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10 - Rehabilitation > 10-04 Stroke > Flashcards

10-04 Stroke Flashcards

1
Q

Types of Strokes (2)

A
  • Ischemic (Clot blocks blood flow)
  • Hemorrhagic (Blood vessel ruptures)
  • Ischemic is most common (80% of strokes)
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2
Q

Transient Ischemic Attack (TIA)

A
  • Temporary interruption of blood flow
  • Lasts few min or hrs, but less than 24 hrs
  • No residual brain damage
  • “TIA only lasts a day”
  • Greater risk of stroke (15% of people)
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3
Q

Stroke

A
  • Deficits last longer than 24 hours
  • Permanent effect
  • 4th leading cause of death in US
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4
Q

Motor Deficits (3)

A
  • Hemiplegia (Paralysis on one side)
  • Hemiparesis (Weakness on one side)
  • Opposite Side (L infarction results in R hemiplegia/paresis; R infarction results in L hemiplegia/paresis)
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5
Q

Atherosclerosis

A
  • Plaque formation
  • Continues to grow along wall after formation
  • Wall narrows, blocking blood flow
  • Forms in bifurcate, angled areas
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6
Q

Arteriovenous malformation (AVM)

A
  • Congenital condition
  • Cluster, tangle of arteries and veins
  • Progressive dilation eventually bleeds (50% of cases)
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7
Q

Stroke Risk Factors (Modifiable)

A
  • Hypertension
  • Heart disease
  • Diabetes
  • Smoking
  • Diet
  • Obesity
  • Stress
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8
Q

Stroke Risk Factors (Non-modifiable)

A
  • Age ( >55 yo)
  • Gender (Women b/c they live longer)
  • Family history
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9
Q

Stroke Risk Factors (Other)

A
  • Atrial Fibrillaton (Abnormal heart beat - blood pools in heart, clots and comes out)
  • TIA
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10
Q

Classic signs of stroke

A
  • Sudden
  • Numbness or weakness of face, UE, LE on one side of the body
  • Confusion, difficulty talking or understanding
  • Loss of vision in one eye
  • Difficulty walking, dizziness, LOB
  • Severe head without cause
  • FAST - Face, Arm, Speech, Time
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11
Q

FAST

A
  • Face, Arm, Speech, Time
  • Face (Assymmetrical)
  • Arm (Weak)
  • Speech (Slurred)
  • Time (How long)
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12
Q

T-PA

A
  • Clot buster
  • Given within three hours
  • Used for ischemic, not hemorrhagic CVA
  • Determine type of stroke with CT Scan
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13
Q

Stroke Pathophysiology

A
  • Interruption of blood flow for few minutes –> Lack of oxygen –> Cellular damage and death within few minutes –> Cerebal Edema –> Tissue Necrosis
  • Cerebral Edema increases pressure, shifts brain. Use shunt or cut skull out to relieve
  • Edema subsides within 2-3 weeks
  • Circle of Willis: Union of anterior, middle and posterior cerebral arteries that form in brain
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14
Q

L Hemispheric Damage (R sided deficits)

A
  • Difficulties in communication
  • Difficulties in processing info in sequence and linear
  • Cautious, anxious, disorganized, more hesitant behaviors
  • Needs lot of support from PTA/PT
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15
Q

R Hemispheric Damage (L sided deficits)

A
  • Difficulty with spatial-perceptual tasks
  • Difficulty understanding the whole idea of task/activity
  • Overestimates abilities, Unaware of deficits, poor insight to problem, impulsive, impaired safety insight (affects motivation to get better)
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16
Q

CT Scan Imaging (Acute)

A
  • Stroke less than three days old
  • Rules out other brain lesions
  • Identify hemorrhagic stroke
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17
Q

CT Scan Imaging (Sub-acute)

A
  • Stroke 3-5 days old
  • Development of cerebral edema
  • Cerebral infarction
  • Extent of CT lesion does not correlate with clinical signs of changes in function
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18
Q

MRI Imaging (Acute)

A
  • Stroke 2-6 hours
  • Identify cerebral infarction
  • Detail extent of infarction or hemorrhage during first 2-3 weeks
  • Can also detect smaller lesions than CT scan
  • Do not use if metal in body (i.e., pacemaker)
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19
Q

