CVA - 5b Stroke Rehab Trunk & Gait

Question 1

primary vs secondary trunk impairments post-stroke

Answer 1

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

Question 2

what is the significance of trunk positioning

Answer 2

impacts position of arms and legs

Question 3

how should trunk be positioned in bed and what should you be aware of in doing so

Answer 3

trunk in alignment w LEs

be aware of impact of trunk position on UEs

Question 4

how should the trunk be positioned in a w/c and why

Answer 4

pelvis positioned completely to back of w/c
- prevent post pelvic sit / sacral sitting
- prevent sliding out
- more comfortable/functional

neutral alignment

Question 5

what ms are often the most neglected in stroke rehab

Answer 5

trunk, pelvis, and core

Question 6

what is a good progression of interventions for trunk dysfunction

Answer 6

start w tone modification, stretching, and postural alignment

facilitate wt shifts
core strength training
functional activities

Question 7

what should you start with to manage trunk dysfunction

Answer 7

tone modification, stretching, and postural alignment

Question 8

what do we want to facilitate w normal wt shifts when managing trunk dysfunction

Answer 8

active lengthening and shortening

Question 9

what are some interventions for core strength training

Answer 9

sitting on theraball
different positions of quadruped, kneeling, supine

Question 10

what are functional activities to incorporate in interventions for trunk dysfunction

Answer 10

bridging
rolling
sitting and standing balance
transitional movements
amb
ADLs

Question 11

what is pusher syndrome

Answer 11

lateral postural imbalance d/t pushing w stronger UE and LE toward weaker side

Question 12

what causes pusher syndrome

Answer 12

altered perception of body orientation in relation to gravity
- don’t know where midline is

Question 13

what stroke syndrome is often responsible for pusher syndrome

Answer 13

R thalamic lesions
- thalamus involved w verticality and orientation

Question 14

what are other terms for pusher syndrome

Answer 14

ipsilateral pushing
contraversive pushing

Question 15

what should you not do when treating pusher syndrome and why

Answer 15

don’t manually correct
- exacerbates condition

Question 16

what are interventions and strategies for treating pusher syndrome (4)

Answer 16

1. facilitate active wt shift to unaffected side
2. provide visual proprioception via mirror, plumb line for reference
3. wall on hemi side for sitting and standing tasks/amb
4. active problem solving and recognition - “are you in midline?”

Question 17

what is retropulsion

Answer 17

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

Question 18

what are interventions and strategies for treating retropulsion (4)

Answer 18

1. environmental modifications and safety cues
2. work in forward trunk positions
3. use sensory inputs
4. visual cues