CVA - 3a Stroke Rehab

Question 1

what are common BSF impairments of pts s/p

Answer 1

ms strength
control of voluntary movements
cardiovascular fitness
spasticity
sensation

Question 2

what are the 3 approaches to PT interventions

Answer 2

restorative
preventative
compensatory

Question 3

what is the restorative approach to PT

Answer 3

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

Question 4

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

Answer 4

restorative

Question 5

what is the preventative approach to PT

Answer 5

aimed at minimizing potential complications and indirect impairments

Question 6

what is the compensatory approach to PT

Answer 6

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

Question 7

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

Answer 7

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

Question 8

stroke recovery results from what 4 factors

Answer 8

recovery of ischemic penumbra
resolution of cerebral edema
neuroplasticity
rehabilitation

Question 9

how does the resolution of cerebral edema result in stroke recovery

Answer 9

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

Question 10

better outcomes for stroke recovery is associated with waht

Answer 10

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

Question 11

what are specialized stroke care centers associated with

Answer 11

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

Question 12

why are specialized stroke care centers associated w better outcomes

Answer 12

providers specially trained and up to date on research

Question 13

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

Answer 13

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

Question 14

what recovery pattern has a poor prognosis for motor recovery

Answer 14

no return 4wks post-stroke

Question 15

what is the typical pattern of recovery

Answer 15

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

Question 16

what measurement tool can be used to predict recovery outcomes

Answer 16

NIHSS

Question 17

what factors make recovery patterns variable

Answer 17

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

Question 18

what impairments have the greatest impact on functional performance

Answer 18

motor and perceptual (ie lateral neglect) impairments

Question 19

what are positive factors for prognosis

Answer 19

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

Question 20

why is intense rehab important in a good prognosis

Answer 20

tap into neuroplasticity

Question 21

what are mortality/poor predictors for prognosis

Answer 21

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

Question 22

what is a depressed mood associated with in the prognosis

Answer 22

associated with disability but not mortality

Question 23

PT approach for acute phase

Answer 23

restorative > compensatory

Question 24

what are foci of PT in the acute phase

Answer 24

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

Question 25

what are secondary complications to prevent in the acute phase

Answer 25

pain loss of ROM joint contractures skin integrity

Question 26

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

Answer 26

prevention and optimize ability to function

Question 27

how are impairments are managed in the acute phase

Answer 27

inc ROM improve strength postural control/balance cognition

Question 28

what type of mobilization is done in the acute phase

Answer 28

early mobilization low intensity, monitor status closely

Question 29

what is the avg acute care stay after a stroke

Answer 29

2-4days

Question 30

what are the foci of PT in the subacute phase

Answer 30

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

Question 31

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

Answer 31

return to home community reintegration

Question 32

what equipment is utilized in the subacute phase

Answer 32

DME orthotics splints, slings, gloves, etc.

Question 33

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

Answer 33

return to work rec activities

Question 34

what are the goals of PT in the chronic phase

Answer 34

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

Question 35

what PT approach is utilized in the chronic phase

Answer 35

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

Question 36

what are the foci PT in the chronic phase

Answer 36

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

Question 37

what is involved in the HEP in the chronic phase

Answer 37

exercise workload - inc appropriately health promotion fall prevention & safety

Question 38

what is a traditional neuro rehab approach

Answer 38

NDT (Bobath) based on developmental sequence & hierarchal theories of motor control not supported well by evidence

Question 39

what are contemporary neuro rehab approaches

Answer 39

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

Question 40

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

Answer 40

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