CVA impairments pt. 1 Flashcards
stage 1 of motor recovery
- period of flaccidity immediately following the acute episode
- no movement of the limbs can be elicited
stage 2 motor recovery
- basic limb synergies
- minimal voluntary movement responses
- spasticity develops
stage 3 motor recovery
- pt gains voluntary control of the movement synergies
- full range of all synergy components does not develop
- spasticity has further increased
stage 4 motor recovery
- some movement combinations that do not follow the paths of either synergy are mastered
- spasticity declines
stage 5 motor recovery
- more difficult movement combos are learned as synergies lose their dominance
stage 6 motor recovery
- disappearance of spasticity
- individual joint movements and coordination approaches normal
- normal motor fxn restored
- recovery can plateau at any stage
what plays a significant role in a pt’s progression through the stages of motor recovery
- initial weakness
- presence of spasticity
- cognitive deficits
- access to rehab
what is recommended before beginning exercise program post-CVA
- graded exercise testing
- ECG monitoring
- MI protocol
what is the MI protocol for exercise
- sub-max protocols
- peak HR 120 bpm or 70% age predicted HRmax
- BP <250/115
if unable to do graded exercise testing:
- light to moderate exercise
- increase training fq, duration or both to compensate for reduced intensity
- close monitoring of HR, BP
dysdiadochokinesia
impaired ability to perform rapid alternating movements
dysmetria
inability to judge distance or range of movement
dysynergia
- fragmented movement patterns
- movement occur in sequence of component parts rather than a single & coordinated cmooth output
asynergia
- loss of ability to associate muscles together for complex movements
- more severe form dyssynergia
rebound phenomenon
inability to rapidly and sufficiently halt movement of a body part after a strong isometric force
tremor
unintentional oscillatory movement
ataxia
- uncoordinated movement that manifests when voluntary movements are attempted
- results in difficulties with fluidity/timing, accuracy and speed of movements
if you have impairments in coordination..
- cerebellar pathology
- basal ganglia pathology
- disruption of dorsal column-medial lemniscus and associated structures
cerebellum potential exam findings
IPSILATERAL
- trunk, limb, and/or gait ataxia
- dysmetria, dyssynergia, dysdiadochokinesia
- balance
- oculomotor deficits
- lack of check reflex
- mild hypotonia
- intentional tremor
- slurred speech (dysarthria)
- significant difficulties with motor learning
basal ganglia potential exam findings
CONTRALATERAL
- trunk, limb, and/or gait ataxia
- dysmetria, dyssynergia, dysdiadochokinesia
- balance
- spasticity (rigidity)
- resting and intentional tremor
- difficulty intiating movements
- slowed movements, smaller movements
- considerable strength deficits
dorsal column potential exam findings
CONTRALATERAL
- trunk, limb, and/or gait ataxia
- dysmetria, dyssynergia, dysdiadochokinesia
- balance
- abnormal sensory exam –> proprioception
- unlikely to see tremor
tone
resistance to passive stretch
acute UMN injuries results in ..
what is the cause and duration
- temporary hypotonia
- cerebral or spinal shock
- variable
when do you get spasticity with UMN injuries
- subacute –> chronic
- does go down over time
