Ch 1 - Stroke: Rehabilitation Flashcards
What are predictors of poor prognosis of motor recovery in stroke?
Complete arm paralysis at onset No grip by 4 wks Severe proximal spasticity Prolonged "flaccidity" >9 day before return of proprioceptive facilitation >13 days of proximal traction response
What is Step 1 of the Brunnstrom process of recovery following stroke-induced hemiplegia?
Flaccidity*/no voluntary movements immediately after the onset
What is Step 2 of the Brunnstrom process of recovery following stroke-induced hemiplegia?
Spasticity* appears
Synergy pattern
Minimal voluntary movements
What is Step 3 of the Brunnstrom process of recovery following stroke-induced hemiplegia?
Patient gains voluntary* control over synergies
Inc spasticity
What is Step 4 of the Brunnstrom process of recovery following stroke-induced hemiplegia?
Some movement patterns out of synergy are mastered
Dec spasticity
What is Step 5 of the Brunnstrom process of recovery following stroke-induced hemiplegia?
More complex movement combinations are learned as the basic synergies lose their dominance over motor acts
What is Step 6 of the Brunnstrom process of recovery following stroke-induced hemiplegia?
Disappearance of spasticity
What is Step 7 of the Brunnstrom process of recovery following stroke-induced hemiplegia?
Normal function is restored
Describe traditional therapy for stroke.
Positioning ROM exercises Strengthening Mobilization Compensatory tech Endurance training
Describe Proprioceptive (peripheral) Neuromuscular Facilitation (PNF).
Uses spiral and diagonal movement with goal of facilitating movement patterns that have functional relevance.
Describe the goals of Bobath approach/Neurodevelopmental technique (ND).
- Normalize tone
- Inhibit primitive patterns of movement
- Facilitate automatic voluntary reactions
Describe the Brunnstrom approach/Movement therapy.
Uses primitive synergistic patterns in an attempt to improve motor control through central
facilitation
Describe the Sensorimotor approach/Rood approach.
Modification of muscle tone and voluntary motor activity using cutaneous sensorimotor stimulation
Describe Motor relearning program/Carr and Shepperd approach.
Goal is for the patient to relearn how to move functionally and how to problem solve during attempts at new tasks
Describe requirements for Constraint-induced movement therapy (CIMT) in the EXCITE trial.
At least 10° of active wrist extension, at least 10° of thumb abduction/extension, and at least 10° of extension in at least two additional digits.
What is the MCC of hemiplegic shoulder pain?
CRPS Type I
Soft-tissue lesions
What is complex regional pain syndrome I also known as?
Reflex sympathetic dystrophy [RSD]
Shoulder-hand syndrome
Sudeck atrophy.
What is complex regional pain syndrome II?
Causalgia: pain limited to a peripheral nerve distribution
What is the gold standard for treating sympathetically mediated CRPS type I?
Sympathetic blockade of the stellate ganglion using local anesthetic
What is the sign of a successful Stellate ganglion block?
Ipsilateral Horner syndrome
What can be used to help diagnose CRPS I the first 3 months after stroke?
Triple phase bone scan that shows diffusely increased juxta-articular tracer activity on delayed images
What medication do patients with CRPS I and positive bone scan respond well to?
Oral steroid therapy
What is shoulder subluxation?
Subluxation of the humeral head from the glenoid fossa inferiorly
What did Friedland say about sling use in shoulder subluxation?
Do not prevent/correct subluxation and not necessary to support pain-free shoulder
