CVA - 5b Stroke Rehab Trunk & Gait Flashcards
primary vs secondary trunk impairments post-stroke
primary:
- motor control/activation
- altered ms tone
- loss of sensation
- coordination problems
- perceptual deficits
secondary:
- weakness, atrophy
- ms length, ROM
- pain
- postural deficits
- vital capacity and respiration
what is the significance of trunk positioning
impacts position of arms and legs
how should trunk be positioned in bed and what should you be aware of in doing so
trunk in alignment w LEs
be aware of impact of trunk position on UEs
how should the trunk be positioned in a w/c and why
pelvis positioned completely to back of w/c
- prevent post pelvic sit / sacral sitting
- prevent sliding out
- more comfortable/functional
neutral alignment
what ms are often the most neglected in stroke rehab
trunk, pelvis, and core
what is a good progression of interventions for trunk dysfunction
start w tone modification, stretching, and postural alignment
facilitate wt shifts
core strength training
functional activities
what should you start with to manage trunk dysfunction
tone modification, stretching, and postural alignment
what do we want to facilitate w normal wt shifts when managing trunk dysfunction
active lengthening and shortening
what are some interventions for core strength training
sitting on theraball
different positions of quadruped, kneeling, supine
what are functional activities to incorporate in interventions for trunk dysfunction
bridging
rolling
sitting and standing balance
transitional movements
amb
ADLs
what is pusher syndrome
lateral postural imbalance d/t pushing w stronger UE and LE toward weaker side
what causes pusher syndrome
altered perception of body orientation in relation to gravity
- don’t know where midline is
what stroke syndrome is often responsible for pusher syndrome
R thalamic lesions
- thalamus involved w verticality and orientation
what are other terms for pusher syndrome
ipsilateral pushing
contraversive pushing
what should you not do when treating pusher syndrome and why
don’t manually correct
- exacerbates condition
what are interventions and strategies for treating pusher syndrome (4)
- facilitate active wt shift to unaffected side
- provide visual proprioception via mirror, plumb line for reference
- wall on hemi side for sitting and standing tasks/amb
- active problem solving and recognition - “are you in midline?”
what is retropulsion
trunk in reclined position
- tend to fall backwards as they are unaware and don’t exhibit postural strength to correct
aka pusher syndrome but in ant-post direction
what are interventions and strategies for treating retropulsion (4)
- environmental modifications and safety cues
- work in forward trunk positions
- use sensory inputs
- visual cues
