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In order Cuccurullo > Ch 1 - Stroke: Rehabilitation > Flashcards

Ch 1 - Stroke: Rehabilitation Flashcards

1
Q

What are predictors of poor prognosis of motor recovery in stroke?

A 
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
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2
Q

What is Step 1 of the Brunnstrom process of recovery following stroke-induced hemiplegia?

A

Flaccidity*/no voluntary movements immediately after the onset

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3
Q

What is Step 2 of the Brunnstrom process of recovery following stroke-induced hemiplegia?

A

Spasticity* appears
Synergy pattern
Minimal voluntary movements

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4
Q

What is Step 3 of the Brunnstrom process of recovery following stroke-induced hemiplegia?

A

Patient gains voluntary* control over synergies

Inc spasticity

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5
Q

What is Step 4 of the Brunnstrom process of recovery following stroke-induced hemiplegia?

A

Some movement patterns out of synergy are mastered

Dec spasticity

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6
Q

What is Step 5 of the Brunnstrom process of recovery following stroke-induced hemiplegia?

A

More complex movement combinations are learned as the basic synergies lose their dominance over motor acts

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7
Q

What is Step 6 of the Brunnstrom process of recovery following stroke-induced hemiplegia?

A

Disappearance of spasticity

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8
Q

What is Step 7 of the Brunnstrom process of recovery following stroke-induced hemiplegia?

A

Normal function is restored

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9
Q

Describe traditional therapy for stroke.

A 
Positioning
ROM exercises
Strengthening
Mobilization
Compensatory tech
Endurance training
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10
Q

Describe Proprioceptive (peripheral) Neuromuscular Facilitation (PNF).

A

Uses spiral and diagonal movement with goal of facilitating movement patterns that have functional relevance.

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11
Q

Describe the goals of Bobath approach/Neurodevelopmental technique (ND).

A
  • Normalize tone
  • Inhibit primitive patterns of movement
  • Facilitate automatic voluntary reactions
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12
Q

Describe the Brunnstrom approach/Movement therapy.

A

Uses primitive synergistic patterns in an attempt to improve motor control through central
facilitation

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13
Q

Describe the Sensorimotor approach/Rood approach.

A

Modification of muscle tone and voluntary motor activity using cutaneous sensorimotor stimulation

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14
Q

Describe Motor relearning program/Carr and Shepperd approach.

A

Goal is for the patient to relearn how to move functionally and how to problem solve during attempts at new tasks

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15
Q

Describe requirements for Constraint-induced movement therapy (CIMT) in the EXCITE trial.

A

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.

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16
Q

What is the MCC of hemiplegic shoulder pain?

A

CRPS Type I

Soft-tissue lesions

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17
Q

What is complex regional pain syndrome I also known as?

A

Reflex sympathetic dystrophy [RSD]
Shoulder-hand syndrome
Sudeck atrophy.

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18
Q

What is complex regional pain syndrome II?

A

Causalgia: pain limited to a peripheral nerve distribution

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19
Q

What is the gold standard for treating sympathetically mediated CRPS type I?

A

Sympathetic blockade of the stellate ganglion using local anesthetic

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20
Q

What is the sign of a successful Stellate ganglion block?

A

Ipsilateral Horner syndrome

21
Q

What can be used to help diagnose CRPS I the first 3 months after stroke?

A

Triple phase bone scan that shows diffusely increased juxta-articular tracer activity on delayed images

22
Q

What medication do patients with CRPS I and positive bone scan respond well to?

A

Oral steroid therapy

23
Q

What is shoulder subluxation?

A

Subluxation of the humeral head from the glenoid fossa inferiorly

24
Q

What did Friedland say about sling use in shoulder subluxation?

A

Do not prevent/correct subluxation and not necessary to support pain-free shoulder

25
Q

What did Hurd say about sling use in shoulder subluxation?

A

No difference in ROM, subluxation or pain with or without slings

26
Q

What is the etiology of brachial plexus injury in stroke hemiplegia?

A

Traction injury to plexus/nerve

27
Q

What is seen on EMG of brachial plexus injury in stroke hemiplegia?

A

Lower motor neuron findings

28
Q

What joints can heteroptic ossification (HO) develop in stroke?

A

Extensor surface of elbow

Shoulder

29
Q

What is seen on exam in Inferior shoulder subluxation in hemiplegia?

A

Acromio-humeral separation

Flaccid

30
Q

What diagnostics should be done in Inferior shoulder subluxation in hemiplegia?

A

X-ray in standing position Scapular plane view

31
Q

What is the treatment of Inferior shoulder subluxation in hemiplegia?

A

FES

32
Q

What is seen on exam in rotator cuff tear in hemiplegia?

A
  • Positive abductiontest
  • Positive drop armtest
  • Flaccid or spastic
33
Q

What diagnostics should be done in rotator cuff tear in hemiplegia?

A
  • X-ray
  • Arthrogram
  • MRI
  • Subacromial injection of lidocaine
34
Q

What is the treatment of rotator cuff tear in hemiplegia?

A
  • Steroid injection
  • PT/ROM
  • Possible surgical repair
  • Reduction of internal rotator cuff tone
35
Q

What is seen on exam in CRPS Type I in hemiplegia?

A
  • MCP compression test
  • Skin changes color
  • Flaccid or spastic
36
Q

What diagnostic tests should be done in CRPS Type I in hemiplegia?

A
  • Triple phase bone scan

* Stellate ganglion block

37
Q

What are treatments for CRPS Type I in hemiplegia?

A
  • Oral corticosteroids

* Stellate ganglion block

38
Q

What is seen on exam in Adhesive capsulitis in hemiplegia?

A
  • ER <15 degrees
  • Early dec scapular motion
  • Spastic
39
Q

What diagnostics should be done in Adhesive capsulitis in hemiplegia?

A

Arthrogram

40
Q

What are treatments for Adhesive capsulitis in hemiplegia?

A
  • PT/ROM
  • Debridement manipulation
  • Subacromial/GH steroid injections
  • Intra-articular steriods
  • Oral steroids
  • Reduction of IR cuff tone
41
Q

What is seen on exam in Impingement syndrome in hemiplegia?

A
  • Pain with abduction of 70°–90°
  • End-range pain with forward flexion
  • Usually spastic
42
Q

What are diagnostic tests of Impingement syndrome in hemiplegia?

A

Subacromial injection of lidocaine

43
Q

What are treatments of Impingement syndrome in hemiplegia?

A
  • PT/ROM
  • Scapular mobilization
  • Subacromial steroid injection
  • Reduction of internal rotator cuff tone
44
Q

What are exam findings of Biceps tendinitis in hemiplegia?

A
  • Positive Speed’s/Yergason test

* Flaccid or spastic

45
Q

What are diagnostics/treatments of Biceps tendinitis in hemiplegia?

A

Tendon sheath injection of lidocaine

46
Q

How does spasticity present in stroke patients (pattern, timing)?

A

Days to weeks after stroke in upper-extremity flexor and lower-extremity extensor patterns

47
Q

What are negative risk factors for return to work post-stroke?*

A

Low score on Barthel index on discharge from rehab
Prolonged rehab LOS
Aphasia
Prior alcohol abuse

48
Q

What is the Barthel index?

A

Functional assessment tool that measures independence in ADLs on 0 to 100
scale

49
Q

What are the functions graded on the Barthel index?

A 
Feeding
Bathing
Grooming
Bowels
Bladder
Toilet use
Transfers (bed to chair and back)
Mobility (on level surfaces)
Stairs

In order Cuccurullo (91 decks)

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