After Midterm Flashcards
CVA typically affect what type of people
older
Risk increases with age and slightly more common in
men
of the people we will see with stroke there is a small percentage that
doesn’t have any impairment at all.
Per 100 stroke survivors - break it down
10 have no more impairments
40 have mild residual deficits
40 have long term deficits
10 need institutional care
A very small percentage of stroke have long term
nursing home care
what is ischemic stroke
Most common. There is a blockage in the vessels. with age and time the blockage can develop. plague build up in the vessel walls. over time it will narrow it makes it harder for the blood to push through.
what is hemorrhagic stroke
less common. vessels get weaker and tear and bleed. typically the person will have surgery to repair the rupture.
what is transient ischemic attach (TIA)
an event that results in neurological symptoms resembling a stroke.2 Although these symptoms develop suddenly and may last up to 24 hours, they resolve completely, leaving no discernable symptoms or deficits.2 TIAs are considered a “warning sign” of an impending stroke and precede approximately 12% of all strokes.
What is a thrombotic stroke
Type of ischemic stroke that is a stationary clot
What is a embolic stroke
a type of ischemic stroke, traveling clot formed elsewhere in the body.
What is a lucunar infarct
Small holes in deep cerebral hemipsphere, pons or basal ganglia
smaller vessel blockage
pure motor ataxic or sensory loss
good prognosis - mild stroke, mild symptoms
Anterior cerebral artery infarct (ACA)
Frontal and parietal lobes
majority of corpus callosum
motor and sensory cortices of leg and foot
motor planning areas.
more difficulty walking and better clinical picture with their arm.
ACA impairment symptoms
contralateral hemiparesis - opposite side of body than brain.
behavioral changes - impulsive.
apraxia - ideomotor or ideational
aphasia - expressive or receptive
Middle cerebral artery infarct afects what type of brains
lateral areas of hemispheres
primary motor and sensory cortices face, trunk, arm, hand
Middle Cerebral Artery (MCA) impairments
left hemisphere damage - apraxia, aphasia
either hemisphere damage
contralateral hemiplegia and sensory loss
homonymous hemianopsia - loss of vision in both of the eyes.
Right hemisphere damage
neglect
visuospatial impairmemnt
emotional lability
behavior disturbance
strong gaze preference toward lesion side.
what is homonymous hemiplegia
loss of vision of part of both eyes. like half of each eye. they need a behavioral optomitrist. What we call a field cut.
if patient has a r brain infarct which side will they look to more
left side.
what is emotional labile
inappropriate expression of emotion - like crying or laughing.
Broca aphasia
trouble with expression, slow effortful speech, short phases less than 4 words. poor repetition ability, comprehension intact.
speech might be really slow and effortful.
Wernicke aphasia
receptive aphasia. A combination of real words and made up words.
paraphasias - saying words a little off that it actually should be.
neologisms - non words, made up words
poor comprehension and repetition
speech apraxia.
what is dysarthria
a motor articulation problem. speech is unclear or garbled. they can’t get the mouth to make the sounds.
what is neologisms
made up words
with a patient with aphasia is it important to do your treatment how
in context.
posterior cerebral artery infarct - where in the brain?
temporal and occipital lobes
primary visual areas, memory, visual spatial analysis, writing, & reading
what does the posterior cerebral artery impairment affect
Left - anomia, agraphia, acalculia, alexia, dyslexia
Right - cortical blindness
L/R discrimination errors
visuospatial impairments
Either hemisphere damage - contralateral hemiplegia and sensory loss
visual field cut
visual agnosia
memory loss
(look up these words, make seperate cards)
vertebral basilar artery infarct affects what part of brain
pons, midbrain, thalamus, caudate nucleaus, lateral medulla, cerebellum
deficits from vertebral basilar artery deficits
Loss of consciousness
brainstem or cranial nerve damage
hemi or quadriplegia
memory loss
agitation
comatose or vegetative state
locked in syndrome
Patient scenario
Toni has is HIV+ along with stroke. multiple strokes, presents with more weakness in L than R. she’s has bilateral CVA’s (less common). She was depressed in rehab. uses a power wheelchair. LIves alone in accesable apartment. hospital bed, roll in shower. Wears bilateral AFO
What are some challenges with her as she ages impact on occupation?
