CVA interventions Flashcards
stroke interventions
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
strategy to improve motor development
strategy development
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)
cognitive
associative
autonomous
cognitive - learning what needs to be done, lots of errors
associative - refined, some errors
autonomous - few errors, skilled performance
strategy to improve motor development
feedback
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)
strategy to improve motor development
practice
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
interventions to improve sensory function
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)
interventions to improve sensory and perceptual function
flexibility and joint integrity (soft tissue/jt mob & ROM, stretching, scapula movement)
positioning, protective devices
interventions to improve strength
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
interventions to improve movement control
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
interventions to improve functional status -
general principles
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
interventions to improve balance
address symmetry, alignment, increased WB on affected side
facilitate normal postural strategies
varied sensory conditions; dual attention tasks
Gentile’s taxonomy
Gentile’s taxonomy
difficulty increases from left to right and top to bottom
strategies for hemiplegic UE - general
- 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)
strategies for hemiplegic UE - constraint induced movement therapy (CIMT)
wear a splint on uninvolved hand to promote use of involved extremity
strategies for hemiplegic UE - electromyographic biofeedback (EMG-BFB)
training focuses on voluntary inhibition of spastic muscles or increasing recruitment of hypoactive muscles
strategies for hemiplegic UE - neuromuscular electrical stim (NMES)
used to reduce spasticity, improve sensory awareness and improve active movement
strategies for hemiplegic UE - GRASP
self admin graded repetitive arm supplementary program
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
strategies for hemiplegic UE - management of shoulder pain/subluxation
flaccid arm should be supported at all times; proper positioning & handling essential in functional movements
strategies for hemiplegic UE - reducing subluxation
NMES - E-Stim reduces subluxation & pain, but not significantly
supportive devices - helps w/pain does not prevent onset
strategies for to improve LE control and function
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
strategies to improve locomotion - goals
increase symmetry, speed and knee control
strategies to improve locomotion - critical aspects of gait
initial weight acceptance, midstance control, propulsion, foot clearance and placement, UE posturing
strategies to improve locomotion - orthotics
AFO’s frequently used for spastic inversion and knee control; KAFO rarely indicated
NMES neuroprosthesis - bioness, walkaide
strategies to improve locomotion - locomotor training
treadmill; follow w/overground practice
BW support- provides stabilization for trunk; allow increased speed; used with treadmill or overground
aquatic therapy
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
contraindications to exercise
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
indications to terminate exercise - absolute
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
indications to terminate exercise - relative
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
stroke impact scale
health status measure
no equipment - a questionnaire
