CVA - 3a Stroke Rehab Flashcards
what are common BSF impairments of pts s/p
ms strength
control of voluntary movements
cardiovascular fitness
spasticity
sensation
what are the 3 approaches to PT interventions
restorative
preventative
compensatory
what is the restorative approach to PT
aimed at improving impairments, activity limitations, and participation
- tap into plasticity and motor learning
what is an appropriate approach to PT in the acute and subacute phases of recovery
restorative
what is the preventative approach to PT
aimed at minimizing potential complications and indirect impairments
what is the compensatory approach to PT
aimed at modifying task, activity, or environment to improve function
what type of approach to PT interventions are used in stroke rehab
flip b/w restorative and compensatory depending on pt goals and their CLOF
stroke recovery results from what 4 factors
recovery of ischemic penumbra
resolution of cerebral edema
neuroplasticity
rehabilitation
how does the resolution of cerebral edema result in stroke recovery
relieve pressure on other structures in brain
- recovery inc bc those structures are able to function
better outcomes for stroke recovery is associated with waht
early medical care
smaller strokes
specialized stroke care centers
early, intensive multidisciplinary rehab approach
what are specialized stroke care centers associated with
lower mortality rates
more functional independence 1yr post
more likely to be living at home 1yr post
why are specialized stroke care centers associated w better outcomes
providers specially trained and up to date on research
why is an early, intensive multidisciplinary rehab approach associated w better outcomes
high rep, high intensity principle of motor learning and neuroplasticity w recovery
what recovery pattern has a poor prognosis for motor recovery
no return 4wks post-stroke
what is the typical pattern of recovery
most recovery in 1st 6mo
- can cont w measurable gains thru chronic stages (>6mo)
what measurement tool can be used to predict recovery outcomes
NIHSS
what factors make recovery patterns variable
ischemic vs hemorrhagic
size of stroke
vessels affected
in evolution vs complete/stable
what impairments have the greatest impact on functional performance
motor and perceptual (ie lateral neglect) impairments
what are positive factors for prognosis
high motivation
stable supportive family
financial/rehab resources
health literacy
intensive training w repetitive practice
why is intense rehab important in a good prognosis
tap into neuroplasticity
what are mortality/poor predictors for prognosis
hx of past CVA
prolonged LOC
respiratory complications
- dysphagia
- aspiration
inc age
ICP -> herniation
size of lesion
what is a depressed mood associated with in the prognosis
associated with disability but not mortality
PT approach for acute phase
restorative > compensatory
what are foci of PT in the acute phase
pt and family ed
prevention of secondary complications
positioning, splinting
manage impairments
early mobilization
dc planning
what are secondary complications to prevent in the acute phase
pain
loss of ROM
joint contractures
skin integrity
what is the goal of positioning and splinting in the acute phase
prevention and optimize ability to function
how are impairments are managed in the acute phase
inc ROM
improve strength
postural control/balance
cognition
what type of mobilization is done in the acute phase
early mobilization
low intensity, monitor status closely
what is the avg acute care stay after a stroke
2-4days
what are the foci of PT in the subacute phase
pt and family goals
max functional status/independence
dc planning if in rehab
equipment use
community re-entry
what dc plan is done in the subacute phase if the pt is in a rehab
return to home
community reintegration
what equipment is utilized in the subacute phase
DME
orthotics
splints, slings, gloves, etc.
what is considered in community re-entry in the sub acute phase
return to work
rec activities
what are the goals of PT in the chronic phase
maintain/cont to improve:
- ROM
- strength
- endurance
- balance
- functional mobility
- independent participation in rec and work activities
what PT approach is utilized in the chronic phase
continue w restorative as able, but may transition to compensatory if plateau and not making gains
- want to foster as much independence as possible
what are the foci PT in the chronic phase
community/rec activities
HEP
interventions - CIMT, bilateral training, VR, etc.
what is involved in the HEP in the chronic phase
exercise workload - inc appropriately
health promotion
fall prevention & safety
what is a traditional neuro rehab approach
NDT (Bobath)
based on developmental sequence & hierarchal theories of motor control
not supported well by evidence
what are contemporary neuro rehab approaches
task orientation retraining
functional movement re-ed
neuromuscular re-ed
how is a contemporary neuro rehab approach different from a traditional one
contemporary is more focused on evidence based concepts of motor control, motor learning, and neuroplasticity