What might be important home and community encironment adaptations
what activity adaptations that might be appropriate
modifying transfers, adaptations for loss of vision. strength, weakness, cognition, memory. She says she independent.
home and community adaptation - jar openers, easier to grip pots and pans.
activity adaptation - if there is a congntive deficity, timed medication dispenser.
Acalculia / dyscalculia
the inability or impaired ability to perform simple mathematical calculations previously mastered
Agnosia
the inability to recognize objects, persons, smells or sounds despite having normal sensory functions
agraphia / dysgraphia
the inability or impaired ability to produce written language
Alexia / Dyslexia
the inability or impaired ability to read written language despite preservation of other aspects of language
Aneurysm
a weakening of an artery wall resulting in a bulge or distension of the artery
Anomia
the inability to name objects or persons
Anosognosia
An unawareness or denial of a neurological deficit that is clinically evident
Aphasia
an acquired multimodality language disorder that results from damage to the language center of the brain
apraxia
The inability to perform purposeful actions despite having normal muscle function
arteriovenous malformation
A tangle of abnormal blood vessels connecting arteries and veins without an intervening capillary bed
Contracture
An abnormal shortening of muscle tissue rendering the muscle highly resistant to passive stretching. Typically results in permanent restrictions in joint motion
Contralateral homonymous hemianopia
An ocular condition where vision has been lost in the same field halves of both eyes
Dysarthria
A speech disorder resulting from paralysis, weakness or incoordination of the muscles involved in speech production
Dysphagia
An eating disorder involving difficulty in manipulating and transporting liquids / solids from oral cavity to pharynx.
hemianesthesia
A loss of sensation in either half of the body
spasticity
A velocity - dependent increase in tonic stretch reflexes. Also denotes a form of muscular hypertonicity with exaggeration of tendon reflexes.
Subluxation
an incomplete or partial dislocation of a joint
Occlusion of the internal carotid artery commonly results in
contralateral hemiplegia, hemianesthesia, homonymous hemianopia, changes in mental functions, and behavioral disturbances
If the stroke occurs in the dominant hemisphere (i.e., hemisphere containing the representation of speech and controlling the extremities used to perform skilled movements such as writing and kicking a ball; the left hemisphere in the majority of individuals), the patient may also present with
aphasia, agraphia or dysgraphia, acalculia or dyscalculia, and apraxia.
If the nondominant hemisphere is involved, the patient may present with
visual perceptual impairments, unilateral body or spatial neglect, anosognosia, and dressing apraxia.
An occlusion of the anterior cerebral artery typically produces
contralateral hemiparesis and somatosensory loss, impacting the leg to a greater degree than the arm.5 Behavioral disturbances, apraxia, and mental changes—such as confusion, disorientation, decreased initiation, and impairments in attention and short-term memory—are often present.
The chart review reflects the patient had a L sided infact R sided hemiplegia and impairment of light touch, localization, pain and temperature in the RUE as the main impairments. Which type of CVA did they MOST likely have?
ACA, MCA, Lacunar, vertebral basilar
Lacunar
Lacunar Stroke symptoms
Pure motor, ataxic or sensory loss
What symptoms would be present with an Anterior Cerebral Artery ACA stroke
Contralateral hemiparesis—greater involvement of the leg and foot Contralateral somatosensory loss—greater involvement of the leg and foot Left unilateral apraxia Behavioral disturbances Mental changes Inertia of speech or mutism
The patient has a PMH of untreated HTN which lead to a weakened internal carotid A. Burst. Which type of CVA did the patient MOST likely have? Hemorrhagic or ischemic
Hemorrhagic
Which of the folowing is true about a tascient ischemic approach TIA.
A. residual dysarthria is common
B. symptoms completely resolve within 24 hrs
C. Residula memory loss is common
D. hemiparesis is more likely int he UE than the LE
B. Symptoms completely resolve within 24 hrs.
A clot that breaks away and travels to and lodges in a smaller vessel is known as which of the following?
A. Embolus
B. Thrombus
A. Embolus
What might the clinical picture look like? Patient 1 - R MCA infarct, ischemic what side is the deficient
Left
R MCA infarct, ischemic. Pt has neglect, visuospatial impairment, emotional lability, bahavior disturbance, contralateral hemiplegia & sensory loss, homonymous hemianopsia, strong gaze preference toward lesion side.
