Positioning after a right-sided stroke helps prevent contractures with a hand roll and a supported left arm

Stroke care isn’t just about stopping the clock; it’s about preserving movement, comfort, and dignity as the days unfold. If you’re studying topics common to the NCLEX Neurologic and Sensory Systems, you’ve probably run into questions about how to keep a patient’s limbs as functional as possible after a cerebrovascular accident (CVA). Here’s a practical way to think through one classic scenario: a client with a right-sided CVA who now has left-sided weakness.

Right-sided CVA: what changes to expect

When a stroke hits the right hemisphere, the left side of the body is usually the one that’s affected. That left arm and hand may be limp or exhibit decreased tone, and the familiar patterns of movement can feel slippery, awkward, or delayed. The big risk isn’t just weakness—it’s the tendency toward contractures, those stubborn shortenings of muscles and tendons that make joints stiff and limit motion over time. If we want rehab potential to stay on track, we address positioning and support early and consistently.

Let’s unpack the options you might see in a question like this, and why one choice stands out.

Option by option: what each intervention aims to do

• A. Apply elastic stockings to prevent flaccid leg muscles

Elastic stockings help with venous return and reduce the risk of DVT in immobile patients. They’re a sensible tool for leg care, but they don’t address contractures in the arms or prevent joint shortening. So, while they have a place in stroke care, they aren’t the most direct answer to preventing contractures in the affected upper extremity.

• B. Use a bed cradle to prevent dorsiflexion of the feet

A bed cradle can keep linen away from the feet, which might reduce discomfort and keep the feet in a neutral position. It’s helpful for preventing foot dystonia or plantar pressure injuries, but it doesn’t target the left arm or the problem of contractures in the upper extremity. Again, useful in its own right, but not the optimal pick for this scenario.

• C. Implement passive range-of-motion exercises to prevent muscle atrophy

Passive ROM exercises help maintain joint mobility and can slow muscle shortening, especially when a patient can’t move a limb on their own. They’re a valuable part of the care plan. However, without proper positioning and support, continuing passive ROM alone may not be enough to prevent contractures and shoulder problems that commonly occur after a left-sided impairment following a right CVA.

• D. Use a hand roll while supporting the left upper extremity on a pillow to prevent contractures

This option hits the core issue: preventing contractures by maintaining a functional length of muscles and keeping the left upper extremity in a supported, neutral position. A hand roll helps keep the fingers from curling into the palm, and supporting the arm on a pillow reduces strain on the shoulder and helps preserve range of motion. This approach directly addresses the risk of muscle shortening and joint deformities that can happen with immobility after a stroke.

Why the hand roll and support strategy works

• Targeted prevention of contractures. The left arm and hand are particularly vulnerable after a right CVA. When the limb is held in a supported, gentle position, the muscles and tendons have a chance to stay lengthened rather than tighten up into a fixed position.

• Shoulder protection. Supporting the arm reduces the risk of shoulder subluxation and discomfort that can derail rehabilitation. A stable shoulder makes it easier to participate in early movement and therapy.

• Facilitation of future function. By preserving soft-tissue length and joint alignment, you create better conditions for future active or guided movement as recovery progresses. In other words, today’s good positioning lays groundwork for tomorrow’s therapy milestones.

Putting this into practice at the bedside

If you’re caring for a client with a right CVA and left-sided weakness, here are practical steps you can take to implement the best intervention:

• Position with purpose. Gently place the affected left upper extremity on a stable surface—think a supportive pillow or foam wedge—so the shoulder isn’t pulling the arm into an awkward angle. A hand roll placed in the palm prevents the fingers from curling inward, which is a common post-stroke pattern.

• Check leg care too, without losing focus on the arm. While your primary goal here is the upper extremity, don’t neglect the legs. Use elastic stockings and reposition the patient regularly to prevent DVT and skin breakdown, especially if the patient has decreased mobility in the legs as well.

• Move and reassess. Include passive ROM for the left arm as appropriate, but pair it with the positioning strategy to maximize benefits. If ROM is being done, do it gently and within the patient’s tolerance, and monitor for pain, new resistance, or signs of muscle spasm.

• Guard the shoulder. The left shoulder is a common site for subluxation after a CVA. Keep the arm supported, avoid pulling or jarring movements, and assess the shoulder for any instability or discomfort during care activities.

• Communicate with the team. Share observations about the left arm’s comfort, position, and any changes in tone or range. Documentation helps the entire care team align on positioning, therapy, and goals.

• Involve the patient and family. Explain why the arm is being supported and how this simple positioning can influence recovery. When family members understand the rationale, they can reinforce proper positioning during care at home or in a rehabilitation setting.

A few broader notes you’ll likely encounter

• Contractures are a long-term risk after stroke, but they’re preventable with consistent positioning and gentle movement. The idea is to keep muscles and tendons in a lengthened, balanced state, not to force movement that isn’t ready.

• Passive ROM has its place, but it’s most effective when paired with correct positioning. Without support, passive movements can sometimes feel awkward for the patient and less protective against contractures.

• Not every intervention is wrong—each one fills a different void in stroke care. The key is to match the intervention to the most pressing risk for a specific patient. In this case, contracture prevention for the affected upper extremity is the priority.

What this means for your NCLEX-minded mindset

In questions like this, the best answer isn’t just about what’s technically correct in isolation; it’s about anticipating complications and prioritizing the patient’s functional future. The hand roll with left arm support directly targets the most preventable complication—contractures—while promoting a smoother pathway to rehab. Other options may contribute to care in meaningful ways, but they don’t address the central risk as directly as this positioning strategy does.

A few quick takeaways you can carry into the bedside

• When a stroke affects one side, protect that limb with supportive positioning to preserve length and flexibility of muscles and tendons.

• Use a hand roll to keep fingers from curling; pair with a pillow to support the arm and shoulder.

• Include gentle, supervised ROM as part of a comprehensive plan, but don’t rely on ROM alone to prevent contractures.

• Always consider the whole patient: posture, comfort, and safety in daily care routines influence recovery alongside any therapy you provide.

If you’re exploring NCLEX-style content around neurologic and sensory systems, remember that the best care blends practical, hands-on techniques with a clear view of potential complications. Contractures aren’t just a medical term—they’re a real hurdle for someone trying to regain independence after a stroke. The simple, thoughtful action of using a hand roll and providing stable support to the affected arm is concrete, compassionate, and aligned with good, patient-centered care.

Curious about more real-world nursing insights like this? You’ll find a wealth of scenarios, explanations, and practical tips that connect classroom concepts to the everyday rhythm of the ward. The goal isn’t to memorize a checklist, but to build a natural, responsive approach to the challenges stroke survivors face. After all, care that respects both body and spirit has the best chance to support meaningful recovery.

If you want, we can go through another common post-stroke question and unpack the best approach step by step. Either way, keeping the patient’s left upper extremity well-supported after a right CVA is a small action with big implications for comfort and future function.