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Neuro Rehab 2 > CVA - 4a Stroke Rehab UE > Flashcards

CVA - 4a Stroke Rehab UE Flashcards

1
Q

what are primary vs second post-stroke UE impairments (5)

A

PRIMARY
motor control/activation
altered ms tone
loss of sensation
coordination problems
unilateral neglect

SECONDARY
weakness, atrophy
ms length, ROM
edema
subluxation
pain

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2
Q

what are 4 interventions/foci of the hemiplegic UE

A

positioning
shoulder joint integ
pain management
UE functioning

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3
Q

what are the goals of positioning for a hemiplegic UE

A

protect joints
limit edema
dec pain
visualize limb
function

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4
Q

what are the goals of preserving shoulder joint integrity of hemiplegic UE

A

prevent subluxation
prevent shoulder-hand syndrome (CRPS)

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5
Q

how can pts experience pain related to the shoulder joint integrity of a hemiplegic UE

A

not having structures to hold humerus and joint capsule appropriately

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6
Q

what is a standardized outcome measure to use for a hemiplegic UE

A

Fugl Meyer

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7
Q

what is the most common sequelae secondary to a hemiplegic UE

A

inferior shoulder subluxation
- ant and superior possible, but inferior most common

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8
Q

why are inferior shoulder subluxations so common in hemiplegic UE

A

weakness, hypotonicity surrounding GH joint and gravity of limb’s wt -> downward rotation of scap and glenoid fossa -> traction of humerus -> soft tissue surrounding GH joint and joint capsule stretches and lengthens -> ms length-tension relationship changes

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9
Q

what could result from improper management of a hemiplegic UE post stroke

A

soft tissue damage causing shoulder and UE pain

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10
Q

what is pain of subluxed hemiplegic shoulder associated with

A

subluxation itself
loss of ROM
nerve impingement (GH rhythm off)
overstretching and/or rupture of ligaments, tendons, and ms of shoulder

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11
Q

how is a shoulder subluxation dx

A

radiographs (reliable, valid)
calipers or tape measure
palpation**
- 1-2 finger gap from acromion/clavicle to HOH
- also see asymmetry

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12
Q

when is it esp important to properly handle pt’s hemiplegic UE and why

A

positioning
bed mobility
transfers

dec risk of developing pain syndromes and improve functional outcomes

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13
Q

what is the goal of the collaborative care of the interdisciplinary team of a pt hemiplegic UE

A

protect from risk of secondary complications

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14
Q

what are 3 causes of hemiplegia shoulder pain

A

malalignment of joints can lead to soft tissue involvement

impingement syndrome

complex regional pain syndrome (CRPS; shoulder-hand syndrome)

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15
Q

how can malalignment of joints cause hemiplegia shoulder pain and what can it lead to

A

can lead to soft tissue involvement:
- tendon tear
- tendinitis
- bursitis

this can cause shoulder pain and dec function, adhesive capsulitis

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16
Q

how can impingement syndrome result from a hemiplegic UE

A

GH rhythm off -> humerus pulled down and not in proper alignment -> GH friction-compression if go into flex or ABD -> risk for impingement

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17
Q

how can CRPS cause hemiplegia shoulder pain

A

ANS changes -> vasomotor changes, discoloration and temp changes (pink and cool with hyperalgesia

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18
Q

how can CRPS in a hemiplegic UE be prevented

A

support and position UE

mobilize scap and UE
- esp w PROM >90deg for shoulder flex and ABD, need to ensure scap is gliding into upward rotation on thoracic wall

promote active movement and WB-ing

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19
Q

what is important education to give to caregivers to prevent CRPS in a hemiplegic UE

A

never pull on hemiplegic UE to roll pt or during transfers

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20
Q

what are 6 PT interventions for hemiplegic UE management

A

ROM
positioning to prevent progression
supportive devices
NMES
taping
promote recovery of motor function

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21
Q

how does trunk control play impact an hemiplegic UE

A

poor trunk control -> abnormal postures -> will affect how they move and scap orientation -> altered scap orientation -> change orientation of glenoid fossa

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22
Q

how does altered ms tone impact an hemiplegic UE

A

spasticity in pec major and lats downwardly rotates scap
- changes glenoid orientation

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23
Q

what does a scap that isn’t moving w ROM put the pt at risk for

A

inc risk for sublux and impingement

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24
Q

how can spasticity present in hemiplegic UE that inc risk of what secondary complication

A

abnormal ms synergy of excessive ADD and IR
- worsens sublux pathomechanics

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25
Q

at what ROM is ensured scapular gliding and approximation of humeral head into glenoid fossa especially important

A

flex and ABD >90deg

26
Q

what ROM is contraindicated in a hemiplegic UE

A

overhead pulleys for self ROM
- can’t confirm scap is moving w arm

27
Q

best positioning practice for hemiplegic UE while supine in bed and why

A

ext elbow and elevate hand, forearm supinated

pts at risk for flexion contractures & inc IR tone

28
Q

how, what, and to who should education be provided on positioning for hemiplegic UE

A

signage
use of supports: pillows, arm troughs, trays
healthcare providers, pt, fam