Wht are some things that you want to evaluate?
vision, balance - if it’s safe to do so, sensation, upper quarter screen - functional range of motion no goniometry. Barthel assessment, transfers and self care skills. Cognition - does he know where he is and does he know what happened to him. mini mental or inpatient rehab. Maybe texas if he has the attention for it.
When doing an assessment of a person with CVA what are some things to consider?
- location and type of brain infarct
- factor co-morbidities including any prior CVA
- consider treatment setting
- client goals and preferences
- social/premorbid status-living alone? driving?
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
What other information do we need to know?
PMH
sensations
how long ago was the CVA
What kind of home
do they live alone
are their steps
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
Which domains would you assess?
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
Which specific assessments would you use?
Cooking assessment. executive route finding task, texas, barthel, showering assessment with transfers and general pacing and impulsivity.
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
Assessments for ADLs
Modified Barthel index shah
AmPAC 65 clicks
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
Assessments for UE
UQS
ROM
Strength
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
Assessment for cognitive and perceptual
MMSE TFLS
SLUMS
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
Assessment for trunk and posture balance
5 times sit to stand. time them. Tug - walk from one point to another, functional reach test - measure how far they can reach
MAR-R
Functional Reach
5xsit to stand
Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
assessment for overall
occupational profile, what the name of that semi formal assessment ??
Describe the pusher
Pt actively pushes toward the hemiparetic side
loss of postural balance and falling toward hemiplegic side
strong resistance to passive correction back to midlie
occurs in 10% of post CVA population
which side to to you sit to if the patient is a pusher
the unaffected side
What helps treat a pusher
constant moving. take the unaffected arm out of the equation. cross midline, come in and out of midline so their have to constantly think through midline.
disadvantage the non-hemi side so they can’t push in to that side.
a lot of movement in an out of base of support.
Closed chain movement with the involved side, arm and leg active.
treat both sides of the trunk and keep them moving
With the hemiplegic arm we always
address the extremity and incorporate it into function
hypotonia
low tone
hypertonia
high tone
What is the role of the hemi arm if the patient is brushing their teeth
it’s used as a support or in visual field
Addressing shoulder pain in hemi arms
normalize tone - if we can normalize tone, that can normalize spasticity and that can help with pain.
proper handling - educate the family to not tug on the arm. Providing gait belts for home use.
address primary pain source - they might have arthritis on top underneath it all
A/AAROM
Functional use
shoulder support
The key for sublexations is to
realign, mobilize and activate
reseat the humeral head. There are exercises we can give the patient. isometrics are a good way to help activate the rotator cuff muscles. Some patients can’t do isometrics if they are cognitively impaired.
Shoulder slings: pros
protection, control, prevention - further over stretching, pressure relief, support, psychological message
Shoulder sling: cons
learned nonuse
shortens soft tissue
dependence
immobilize
fails to correct malalignment
interferes with normal movement
interfers with function
blocks sensory input
hinders balance
psychological message
look up barthel assessment
In the acute stage of CVA what are the hospital setting priorities?
positioning, dysphagia management, fall prevention, early mobilization, beginning self care retraining, COTA role
explain how you’d have a patient with a hemi arm lay sidelying?
have them reach arms into air to protract shoulder blade then role over.
within the first 24 hrs people with stroke will have soft tissue contractures. What will help with this?
OT, early mobilization, doing ADLs, encouraging people to move. Teaching the family right away.
What would the COTA role be with an early CVA
they can participate in some of the evaluation, they take on the treatments if the OTR hands it over.
what would rehabilitation stage look like for a pt with a CVA
Restoring of compensating for performance skill deficits,
Maximize ADL and IADL independence
UE function
Valance
Functional mobility
Cognition and perception
COTA role
which group of people would adaptive devices be hard for ?
people with apraxia
what are the priorities for CVA in home and health environment recovery?
Maximize independence in IADLs
Build skills for return to work
Resume driving & community mobility
Promote engagement in leisure and socialization
COTA role
Trunk represents how much of the human body mass
more than half
weight shift within trunk is essential for
normal functional movement
What is postural control
the motor act of maintaining, achieving or restoring a state of balance during activity
balance in the core is directly related to
daily occupations
balance is what two things in teh OTPF
client factor and performance skill
higher balance score correlate with higher ________ scores
ADL
functional reaching training positively influences __________ and ____________
trunk control and ADL performance
what is the leading cause of fall?
impaired balance
decreased occupation and independence may be a result of
balance deficits
what are some signs of balance issues
sit to stand, trouble getting out of the chair, wide stance or gait. feet shuffling. sitting slumped over or bad posture
Assessments of balance
- chart review, PMH, vitals, gait belt
- bedside screen - bed mobility - can they scoot, roll over, bridge.
