In the acute phase after a stroke with a hemiplegic hand, which area should be prioritized to enable the patient to overcome barriers to ADL performance?

• A. Passive range of motion and positioning of the affected upper extremity, bed mobility
• B. Visual and cognition issues, upper-extremity orthotic needs
• C. Transfers, therapeutic exercise for upper-extremity strengthening
• D. Community mobility, fine motor coordination

Answer: (A)

In the acute phase after a stroke with a hemiplegic hand, the priority is to prevent secondary problems that would block later recovery of daily activities. Focusing on passive range of motion and the position of the affected upper extremity helps keep joints supple and tissues lengthened, reducing the risk of contractures and abnormal scar formation. Proper positioning, especially around the shoulder, supports alignment and decreases pain and edema, which are common barriers to later functional use of the arm and hand.

Practicing bed mobility at this stage—rolling, repositioning, and safe transfers—keeps the limb integrated into daily tasks and sets the stage for more active ADL training as recovery progresses. By preserving ROM, maintaining socketed alignment, and minimizing discomfort, the patient is better positioned to regain self-care skills like dressing, grooming, and feeding when motor control begins to return.

Other areas, such as later transfers and strengthening, or fine motor skills and community mobility, become the focus after foundational ROM and positioning have been established and the patient can participate meaningfully in therapy.