Primary Impairments (7)

A
  • Sensation
  • Motor Function
  • Postural control and balance
  • Speech, language, swallowing
  • Perception and cognition
  • Emotional
  • Bladder and bowel function
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20
Q

Sensation Deficits

A
  • Frequentlty impaired, rarely absent
  • Common pattern: face, UE, LE on one side
  • Deficits affect opposite side of damage, can also affect ipsilateral side to a lesser extent
  • Leads to impaired spontaneous movement
  • Affects proprioception, light touch, pain, temperature, neglect, graphesthesia
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21
Q

Sensation: Thalamic Pain

A
  • Central Post-Stroke Pain (CPSP) affects 70% of patients
  • Constant burning pain
  • Intermittent sharp pains
  • Exaggerated pain response to stimuli
  • Intolerable
  • Delayed onset of pain (weeks to months)
  • Spontaneous recovery is rare
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22
Q

“Shoulder Syndrome”

A
  • Thalamic pain
  • RSD (Reflex Symathetic Dystrophy)
  • Shoulder-hand syndrome
  • Arm is on fire (4 stages - first two are reversible, last two are not)
  • Treat with joint mobility, ROM
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23
Q

Homonymous Hemianopsia

A
  • Loss of vision in the contralateral half of visual field (nasal of one eye, lateral field of other eye)
  • R sided damage will affect L visual field
  • Incorporate mirror, PNF to cross midline
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24
Q

Visual Neglect

A
  • Visually unaware of the left side of the world (left side does not react to stimulus)
  • Head often turned away from hemi-side
  • Problems with awareness of body parts, awareness of environment, depth perception, spatial relationships
  • Treat by covering good eye, force pt to see with left side; force patient to use left side (mirror therapy, set objectives so patient has to literally turn to left to recognize that there is a world on that side)
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25
Q

Diplopia

A
  • Double vision
  • Both eyes are working, but not together
  • Treat using patch, enables pt to see world as it should be
  • Refer to OT to see how often to change patch position
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26
Q

Alterations in tone (Flaccidity)

A
  • Hypotonia
  • Acutely, altered by cerebral shock, followed by increase in tone)
  • Temporary, but can persist for few days to few weeks
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27
Q

Alterations in Tone (Spasticity)

A
  • Hypertonia
  • Predominate in gravity-dependent muscles
  • Occurs in 90% of patients
  • Occurs on side of body opposite lesion
  • Graded by Modified Ashworth Scale (MAS)
  • Sx includes scissoring gait
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28
Q

Synergy Patterns

A
  • Inability to perform isolated patterns

- Unable to perform isolated movements without producing movements in the remainder of limb (movements are grouped)

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29
Q

Stages of Motor Recovery (6)

A
  • Stg 1: Flaccidity
  • Stg 2: Early synergy, min to no voluntary movement
  • Stg 3: Voluntary movement in strong synergy pattern
  • Stg 4: Synergy declines; voluntary movement out of synergy pattern
  • Stg 5: Movement independent of voluntary synergy movement, some residual spasticity
  • Stg 6: Isolated volitional movements, near normal movement patterns, no spasticity
  • (Stg 7: Normal motor function restored)
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30
Q

Altered Coordination (Motor deficits) (5)

A
  • Ataxia
  • Motor Weakness
  • Timing and sequencing
  • Bradykinesia (slow movement caused by basal ganglia)
  • Involuntary movements: choreoathetosis, hemiballism
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31
Q

Ataxia

A
  • Uncoordinated movement appears when voluntary movement is attempted
  • Lack of proprioception, trying to walk across floor
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32
Q

Choreoathetosis

A
  • Rapid worm-like movements
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33
Q

Hemiballism

A
  • Jerking movements on one side of the body
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34
Q

Motor Praxis

A
  • Ability to plan and execute coordinated movement
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35
Q

Apraxia

A
  • Impairment of voluntary learned movement

- Characterized by inability to perform purposeful movement

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36
Q

Ideational Apraxia

A
  • Inability to produce movements either on command or automatically
  • Complete breakdown in conceptualization of task
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37
Q