- Sitting balance - can they sit on edge of bed, can they reach out of their base of support.
- standing balance
static sitting balance fair
sitting unsupported without balance loss and without UE support
dynamic balance
able to sit unsupported able to weight shift and cross midline maximally
static standing balance
able to stand unsupported standing balance against maximal resis
impaired trunk control can lead to
- dysfunfunction in upper and lower extremities
- potential spinal deformity and contracture
- increased risk of fall
- impaired ability to interact with the environment
- visual dysfunction resulting form head / neck malalignment
- decreased independence in occupation
- decreased sitting and standing tolerance, balance, and function
Trunk Control Test
examines four functional movements: roll from supine to the weak side, roll from supine to the strong side, sitting up from supine, and sitting on the edge of the bed for 30 seconds (feet off the ground).
Trunk impairment scale A
assessment that evaluates motor impairment of the trunk after stroke. The tool scores static (3 items), dynamic sitting balance (10 items), and trunk coordination (4 items). It also aims to score the quality of trunk movement and to be a guide for treatment.
Trunk Impairment Score B
This tool consists of seven items. Abdominal muscle strength and verticality items were derived from the Stroke Impairment Assessment Set, and the other five items consist of the perception of trunk verticality, trunk rotation muscle strength on the affected and the unaffected sides, and righting reflexes both on the affected and the unaffected sides.
postural assessment scale for stroke patients
Assessment that includes items related to trunk control. Scale contains 12 4 pt items. higher the score the better the function. things like sitting and standing without support.
The Chedoke-McMaster Stroke Assessment
is used to assess physical impairment and disability in clients with stroke. It has two components including the Impairment Inventory (which determines the presence and severity of physical impairments in the six dimensions of shoulder pain, postural control, and arm, hand, foot, and leg quantified in a seven-point staging system) and the Activity Inventory (which measures the client’s functional ability). The Activity Inventory has two components: the Gross Motor Function Index (with items including moving in bed and transferring to a chair) and the Walking Index (with items including walking on rough ground and climbing stairs).
Balance assessment
modified functional reach test
functional reach test
five time sit to stand test
Less used balance assessment
time up and go test TUG
Berg Balance Test
how do we intervene for balance
Create an individualized plan that addresses cause of balance impairement
remediation
compensation
adaptation
What parr of the nervous system does Guillian Barre affect
peripheral nervous system
what the difference between guillian barre and MS
they both deal with demylination but GB can have a full recovery, MS is progressive and no cure
Are the issues in Guillian Barre asymetrical or symmetrical
symmetrical
When does Guillian BArre plateau?
1-4 weeks after initial onset
Sometimes Guillian Barre can affect the
respiratory system
What are the neurological signs?
numbness or loss of sensation, tingling, paresthesias, progressive muscle weakness, sympetrical ascending weakness, ANS involvement.
In severe cases: Orthostatic dizziness
Bowel & Bladder (incontinence)
Cardiac Symptoms
What disorder is this? Glove and stocking sensory loss, symmetrical ascending paralysis starting with feet, absence of deep tendon deep tendon reflex
Guillian Barre
Causes of Guillian Barre
Preceding GI or respiratory infection with diarrhea 4 weeks prior in 40-70% of cases (Brooks, 2014)
Immune system attacks myelin, axons of PNS
Bacterial or viral illness with Cytomegalovirus provoking immune mediated nerve dysfunction
phases of Guillian barre
Onset or acute inflammation
Plateau phase
Progressive recovery phase
Describe onset or acute inflammation stage of Guillian Barre
first stage. Manifests as weakness in at least 2 limbs that progresses and reaches its maximum in 2-4 weeks
Accompanied by increasing SX
Mechanical ventilation needed for 20-30%
Describe plateau phase
No significant change in progression
Lasts for a few days or a few weeks when greatest disability is present
describe progressive recovery phase of GB
Remyelination and axonal regeneration occur and may last for up to 2 years
Recovery starts at head and neck and proceeds distally
50% of patients have complete functional return
35% have residual weakness that does not resolve
Remaining 15% have significant permanent disability
what are the assessments used for Guillian Barre ICU - rehab
Motor - UQS, manual muscle testing, pinch and grip, maybe goniometry
Sensory- sensation testing (all modalities)
ADL - barthel, AMPAC 6 click, function observation and noting of what type of assist - driving assessment.