29
Q

what type of stroke might a wc tray be esp good in and why

A

R side
impulsive, poor safety awareness, reminder not to get up

30
Q

what are pros to the use of a traditional sling

A

protect from overstretching supraspinatus and joint capsule
free up therapist hands

31
Q

what are cons to the use of a traditional sling (5)

A
  1. don’t dec sublux
  2. don’t encourage functional use of limb
  3. encourage secondary adaptive shortening and contractures
    - IR, ADD, elbow flex, finger flex
  4. encourage learned nonuse and exacerbate neglect
  5. contribute to balance deficit
    - COM shift ant, inc postural instability
32
Q

what is the GivMohr sling

A

places pt affected extremity in anatomically correct position in standing
- support at hand/wrist and elbow to approximate shoulder joint

33
Q

what are the pros of the GivMohr sling (3)

A
  1. prevent/dec loss of ROM and contractures - UE rests at side and not flex/IR
  2. prevent/dec pain
  3. prevent/dec hand edema
34
Q

what is a con of the GivMohr sling

A

no improvement seen in shoulder subluxation when sling removed
- see benefits if sling is on
- can’t prevent if sling is off

35
Q

who is NMES appropriate for

A

reducing subluxation & prevent further joint separation in acute and subacute stroke (<6mo)

36
Q

what/who did NMES have no effect on

A

chronic stroke
arm function
shoulder pain

37
Q

why is NMES ineffective in chronic stroke

A

ligamentous structures already overstretched, could provide temporary joint support during stim time
- but no carryover once stim is off

38
Q

what does the evidence say about the use of NMES for strengthening in post-stroke

A

most effective if in conjunction w active practice of task
- no evidence that use alone will lead to return of ms function

39
Q

what does evidence say about the use of taping or strapping of shoulders post-stroke

A

low levels of evidence
may delay pain onset
doesn’t reduce sublux or improve function

not great research available, mostly anecdotal

40
Q

what are interventions included in task-oriented retraining (contemporary approach) - 3

A

CIMT
bimanual therapy
progressive resistance exercise

41
Q

what is key in promoting neuromotor recovery

A

repetition!!!!!

42
Q

what are tools of technology that can be used in promoting neuromotor recovery and how

A

EMG biofeedback
- facilitate movement
NMES
- while doing task for strengthening
robotic assist
VR
- w impaired UE

43
Q

what does evidence say about PNF and neuromotor recovery

A

none to support use for return of function
- some support for improvement in ROM

44
Q

who is appropriate for CIMT

A

min cog and sensory deficits
min 20deg active wrist ext
min 10deg active finger ext

45
Q

what are characteristics of CIMT

A
  1. restraint
  2. repetitive task practice
  3. shaping - memory and motor learning for task
46
Q

what is a modified version of CIMT and when is this used

A

dec duration of therapy
less time using mitt

more home-based therapy

47
Q

why does bimanual therapy work

A

helps w crossover when intact brain is doing to mobilize to cross over to impaired side

48
Q

what is the full name for bimanual therapy

A

hand-arm bimanual intensive training (HABIT)

49
Q

who was bimanual therapy studied in

A

children w CP

50
Q

what populations are and aren’t appropriate for bimanual therapy and why

A

appropriate - children
- children should practice functional tasks as most functional activities are bimanual

not - adults w stroke
- have already acquired bimanual skills so focus is on impaired UE

51
Q

what are examples of augmented sensory input and feedback

A

WBing
joint compression
tapping
brushing
stroking
air sleeves
vibration
visual input

52
Q

what is the key quality of interventions to getting motion back in impaired UE

A

practice functional, not passive tasks

53
Q

what are examples of simultaneous bimanual activities

A

UBE
rolling pin
weighted wand
open jar
dial phone
typing
writing

54
Q

why should simultaneous bimanual activities be promoted

A

activity and proprioception in less affected UE can help improve activation and control of affected limb

55
Q

why do we bother doing any strength training if functional activities are more effective

A

prevent atrophy and secondary weakness

56
Q

what does evidence say about strength training

A

inc strength
improve activity
doesn’t inc/worsen spasticity

57
Q

how should strength training be implemented in a POC

A

as a complement to functional training
- don’t want to just do strength training w/o task oriented approach

58
Q

what are examples of strength training interventions

A

grip strength - putty, foam, etc
theraband
hand-held wt cuff
medicine balls
UBE
pushing, pulling, grasp/release w progressively heavier objects

59
Q

what is PT’s role with tone management

A

we can’t directly treat tone but we can prepare limb to tolerate ROM easier and be more functional

60
Q

what is the primary management of tone

A

pharmacological

61
Q

how can PT help to manage tone in a hypotonic limb (5)

A

positioning
protection
resting splints
WB-ing w good alignment
tapping

62
Q

how can PT help to manage tone in a hypertonic limb (6)

A

positioning
- ER, ABD, ext elbow/fingers, neutral hand positioning
splinting (dynamic)
serial casting
prolonged stretch
deep pressure on tendons
- esp for pts w clonus
neutral warmth

Neuro Rehab 2 (48 decks)

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