Ideomotor Apraxia

A
  • Inability to perform task on command and to imitate gestures, even though patient understands concept of task
  • Able to carry out habitual tasks automatically
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38
Q

Reactive postural control

A
  • Postural control based on reaction to an external force
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39
Q

Anticipatory postural control

A
  • Self-initiated postural control
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40
Q

Factors causing postural control deficits (2)

A
  • Timing and sequencing of muscle activity (postural sway, uneven weight distribution)
  • Abnormal co-contraction
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41
Q

Postural control compensations (2)

A
  • Balance issues
  • Excessive hip movements
  • Excessive knee movements
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42
Q

Pusher Syndrome

A
  • High fall risk
  • Ipsilateral/contraversive pushing: Active pushing with stronger extremities toward hemiparetic side –> fall towards hemiparetic side
  • Patient may have aphasia
  • Deficit in processing somesthetic info (sensory perception of body sensation (light touch, pain, etc.)
  • Can last up to six months and disappear
  • Interventions: Sit to stand with mirror/tape to show midline, reaching exercise across midline, relying more on stronger leg to balance
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43
Q

Pusher Syndrome (Functional Complications)

A
  • No fear or sense of “pushing” from patient
  • Pt strongly resists attempts to passively correct
  • Results in instability (scissoring), asymmetry, deficits in transfers, standing
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44
Q

Aphasia

A
  • Communication disorder
  • Impairment in formulating, comprehending and/or use of speech
  • 30% of patients affected
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45
Q

Receptive Aphasia

A
  • Wernicke’s aphasia (fluent aphasia)

- Can talk, but does not understand

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46
Q

Expressive Aphasia

A
  • Broca’s aphasia (non-fluent aphasia

- Difficulty talking, but understands

47
Q

Global Aphasia

A
  • Receptive + Expressive Aphasia
48
Q

Dysarthria

A
  • Motor disorder
  • “Slurred Speech”
  • Deficits in speech articulation (speech errors, timing, vocal quality, pitch, volume, breath frequency)
  • May be accompanied by aphasia
49
Q

Dysphagia

A
  • Swallowing disorder
  • Affects 50% of patient - delayed triggering
  • Cause: Muscle weakness or paralysis
  • Cause: Cerebral damage
  • Cause: CN IX & X (glossopharyngeal and vagus nerves)
50
Q

Dysphagia (Ways to eat)

A
  • NGT
  • PEG: Percutaneous endoscopic gastronomy (prevents aspiration, penetration of food/liquid into airway, acute respiratory distress)
  • (NPO - not by mouth)
51
Q

Modified Barium Swallowing Test (MBS)

A
  • Barium Dye

- X-ray exposure used to track swallowing

52
Q

Fiberoptic Esophogeal Evaluation of Swallowing (FEES)

A
  • Fiberoptic inserted through nose

- Patient swallow; can see through camera

53
Q

Body Schema

A
  • Relation of body parts to each other and environment

- Deficit can affect feelings regarding body parts

54
Q

Somatoagnosia

A
  • Awareness of body parts

- Includes unilateral neglect, R/L discrimination, Agnosia, Anosognosia, Spatial relationships

55
Q

Unilateral Neglect

A
  • Neglect of half of the body
  • Can be a complete or visual cut
  • No reaction to visual/auditory stimulus on affected side (most common side is left side)
  • Intervention: PNF (chopping movement)
56
Q

Right/Left Discrimination

A
  • Inability to identify the right and left sides of one’s own body or that of the examiner
  • Inability to execute movements in response to verbal commands of “right” and “left”, or imitate movements
57
Q

Agnosia

A
  • Inability to recognize familiar objects

- Object (visual), Auditory (nonspeech sounds), Tactile (by touch), Finger (cannot recognize fingers)

58
Q

Anosognosia

A
  • Lack of awareness or insight
  • Perceptual impairment including denial, neglect, lack of awareness of the presence or severity of one’s own paralysis
  • You can teach them, but they still don’t think they need treatment
59
Q

