CVA - 3a Stroke Rehab Flashcards

1
Q

what are common BSF impairments of pts s/p

A

ms strength
control of voluntary movements
cardiovascular fitness
spasticity
sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 3 approaches to PT interventions

A

restorative
preventative
compensatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the restorative approach to PT

A

aimed at improving impairments, activity limitations, and participation
- tap into plasticity and motor learning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is an appropriate approach to PT in the acute and subacute phases of recovery

A

restorative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the preventative approach to PT

A

aimed at minimizing potential complications and indirect impairments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the compensatory approach to PT

A

aimed at modifying task, activity, or environment to improve function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what type of approach to PT interventions are used in stroke rehab

A

flip b/w restorative and compensatory depending on pt goals and their CLOF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

stroke recovery results from what 4 factors

A

recovery of ischemic penumbra
resolution of cerebral edema
neuroplasticity
rehabilitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how does the resolution of cerebral edema result in stroke recovery

A

relieve pressure on other structures in brain
- recovery inc bc those structures are able to function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

better outcomes for stroke recovery is associated with waht

A

early medical care
smaller strokes
specialized stroke care centers
early, intensive multidisciplinary rehab approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are specialized stroke care centers associated with

A

lower mortality rates
more functional independence 1yr post
more likely to be living at home 1yr post

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

why are specialized stroke care centers associated w better outcomes

A

providers specially trained and up to date on research

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why is an early, intensive multidisciplinary rehab approach associated w better outcomes

A

high rep, high intensity principle of motor learning and neuroplasticity w recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what recovery pattern has a poor prognosis for motor recovery

A

no return 4wks post-stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the typical pattern of recovery

A

most recovery in 1st 6mo
- can cont w measurable gains thru chronic stages (>6mo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what measurement tool can be used to predict recovery outcomes

A

NIHSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what factors make recovery patterns variable

A

ischemic vs hemorrhagic
size of stroke
vessels affected
in evolution vs complete/stable

18
Q

what impairments have the greatest impact on functional performance

A

motor and perceptual (ie lateral neglect) impairments

19
Q

what are positive factors for prognosis

A

high motivation
stable supportive family
financial/rehab resources
health literacy
intensive training w repetitive practice

20
Q

why is intense rehab important in a good prognosis

A

tap into neuroplasticity

21
Q

what are mortality/poor predictors for prognosis

A

hx of past CVA
prolonged LOC
respiratory complications
- dysphagia
- aspiration
inc age
ICP -> herniation
size of lesion

22
Q

what is a depressed mood associated with in the prognosis

A

associated with disability but not mortality

23
Q

PT approach for acute phase

A

restorative > compensatory

24
Q

what are foci of PT in the acute phase

A

pt and family ed
prevention of secondary complications
positioning, splinting
manage impairments
early mobilization
dc planning

25
Q

what are secondary complications to prevent in the acute phase

A

pain
loss of ROM
joint contractures
skin integrity

26
Q

what is the goal of positioning and splinting in the acute phase

A

prevention and optimize ability to function

27
Q

how are impairments are managed in the acute phase

A

inc ROM
improve strength
postural control/balance
cognition

28
Q

what type of mobilization is done in the acute phase

A

early mobilization
low intensity, monitor status closely

29
Q

what is the avg acute care stay after a stroke

A

2-4days

30
Q

what are the foci of PT in the subacute phase

A

pt and family goals
max functional status/independence
dc planning if in rehab
equipment use
community re-entry

31
Q

what dc plan is done in the subacute phase if the pt is in a rehab

A

return to home
community reintegration

32
Q

what equipment is utilized in the subacute phase

A

DME
orthotics
splints, slings, gloves, etc.

33
Q

what is considered in community re-entry in the sub acute phase

A

return to work
rec activities

34
Q

what are the goals of PT in the chronic phase

A

maintain/cont to improve:
- ROM
- strength
- endurance
- balance
- functional mobility
- independent participation in rec and work activities

35
Q

what PT approach is utilized in the chronic phase

A

continue w restorative as able, but may transition to compensatory if plateau and not making gains
- want to foster as much independence as possible

36
Q

what are the foci PT in the chronic phase

A

community/rec activities
HEP
interventions - CIMT, bilateral training, VR, etc.

37
Q

what is involved in the HEP in the chronic phase

A

exercise workload - inc appropriately
health promotion
fall prevention & safety

38
Q

what is a traditional neuro rehab approach

A

NDT (Bobath)

based on developmental sequence & hierarchal theories of motor control

not supported well by evidence

39
Q

what are contemporary neuro rehab approaches

A

task orientation retraining
functional movement re-ed
neuromuscular re-ed

40
Q

how is a contemporary neuro rehab approach different from a traditional one

A

contemporary is more focused on evidence based concepts of motor control, motor learning, and neuroplasticity