cognition - SLUMS, mini mental, texas, MOCA, cognitive performance test, KTA, CPT
Coordination - 9 hole, functional dexterity, box and blocks
Balance - Modified FXL reach, 5xsts, TUG
Other? - Dysphagia, feeding assessment
Where do interventions start with GB?
Muscle and joint function
Length, strength & ROM
Intercostal & abdominal muscle function
Controlled deep breathing, bridging, rolling exercises, sitting, standing
Intrinsic hand muscles; last to recover
ADL’s
Persistent fatigue, address energy conservation with carefully graded activities
For Guilliane Barre, what muscle strength do you have to wait for you do resistance activity
3+/5
When Guilliane Barre strength is only 1/5 what do you do
PROM, muscle reducation but do not over tire muscles, use mouth stick if pt can tolerate
for Guilliane barre what do you do if there strength is 2/5
Gravity eliminated only. deltoid aid, arm skateboard, mobile arm support on WC.
when Guilliane barre muscle strength is 3/5 what do you do
No resistive exercise, AROM antigravity, use dowel exercises of SH and elbow in supine. use long opponens splint
if guilliane barre muscle strength is 3+-5 what can we do?
graduated resistive exercises when muscles consistently test 3+/5, strengthen wrist flexors and extensors, strengthen hand muscles.
what would be good hand wrist extensor strengthening exercises for GB
twisty thing, light weight over a wedge or edge of table.
Treatment ideas for a person with GB
Build fine motor skills, dexterity and hand strength
energy conservation and activity pacing
sensory retraining, mirror therapy compensatory strategies to protect skin
functional mobility
breath control with activity
self care
IADLs
compensatory skill building and equipment
congnition training graduated resistive exercise when muscles test 3+/5,
static dynamic balance in sitting and standing
What is dyphasia?
Dysphagia means swallowing difficulty
How does OT treat dysphasia?
Self feeding
Cognition & perception
Sensory and motor skills
Postural control
Altered swallowing mechanism (advanced dysphagia training
diagnosis that could lead to dysphagia
Cancer of the head & Neck
CVA
TBI
Parkinson’s Disease Dementia
MS
CP
ALS
SCI
Pneumonia
Oral preparatory stage of swallowing
Voluntary - Food is received and contained in mouth
Preparation of the bolus with the aid of saliva, good lip seal, jaw movement and chewing
Buccal muscles contract to prevent food from pocketing
Oral Stage of swallowing
During the Oral stage, the tongue elevates and rolls back, sequentially contacting the hard and soft palate, moving the bolus backwards
What are oral stage impairments
Difficulty manipulating food and liquids in and through the mouth.
Chewing of solid food may be affected.
Weakness and discoordination of tongue movements is commonly seen in oral stage swallowing.
Tongue does not propel the food towards the throat efficiently.
Drooling
Loss of food or liquid from the front of the mouth
Pocketing of food in the mouth/cheeks
Prolonged or ineffective chewing
Poor intake, or weight loss
Pharyngeal phase
Involuntary stage
Soft palate elevates to close of nasopharynx
Preventing food from escaping into the nose
Tongue base moves back to contact pharyngeal wall
Larynx (voice box) & hyoid bone move up and forward
Epiglottis (top part of larynx) is tilted down and back to guide the food past the airway
Vocal cords close
Bolus is propelled through pharynx
Breathing momentarily stops
Vocal folds come together to further protect airway
Muscles of the pharynx contract Peristalsis (a wave of contraction) moves the food through the esophagus
The lower esophageal sphincter relaxes to allow the food to pass into the stomach
Food passes into the esophagus
The pharyngeal stage lasts approximately 1 second
Pharyngeal stage dysphagia or impairments
Coughing at meals
Frequent throat clearing
Wet/ gurgle vocal quality
Runny nose/watery eyes
Temperatures after eating/drinking
Delayed swallow initiation
Frequent bouts of pneumonia/bronchitis
Shortness of breath when eating/drinking
Temperature spikes after meals
Esophageal phase
There is dysfunction of peristalsis (contraction wave) which normally squeezes food from the esophagus into the stomach.