Spatial Relations

A
  • Usually R sided brain lesions, weakness in L side
  • Visual-spatial: Inaccurate depth perception
  • Spatial relationship between body and object
  • Safety is challenge because they cannot discern space relationship between body and object
60
Q

Delirium

A
  • Clouding of consciousness: Acute state of confusion, dulling of cognitive processing, impaired alertness
  • Characteristics: Inattention, incoherent, Fluctuating LOC, sometimes hallucinations or agitation
  • Metabolic imbalance for stroke patients
  • Test with orientation test
61
Q

Attention

A
  • Ability to select and attend while suppressing extraneous stimuli
  • Sustained attention, selective attention, dividing attention (dual task), alternating attention
  • Isolate patient if deficits in attention
62
Q

Memory

A
  • Storage of experiences and perceptions for recall
  • Immediate memory, short-term memory, long-term memory
  • Affect on PT intervention: Carry-over
  • No carry-over with STM
63
Q

Confabulation

A
  • Pt fills in missing info with embellishment
  • Info missing because of lack of memory, lack of knowledge
  • Not attempt to be deceptive; patient believes what they are saying
  • Lesion in prefrontal cortex
64
Q

Perservation

A
  • Patient is “stuck”
  • Continued repetition of words, thoughts, actions
  • Usually unrelated to current context
65
Q

Executive Function

A
  • Complex, inter-related processing to produce action (normal)
  • Ability to engage in purposeful behaviors: volition, planning, purposeful action, effective performance
  • Deficits include decision making
66
Q

Executive Function Impairments

A
  • Impulsiveness
  • Inflexible thinking
  • Lack of abstract thinking
  • Impaired organization and sequencing of actions or thoughts
  • Impaired insight
  • Impaired planning ability
  • Impaired judgement
67
Q

Affect

A
  • Emotion or outward expression of emotion

- Labile, Apathy, Euphoria, etc.

68
Q

Labile

A
  • PBA (Pseudobulbar Affect)
  • Uncontrolled or exaggerated emotion
  • Can move from one extreme to another (ex: laughing to crying) with quick change
  • Inconsistent with mood or circumstance
  • Pt unable to control emotional fluctuations
69
Q

Apathy

A
  • Dulled/blunted response (Shallow affect)

- Misinterpreted as depression or lack of motivation

70
Q

Euphoria

A
  • Exaggerated feeling of well-being or happiness
71
Q

Depression

A
  • Affects 35% of patients
  • Refer to psychologist/neuropsychologist for treatment
  • Pt will not want to participate; ask about hobbies, etc. to engage
72
Q

Other emotional deficits

A
  • Exaggerated irritability
  • Exaggerated frustration
  • Social inappropriateness
73
Q

Bowel and bladder deficits

A
  • Disturbances, especially acutely
  • Deficits generally improve quickly
  • Toileting schedule: Retrain body to run on schedule; work with nursing to develop
74
Q

Musculoskeletal Deficits - Stroke (6)

A
  • Loss of voluntary movement
  • Immobility
  • Contractures
  • Edema (dependent position - no mobility cannot push fluid
  • Disuse atrophy and weekeness
  • Osteoporosis (not WB)
75
Q

Neurological deficits - Stroke (2)

A
  • Seizures (more acute stages)

- Hydrocephalus (excessive CSF in spinal cavity, shunt to drain)

76
Q

Cardiovascular/Pulmonary - Stroke (3)

A
  • DVT (47% of patients, can result in embolism)
  • Underlying CV disease: cardiac output, cardiac decompensation, rhythm disorders
  • Aspiration
77
Q

Stroke Recovery/Prognosis

A
  • First 4-6 weeks = fast progress )most neuroplasticity takes place)
  • Slower process follows - anticipate recovery up to 2 years or more
78
Q

Stroke Rehab Phase (Acute)

A
  • Early mobilization
  • Early stimulation and use of hemiparetic side –> functional reorganization
  • Foster positive attitude, minimize depression, apathy
  • Goals: resume ADLs, independent function
  • Before beginning treatment: vital signs, look at MD orders, reinforce with positive attitude
79
Q

Stroke Rehab Phase (Post-Acute)

