CVA - 3b Stroke Rehab Flashcards
what type of interventions in all phases post-stroke is there strong evidence for
intensive, high rep, task-oriented and task-specific training
what is an important consideration if you do part-task practice w a patient
have to do whole-task practice after
what is the progression of types of interventions after the exam
task analysis
part-task practice
whole-task practice
transfer of training
what is task analysis
observe movements
compare and analyze
- normal vs abnormal
- essential components
- absence of motor activity
- timing/coordination
- excessive/inappropriate ms activity
- compensations
what is a common task analysis observation in cerebellar dysfunction
excessive movement
what is a common task analysis observation in parkinsons
have trouble w initiation and then have trouble stopping the movement
what is a strategy with managing clonus
can quiet down by apply compression in continued long stretch
what motor learning principles are relevant to part task practice
instructions, cues, feedback
guidance
environmental factors
practice schedule
repetition
what is an important consideration when transitioning intervention from part to whole task practice
put component into integrated functional context asap
according to motor learning principles what strategies are most effective (3)
not giving feedback every time
random
constant
distributed
what pt population is a closed environment best for
TBI pts w a lot going on, more acute
what are types of guidance to be implemented in whole task practice
hands on vs demonstration vs none
how can instructions be presented for whole task practice
internal or external focus of attention
what are considerations of feedback given during whole task practice
telling vs asking
frequency: after each trial or after a set of trials
KP vs KR
practice schedule considerations for whole task practice
blocked vs random
variable vs constant
massed vs distributed (rest periods)
what are the 3 motor learning stages
cognitive
associated
autonomous
what is the learner doing in the cognitive stage of motor learning? what are strategies to use?
learner begins to develop understanding of task
cognitive mapping
perform initial approximations of task
“what to do”
what is the learner doing in the associated stage of motor learning? what are strategies to use?
learner practices movements, refines motor plan
dec error, extraneous movements
dec dependence on external feedback; inc prop feedback
“how to do”
what is the learner doing in the autonomous stage of motor learning? what are strategies to use?
learner practices movements -> refines motor responses
largely error free
min level of cog monitoring
“how to succeed”
what are 4 considerations for positive outcomes
re-eval often
variability of practice
- “repetition without repetition”
encourage problem-solving
mental practice
who should be involved with the transfer of training
relatives
staff
caregivers
what are 2 ways to facilitate transfer of training
practice learned task in new contexts
practice slightly different tasks in same contexts
where does task fit into the ICF model
activity
what are functional tasks that PT should practice per contemporary rehab approach (6)
- UE reaching, grasping, placing, holding
- bed mobility, supine to sit
- sitting and standing balance activities
- transfers: STS, bed to chair
- amb and stairs
- wc mobility skills
what area of the brain affected results in unilateral neglect and why
non-dominant (R) inferior parietal lobule
- spatial awareness
what is unilateral neglect
failure to report, orient toward, or respond to stimuli on the contra side of space that cannot be attributed to sensory or motor dysfunction
what often occurs in combination with unilateral neglect
anosognosia (unaware of deficit)
- ie leave arm behind them when doing task
what are 6 unilateral neglect intervention strategies
- encourage awareness of hemi-body (active movement and WB) and hemi-environment
- active visual scanning thru turning head and axial trunk
- cueing using visual, verbal, motor cues
- have person look at limbs while moving them (makes active movements more effective)
- UE exercises (ie PNF) and functional task training involving crossing midline
- bilateral UE functional activities
what are 3 interventions for unilateral neglect
- imagery
- mirror therapy
- optokinetic stim and prism adaptation
describe the use of an imagery intervention for unilateral neglect
to facilitate scanning toward affected side
“imaging you are a lighthouse beam; use your beam and sweep the floor from one side to another”
describe the use of mirror therapy intervention for unilateral neglect
people move uninvolved arm and they will perceive as involved arm moving
- evidence supporting it can reduce neglect
why does mirror therapy work
mental representation of movement on involved side
inc neural activity and motor networks in areas involved w allocation of attention and cog control
what is optokinetic stim and prism adaptation and how is it used as an intervention for unilateral neglect
brief, daily visuo-motor training sessions while wearing optical prisms
promising treatment for neglect
