CVA - 3b Stroke Rehab

Question 1

what type of interventions in all phases post-stroke is there strong evidence for

Answer 1

intensive, high rep, task-oriented and task-specific training

Question 2

what is an important consideration if you do part-task practice w a patient

Answer 2

have to do whole-task practice after

Question 3

what is the progression of types of interventions after the exam

Answer 3

task analysis
part-task practice
whole-task practice
transfer of training

Question 4

what is task analysis

Answer 4

observe movements
compare and analyze
- normal vs abnormal
- essential components
- absence of motor activity
- timing/coordination
- excessive/inappropriate ms activity
- compensations

Question 5

what is a common task analysis observation in cerebellar dysfunction

Answer 5

excessive movement

Question 6

what is a common task analysis observation in parkinsons

Answer 6

have trouble w initiation and then have trouble stopping the movement

Question 7

what is a strategy with managing clonus

Answer 7

can quiet down by apply compression in continued long stretch

Question 8

what motor learning principles are relevant to part task practice

Answer 8

instructions, cues, feedback
guidance
environmental factors
practice schedule
repetition

Question 9

what is an important consideration when transitioning intervention from part to whole task practice

Answer 9

put component into integrated functional context asap

Question 10

according to motor learning principles what strategies are most effective (3)

Answer 10

not giving feedback every time
random
constant
distributed

Question 11

what pt population is a closed environment best for

Answer 11

TBI pts w a lot going on, more acute

Question 12

what are types of guidance to be implemented in whole task practice

Answer 12

hands on vs demonstration vs none

Question 13

how can instructions be presented for whole task practice

Answer 13

internal or external focus of attention

Question 14

what are considerations of feedback given during whole task practice

Answer 14

telling vs asking
frequency: after each trial or after a set of trials
KP vs KR

Question 15

practice schedule considerations for whole task practice

Answer 15

blocked vs random
variable vs constant
massed vs distributed (rest periods)

Question 16

what are the 3 motor learning stages

Answer 16

cognitive
associated
autonomous

Question 17

what is the learner doing in the cognitive stage of motor learning? what are strategies to use?

Answer 17

learner begins to develop understanding of task

cognitive mapping
perform initial approximations of task
“what to do”

Question 18

what is the learner doing in the associated stage of motor learning? what are strategies to use?

Answer 18

learner practices movements, refines motor plan

dec error, extraneous movements
dec dependence on external feedback; inc prop feedback
“how to do”

Question 19

what is the learner doing in the autonomous stage of motor learning? what are strategies to use?

Answer 19

learner practices movements -> refines motor responses

largely error free
min level of cog monitoring
“how to succeed”

Question 20

what are 4 considerations for positive outcomes

Answer 20

re-eval often
variability of practice
- “repetition without repetition”
encourage problem-solving
mental practice

Question 21

who should be involved with the transfer of training

Answer 21

relatives
staff
caregivers

Question 22

what are 2 ways to facilitate transfer of training

Answer 22

practice learned task in new contexts

practice slightly different tasks in same contexts

Question 23

where does task fit into the ICF model

Answer 23

activity

Question 24

what are functional tasks that PT should practice per contemporary rehab approach (6)

Answer 24

1. UE reaching, grasping, placing, holding
2. bed mobility, supine to sit
3. sitting and standing balance activities
4. transfers: STS, bed to chair
5. amb and stairs
6. wc mobility skills

Question 25

what area of the brain affected results in unilateral neglect and why

Answer 25

non-dominant (R) inferior parietal lobule
- spatial awareness

Question 26

what is unilateral neglect

Answer 26

failure to report, orient toward, or respond to stimuli on the contra side of space that cannot be attributed to sensory or motor dysfunction

Question 27

what often occurs in combination with unilateral neglect

Answer 27

anosognosia (unaware of deficit)
- ie leave arm behind them when doing task

Question 28

what are 6 unilateral neglect intervention strategies

Answer 28

1. encourage awareness of hemi-body (active movement and WB) and hemi-environment
2. active visual scanning thru turning head and axial trunk
3. cueing using visual, verbal, motor cues
4. have person look at limbs while moving them (makes active movements more effective)
5. UE exercises (ie PNF) and functional task training involving crossing midline
6. bilateral UE functional activities

Question 29

what are 3 interventions for unilateral neglect

Answer 29

1. imagery
2. mirror therapy
3. optokinetic stim and prism adaptation

Question 30

describe the use of an imagery intervention for unilateral neglect

Answer 30

to facilitate scanning toward affected side

“imaging you are a lighthouse beam; use your beam and sweep the floor from one side to another”

Question 31

describe the use of mirror therapy intervention for unilateral neglect

Answer 31

people move uninvolved arm and they will perceive as involved arm moving
- evidence supporting it can reduce neglect

Question 32

why does mirror therapy work

Answer 32

mental representation of movement on involved side

inc neural activity and motor networks in areas involved w allocation of attention and cog control

Question 33

what is optokinetic stim and prism adaptation and how is it used as an intervention for unilateral neglect

Answer 33

brief, daily visuo-motor training sessions while wearing optical prisms

promising treatment for neglect