A
  • Inpatient rehab (17 days average); goal is home health or outpatient)
  • Outpatient = higher level of recovery
  • Focus on neuroplasticity and neurorecovery vs. compensation
  • Team approach to treatment
  • Team includes patient, family, caregiver, MD, MD assistant, nurse, PT, PTA, OT, ST, CM/SW, neuropsychologist, psychologist, dietician, RT, vocational rehab/therapist
  • Inpatient Rehab (SNF) = 1.5-2.5 hrs/day
  • Inpatient Rehab (Hosp) = 3 hrs/day
80
Q

Stroke Rehab Phase (Chronic)

A
  • Outpatient
  • Greater than 6 months after CVA
  • Goals: HEP, community activities
81
Q

Stroke Outcome Measures

A
  • Fugl-Myer Assessment of Physical Performance (FMA)
  • National Institute of Health Stroke Scale (NIHSS)
  • Stroke Rehab Assessment of Movements (STREAM)
  • Motor Assessment Scale (MAS)
  • Chedoke-McMaster
  • Stroke Input Scale (SIS)
  • FIM
  • Upright Motor Control Test
82
Q

Focus of PT Interventions (12)

A
  • Sensory function
  • Motor function
  • Flexibility/joint integrity
  • Strength
  • Management of hypotonia
  • Management of spasticity
  • Initial movement control
  • Motor learning
  • Postural control and functional mobility
  • Pusher syndrome
  • UE function
83
Q

Strategy: Improve sensory function

A
  • Direct pt attention to stimulation and task
  • Eyes open, then eyes closed; encouragement/feedback; visual, tactile, proprioceptive stimuli on involved side (limit amount of input)
  • Stroking, brushing, icing, vibration involved side
  • Stroking hand with different textures
  • Press object into hand or draw shape/letter
  • Approximation through extended UE during WB
  • Approximation through LE in standing (WB)
  • Inflatable air splints
  • Safety education
  • Unilateral neglect: Active visual tracking/scanning with head and trunk rotation to involved side (red line on floor or mirror), imagery, direct pt attention to neglected/hemi side
84
Q

Strategy: Improve motor function

A
  • Flexibility/joint integrity (prevent contractures)
  • Strength
  • Spasticity management
  • Initial movement control
  • Motor learning
  • Postural control and functional mobility
  • UE function
  • LE function
  • Balance
  • Ataxia
85
Q

Strategy: Improve Flexibility/joint integrity

A
  • Soft tissue mobilization
  • Joint mobilization - grades 1 & 2
  • ROM - Terminal stretch, self-ROM (start with AAROM to preserve ROM/flexibility)
  • Arm cradling
  • Table-top polishing
  • Sitting and reaching toward floor
  • Supine, hand clasp together (chopping)
  • Mirror therapy
  • Positioning: Strategies, US on lap tray or arm trough, splinting of hand
  • WS in sitting or standing onto feet in PF
86
Q

Strategy: Improve Strength

A
  • Graded exercise training (Specificity of training - functional, task-specific, combine resistance trg with functional activities)
  • Concentric/Eccentric (Ecc = less CV stress)
  • Powder board (gravity-minimized), skate, sling suspension, free weights
  • Aquatic PT
  • Contraindication: Valsalva
87
Q

Strategy: Manage Hypotonia

A
  • Facilitation techniques
  • Approximation
  • WB
  • Support (slings, orthotics, w/c: arm troughs, laptrays, leg rests)
88
Q

Strategy: Manage Spasticity

A
  • Early mobilization (elongation of spastic muscle, prolonged stretch, sustained stretch through positioning)
  • Rhythmic rotation (on elongated limb, combined with axial trunk rotation - side-lying, sitting, hooklying - to reduce trunk tone: chopping limb followed by trunk)
  • WB (slow rocking over elongated limb - UE, quadruped, kneeling)
  • PNF upper trunk patterns (chopping or lifting)
89
Q

