effective postural techniques to counteract abnormal muscle tone (spasticity) and appropriate aids to seated balance. The latter can include molded seating, tilting chairs with table attachment, and limb stabilizers.

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