CVA interventions

Question 1

stroke interventions

Answer 1

early intervention is optimal
use affected side (neuroplasticity - use it or lose it)
most significant recovery w/in 3-6 mths after injury
pt fully engaged & motivated

Question 2

strategy to improve motor development

strategy development

Answer 2

consider stage of learning (cognitive, associative, autonomous)
part vs. whole task training (performance vs. learning)
appropriate speed (keep the function)
carryover/generalization (can perform in home)
bimanual tasks (dressing, pillow case on)
mental practice
have pt self assess (think about plan)

Question 3

cognitive
associative
autonomous

Answer 3

cognitive - learning what needs to be done, lots of errors
associative - refined, some errors
autonomous - few errors, skilled performance

Question 4

strategy to improve motor development

feedback

Answer 4

extrinsic vs. intrinsic
fading: extrinsic to intrinsic (cognitive phase may need more extrinsic then fade out feedback)
limit use of immediate feedback: concurrent vs. terminal
knowledge of performance (how/why) vs. knowledge of results (did it work/was it successful)

Question 5

strategy to improve motor development

practice

Answer 5

organized practice
blocked-early motivation & initial learning
random better than blocked for retention of skills (promote learning as opposed to performance) (put all blocked together)
variable-helps w/adaptability of task & generalizability to other environments

Question 6

interventions to improve sensory function

Answer 6

sensory stim for recovery to avoid learned non-use
training focuses on improved sensitivity of more affected extremities
presentation of repeated sensory stimuli for tactile, mechano- and muscle receptors (stroking, superficial & deep pressure)

Question 7

interventions to improve sensory and perceptual function

Answer 7

flexibility and joint integrity (soft tissue/jt mob & ROM, stretching, scapula movement)
positioning, protective devices

Question 8

interventions to improve strength

Answer 8

resistive strengthening

• sig improvement w/out increase in spasticity
• less evidence for carryover of function-specificity of training may be more important
• monitor BP for HTN
• spastic muscle doesn’t mean it’s strong
• don’t create breath hold with resistance

Question 9

interventions to improve movement control

Answer 9

promote normal posture alignment & control; functional use of extremities
stress out synergy movement pattern (variety of patterns & contractions)
start out guiding & assisting, but shift to active ASAP (facilitate if too weak)
task specific
compensation

Question 10

interventions to improve functional status -

general principles

Answer 10

positioning the pelvis
trunk symmetry & bilaterality
guided & AAROM as needed
stability progression: stability to controlled mob to skill
rolling and supine <>sit
other positions/transitions = floor, car, tub
postural control in sitting and standing

Question 11

interventions to improve balance

Answer 11

address symmetry, alignment, increased WB on affected side
facilitate normal postural strategies
varied sensory conditions; dual attention tasks
Gentile’s taxonomy

Question 12

Gentile’s taxonomy

Answer 12

difficulty increases from left to right and top to bottom

Question 13

strategies for hemiplegic UE - general

Answer 13

• pt’s w/severe impairments are less responsive to interventions (require early mob, ROM, pos, compensatory training & enviro adaptations)
• pt’s w/better recovery benefit from repetitive & intense use of tasks (postural support, reaching, manipulation)

Question 14

strategies for hemiplegic UE - constraint induced movement therapy (CIMT)

Answer 14

wear a splint on uninvolved hand to promote use of involved extremity

Question 15

strategies for hemiplegic UE - electromyographic biofeedback (EMG-BFB)

Answer 15

training focuses on voluntary inhibition of spastic muscles or increasing recruitment of hypoactive muscles

Question 16

strategies for hemiplegic UE - neuromuscular electrical stim (NMES)

Answer 16

used to reduce spasticity, improve sensory awareness and improve active movement

Question 17

strategies for hemiplegic UE - GRASP

self admin graded repetitive arm supplementary program

Answer 17

homework based ex program
ex includes: strengthen arm/hand, ROM, gross and fine motor skills, rep goal & task for whole skill sets
significant improvements: ability to use paretic UE in ADL; ability to reach & grasp objects; increase use of UE during ADL outside therapy time

Question 18

strategies for hemiplegic UE - management of shoulder pain/subluxation

Answer 18

flaccid arm should be supported at all times; proper positioning & handling essential in functional movements

Question 19

strategies for hemiplegic UE - reducing subluxation

Answer 19

NMES - E-Stim reduces subluxation & pain, but not significantly
supportive devices - helps w/pain does not prevent onset

Question 20

strategies for to improve LE control and function

Answer 20

LE training or pre-gait ex - controversial
-moving out of synergy
specific challenges: weak DF’s and hams, tight/weak PF and hip ext, lack of knee control, general extensor tone

Question 21

strategies to improve locomotion - goals

Answer 21

increase symmetry, speed and knee control

Question 22

strategies to improve locomotion - critical aspects of gait

Answer 22

initial weight acceptance, midstance control, propulsion, foot clearance and placement, UE posturing

Question 23

strategies to improve locomotion - orthotics

Answer 23

AFO’s frequently used for spastic inversion and knee control; KAFO rarely indicated
NMES neuroprosthesis - bioness, walkaide

Question 24

strategies to improve locomotion - locomotor training

Answer 24

treadmill; follow w/overground practice

BW support- provides stabilization for trunk; allow increased speed; used with treadmill or overground

Question 25

aquatic therapy

Answer 25

warm water - relax muscles, i circulation, stim body awareness, balance and trunk stability
viscosity of water - resistance
buoyancy- d pain sensitivity, supports joints and body weight
improve morale

Question 26

contraindications to exercise

Answer 26

MI
unstable angina
uncontrolled cardia arrhythimias 
resting ST segment displaced
symptomatic heart failure and aortic stenosis
aortic dissection
acute infection: fever, swollen lymph glands, body aches
uncontrolled diabetes
cannot understand exercise risks; can't express pain
uncontrolled seizure
severe motion-induced dizziness
severe pain w/ weight bearing

Question 27

indications to terminate exercise - absolute

Answer 27

onset of angina or suspicion of MI
Drop in SBP w/increasing workload
signs of poor perfusion
severe or unusual SOB
CNS symptoms (vertigo, ataxia, confusion)
serious arrhythmias
technical inability to monitor ECG
Request by pt to stop

Question 28

indications to terminate exercise - relative

Answer 28

severe fatigue or physical/verbal signs of SOB
leg cramps or intermittent claudication
hypertensive
less serious heart arrhythmias
exercise induced bundle branch block
ST segment changes from baseline

Question 29

stroke impact scale

Answer 29

health status measure

no equipment - a questionnaire