Strategy: Improve initial movement control

A
  • Focus: Dissociation of body segments(able to move body areas separately); selective movement patterns; functional activities (reaching, walking, stairs); activate muscles with variety of activities with varied contractions; practice eccentric (ex: wall squats) before concentric
  • Guided –> assist –> active –> resisted –independent
  • Assisted/guided movements progress to active control
  • Manual (tracking) resistance
  • Proprioceptive loading (WB)
  • Tapping
  • Practice: Sit –> Stand, Stabilizing in stance, Stand –> Sit
90
Q

Strategy: Improve motor learning

A
  • Pt fully engaged, meaningful activity (important to pt)

- 3 aspects: Strategy development, feedback, practice

91
Q

Strategy: Development for motor learning

A
  • PTA demonstrates task
  • PTA assists pt in learning desired task
  • Pt begins to practice - if multiple components, practice parts, then whole task
92
Q

Strategy: Feedback for motor learning

A
  • Intrinsic (internal) and extrinsic (external - PTA verbal, manual cues; environmental) feedback
  • Visual input: Mirror
  • Proprioceptive input: manual contacts, tapping, tracking resistance, antigravity postures, vibration
93
Q

Strategy: Practice for motor learning

A
  • Practice, practice, more practice
  • Essential for motor skill learning and recovery
  • Stroke patient: Closed environment (if distracted) –> open environment
  • Motivation: Ask patient, show patient how to progress
  • “Easy street” internal mini-town to acclimate patient to open environment
  • Blocked practice: One single task, constant repetition, a “building”
  • Random practice: Few tasks in one session in no specific order; depends on patient, work easiest to hardest
94
Q

Strategy: Improve postural control/functional mobility

A
  • Focus on trunk symmetry, using both sides of body, progressing from guided movements to active movements
  • Posterior alignment, move COM away from BOS, Impatient for strategies they face in everyday life
95
Q

Strategy: PC/FM (Rolling)

A
  • Roll to both sides (roll to strong side is more difficult)
  • Attention to hemi side not left behind (hand clasp - prayer position)
  • LE push off in hooklying position
  • PNF D1 Flexion of LE to facilitate movement
  • Rolling, esp with hooklying push off, with involved LE into sidelying-on-elbow promotes early WB
96
Q

Strategy: PC/FM (Supine Sit)

A
  • Supine to Sit
  • Sit to Supine
  • Practice from R and L
  • Emphasize from more involved side
97
Q

Strategy: PC/FM (Sitting)

A
  • Symmetrical posture
  • Spine alignment
  • Pelvic alignment
  • Feet on floor
  • Progression: Holding posture (stability); Moving in sitting (controlled mobility = dynamic stability); Dynamic challenges (reaching)
  • INT: Dissociate
  • INT: Therapy Ball
  • INT: Can use lateral WS: Hard flat surface –> Airex –> Physioball
98
Q

Strategy: PC/FM (Bridging)

A
  • Develop trunk
  • Hip extensors
  • LE out-of-synergy control
  • Simulates early WB through foot
  • FA: Bedpan
  • FA: Pressure relief
  • FA: Initiate bed mobility (scooting)
  • FA: Sit stand transfers
  • FA: Simulates early WB
99
Q

Strategy: PC/FM (Sit Stand)

A
  • Tech: Symmetrical WB
  • Tech: Active trunk flexion –> use momentum to shift body forward
  • Tech: Feed positioned posteriorly, in DF –> assist with forward momentum
  • Tech: Pt’s eyes on visual target (head up)
100
Q

Strategy: PC/FM (Standing, modified plantargrade)

A
  • Early standing posture
  • Increase postural control
  • Improve extremity control
101
Q

Strategy: PC/FM (Standing)

A
  • Progression: BUE support –> light fingertip support –> 1 UE support –> No UE Support
  • Pt may still lean, can lean on PTA
102
Q

Strategy: PC/FM (Transfers)

A
  • Bed chair
  • Practice toward STRONGER side (As control, practice toward weaker side)
  • INT: Change seat height to increase/decrease challenge
  • INT: Practice transfer to both sides
  • INT: UE placed by side or in prayer position (to protect involved UE)
  • INT: Assist with manual assistance or manual cues
103
Q

Strategy: PC/FM (Other positions)

