Anyone interested in a challenge?

Hey Everyone,

I just wanted to share an interesting patient with you. I am on my musculoskeletal outpatients at the moment. I have been seeing a lady who had a right total shoulder replacement 12 weeks ago. Her relevant past medical history is that her left shoulder is fused and therefore limited range on top of this she has RA and therefore she has deformities and loss of function in both hands. This lady is wonderfully keen and optimistic to regain ROM in her right shoulder. I have become very motivated working with this lady due to her keen attitude and due to how important function is in that remaining shoulder. Her goal is to be able to wash her hair.
She only has 110 degrees of active abduction, and 130 degrees of shoulder flexion. She needs active assisted exercises in her HEP to help her gain range at her shoulder. Currently she uses the stick for assisted abduction, a home made pulley system for flexion. The current challenge of increasing range has become limited by her right fussed shoulder and she lives at home alone and therefore has no one else to help. My question is for any other useful active assisted exercises that might help increase her range but that do not require the other arm assisting and full hand function. So far I have come up with hydro therapy to help, the use of a longer stick, and rolling a ball in side flexion. I tried the finger walking up the wall however her deformities in her hands made it difficult. Finally we have started anchoring her arm and lowering her body to increase the elevation at her shoulder. I will see this week how effective that was.
It has been a fun challenge to think of how to increase her ROM keeping in mind her impairments. I will be seeing her again on Monday prior to her review to see if any of the new suggestions were successful or not. If anyone has any other innovative ideas that you think might work for this lady she is very keen and will take any of your suggestions on board. Thanks for the help ladies and gentlemen.