Individuals feel food “stuck” at some level
Related to neurological disorders, mechanical problems (obstructions such as cancer or strictures) or specific motility problems with the esophageal muscles
These may also be seen with aging
impairments in the esophageal stage
Sensation of food sticking in the chest area or throat
Difficulty swallowing solid food
Heartburn
Drooling
Regurgitation
Unexplained weight loss
Change in dietary habits
Gastroesophageal Reflux Disease (GERD)
Zenker’s Diverticulum
Esophageal dysmotility or stricture
how are swallowing disorders diagnosed?
FEES (fiberoptic endoscopic ecaluation of swallowing)
what is aspiration
anytime the person is swalowing and material enters the laryngeal space and falls below the vocal cords and enters the trachea - usually creates a cough
what is penetration (swallowing)
material enters the larungeal space but does not fall belwo the level of the vocal cords
silent aspiration
patent lacks sensation (does not cough) in response to aspiration.
Implications of dysphagia
poor nutrition or hdration
risk of aspiration, which can lead to pneumonia and chronic lung disease
less enjoyment of eating or drinking
embarrassment or isolation in social situations involving eating.
what does a nosey cup do?
it has a cut out for the nose so the pt doesn’t have to tip their head back
Why do we need to think about positioning
positioning can help alleviate pain, respiratory and swallow function, poor posture can lead to poor self esteem and will limit how they interact with the environment
Symptoms that can affect positioning of a patient
abnormal tone
weakness
ataxia/apraxia
cognitive deficits
sensory deficits - can’t feel the need to weight shift
vision deficits and midline orientation they may think they’re upright.
Goals for posture
postural alignment
postural support and stability
pressure distribution
pressure relief
function
position checklist for seating in wheelchair
pelvis
Trunk
Head
Lower Extremities
Back Height
Seath Depth
Lower Leg Length
Chronic pain
pain that lasts 3 months or longer.
Fibromyalgia
widespread pain with tenderness & stiffness. Independent of an injury or lesion. Etiology unknown. Abnormalities in CNS pain processing suspected. Dianoses of exclusion.
Acute pain
more specific, pain is a symptom. well defined time of onset. pathology is often identifiable
Neuropathic pain
due to damaged peripheral or central nervous system and sensations.
Management of chronic pain occurs
in conjunction with typical OT assessments and interventions such as UQS, ADL assessment etc.
What are questions to ask about pain
can you describe it
where?
how long?
what do you do that helps?
What do you do that makes it worse?
Do you take anything for the pain?
pain assessments
visual analog scale
pain disability index
brief pain inventory - short or long version
observe during functional tasks
Brief pain inventory
self report likert scale - short version or long. 0=no pain, 10=worst pain ever. pain indicated on anatomical diagram
aging in place
using design, strategies and modifications to keep patients in their own homes.
you can be certified in ageing in place through
national association of home builders, New York State has resourses on website,
Aging in place assessment
Home safety self assessment - determine the need of home modifications and needs, pt and caregiver training.
What are the 3 main things that can really help a patient make their home more accessable
Door handles that are handles rather than knobs.
LED lights so that they are bright.
Rocker wall switches
Neuro technology can help rehabilitate
-Motor control & performance
-Gross & fine motor coordination
-Functional movement patterns
-Cognition
-Sensory stimulation
Neuro technology can help
make treatment more efficiently and quickly.
ipad use with recovery
Self care (grooming, dressing, bathing, hygiene)
IADLs (feeding pets, cooking, shopping, money management)
Cognitive and perceptual skills
Fine motor skills
IPad apps for fine motor
dexteria
angry birds
labryinth
bubble pop
benefits of robotics
Reduces therapist strain
Task repetitive dosing
Technical precision and accuracy
Collects objective data about pt. performance
Enhances motivation
Offers precision in desired movement patterns
Lacunar Infarct
Small holes in deep cerebral hemisphere, pons, or basal ganglia
Smaller vessel blockage
Pure motor, ataxic or sensory loss
Good prognosis