A
  • Prone on elbows
  • Table top WB
  • Quadruped
  • Side-sitting
  • Kneeling
  • Half-kneeling
  • Floor Chair or stand
104
Q

Strategy: Pusher Syndrome

A
  • Pt pushes with stronger extremities toward weaker/involved side –> stronger WS to weaker side
  • PTA attempts to correct –> stronger pushing
  • Intervention focus: Vertical position (postural orientation) - verbal/tactile cues; Active movements and WS toward stronger side; Visual cues (mirror, lines, environmental prompts - walk around table, push into wall)
  • Intervention techniques: Ball; Cross weaker LE over stronger/pusher LE; Air splints - promote muscular activation; Tapping - promote muscular activation; If use cane, shorten to facilitate WS to stronger side; Environmental boundary (doorway, corner) to facilitate symmetry; Block stronger extremities from moving into postures that result in pushing; Engage pt in problem-solving
105
Q

Strategy: UE Function (UE as postural support)

A
  • Promote proximal stability: WB on extended UE with hand stabilized (counteracts flexor synergy)
  • UE WB activities: sitting, modified plantargrade, standing
  • Intervention progression: static holding –> dynamic stabilization
106
Q

Strategy: UE Function (Reaching)

A
  • Requires scapular upward rotation and protraction (might have to mobilize), elbow extension, wrist/finger extension, accurate visual-perceptual processing
  • Intervention progression (Sidelying): UE forward reaches and holds –> eccentric –> reciprocal movement
  • Intervention progression (Sitting): Supported reaching with hand on table top –> slide hand along table top –> reaching against gravity (PNF)
  • Standing
  • Vary height of reach, distance
107
Q

Strategy: UE Function (Manipulation/Dexterity)

A
  • Meaningful, task-oriented
  • Grasp and manipulation
  • Voluntary release
  • Facilitate extension: stretching, positioning, inhibitory techniques if spastic
  • Use uninvolved hand to stabilize or assist (hold paper while writing with other hand)
108
Q

Strategy: UE Function (Enhanced Training)

A
  • CIMT (Constraint Induced Movement Therapy): constrain strong side, force pt to use weak side; 6 hrs/dayfor 10-15 consecutive days; compliance is issue
  • EMG Biofeedback: increase use of motor limits in hyperactive motion
  • NMES: reduce shoulder subluxation; combine with functional activity
  • Robotic assisted technology: Exoskeleton; targeted for med-to-severe deficits
109
Q

Strategy: UE Function (Manage Shoulder Pain)

A
  • CRPS (complex regional pain syndrome), RSD, Shoulder-hand syndrome
  • Sharp stabbing pain, more often with movement than at rest
  • Intermittent (early stage) or constant (later stages; progresses to debilitating
  • Interventions: Positioning/handling, NMES, Supportive devices, normalize tone, mobilization for pain, cryotherapy, relaxation, EMG biofeedback, PROM
110
Q

Strategy: UE Function (Supportive Devices)

A
  • Especially for hypotonia
  • Especially for early transfers/GT
  • W/C position: arm board, lap tray, UE support
  • Slings
  • Humeral cuff sling, figure-eight harness
  • Other alternatives: taping, NMES
111
Q

Strategy: LE Function

A
  • Reduce synergy pattern: PNF LE D1, lateral side-step
  • Stress hip ADD with hip/knee flexion activities: PNF LE D1, standing, step-ups
  • Hip ext, knee flex: Bridging, Supine hip ext with knee flex over side of mat, push dowm through heel, standing post hell raises
  • Rotation: stting, sideling, modified plantargrade, hooklying, kneeling, half-kneeling
  • Therapy ball
  • Reciprocal action: Smooth reversals, flex/ext movements
  • Increase challenges
112
Q

Strategy: LE Function (Balance Training)

A
  • COM over BOS

- Limits of stability (LOS)

113
Q

Strategy: Manage Ataxia

A
  • Frenkel’s exercises: Instruct with slow, even voice, activity multiple times, slow and precise; visual track to guide correct movement; regain movement control through cognitive compensation
  • Weighting ataxic limb or trunk
  • Ataxia increases with stress, anxiety, excitement

10 - Rehabilitation (25 decks)

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