early rehabilitation of the trunk and LL and UL

Question 1

observations in sitting with patient with hemiplegia

Answer 1

they might lean toward their unaffected side and compensate with this side,

Question 2

what do we need to do-trunk?

Answer 2

realign trunk- i.e. strengthen the affected side and improve the QOM,

Question 3

trunk realignment- therapist

Answer 3

sit behind patient with cushion, ways to reduce fixation= take support of them and position hand on leg with palm upwards (stop gripping) and reduce feet fixing= BOS unstable, trunk lateral shift to stretch (obliques)= stabilize around shoulders or rib cage, extension of trunk, anterior/posterior pelvic tilt

Question 4

trunk realignment- test balance

Answer 4

can do static (lifting arms and legs) or dynamic (reaching- 2 therapist- one support upper body one support shoulder) to challenge BOS, can use gym ball to stretch- lean on ball, can sit on wobble bored- higher level- progression

Question 5

observation of SCI

Answer 5

spinal cord stability sitting- patient hyperextended elbows backwards and forwards to stabilize (tenodesis), mirror in front= visual feedback, close eyes- challenge vestibular system, sensory feedback from hands, ensure patient doesn’t fall forward

Question 6

transfer with hemiplegic

Answer 6

practice with transfer board, rotunda

Question 7

why is standing a good position for physio

Answer 7

high COG/small BOS, increased weight bearing/ strength and motor recruitment, psychological benefits, visual stimulation, increased bone density, decreased risk of secondary MSK complications, cardiovascular benefits, respiratory benefits, relieve pressure, bladder/bowel sensation

Question 8

sit to stand with hemiplegic patient

Answer 8

sit on chair lower than bed, wedge leg in between leg, positioned to side to allow space, then stand (place hands on hips), make sure something is there to hold when standing, ensure equal weight bearing, wants to active hip/knee extension by tapping when stepping, first practice weight transfer then step (may need to move damaged leg)

Question 9

potential problems with standing with hemiplegic patient

Answer 9

BP/HR, autonomic dysreflexia, bowel/bladder, respiratory dysfunction, colour/sweating

Question 10

advantages of mechanical standing aids

Answer 10

conform to mannual handling guidelines, allow early rehab of heavy patients, allow rehab of very disabled patients, allows for grading of movement, require fewer staff

Question 11

restrictions of mechanical standing aids

Answer 11

activity level is restricted by equipment, not normal sensation of standing, reduced feedback to therapist re activity

Question 12

example of mechanical standing age

Answer 12

tilt table, oswestry standing frame

Question 13

UL observations- from behind

Answer 13

levels of shoulders (UF traps), spine to medial border of scapula, spine to inferior angle of scapula, position of inferior angle scapula, scapula to humerus, skin folds

Question 14

UL observations- from the front

Answer 14

position of head/ trunk/ elbow/ wrist and hand, suprascapular fossa should be equal, arms flexed forward to 90°- dimples above deltoid

Question 15

Assessment- AROM and PROM

Answer 15

quality of movement (2:1 scapulo-humeral rhythm, associated reactions, pain, compensations/abnormal movement patterns)
PROM- range/ feel (tone), ? pain)

Question 16

Assessment- other

Answer 16

strength (low tone=isometric), coordination- FTN and HTS (dysdiachokinesis), sensation, function- dressing/ grooming/ drinking/ writing/ grips

Question 17

what does stability of the GHJ depend on

Answer 17

direction of glenoid fossa, glenoid labrum, capsule (superior part), rotator cuff

Question 18

inferior subluxation

Answer 18

scapula looses stability on thorax- depression and MR, humerus in relative abduction, joint unprotected by stability of capsule and supraspinatus

Question 19

anterior and superior subluxations

Answer 19

anterior- due to tight pecs and lat dorsi, superior- due to tight supraspinatus or deltoid

Question 20

subluxation and pain

Answer 20

can result in pain for people with hemiplegia due to-
soft tissue overstretching- to muscle imbalance, alteration of joint biomechanics, soft tissue injury, traction to blood vessels= ischaemic pain, impingement, altered sensitivity, sympathetic changes- shoulder- hand syndrome

Question 21

hemiplegic shoulder pain

Answer 21

limits function, limits therapy, poor recovery of UL function, longer hospital stay, poor discharge home rates

Question 22

early treatment options for stroke and TBI= care of shoulder and hand Edema

Answer 22

shoulder= education/ positioning/ supportive devices

hand edema= passive/ AROM, measure oedema- prevent CRPS/ CPM hand, FES hand

Question 23

early treatment options for stroke and TBI= whole arm and splints

Answer 23

whole arm= strengthening/ mirror box/ mental practice/ sensory retraining/ compensatory technique/ spasticity/ FES
splints

Question 24

care of shoulder

Answer 24

importance of not pulling on shoulder or arm when moving in bed, transfers etc.
educating familt and carers about care of shoulder, shoulder subluxation subcuffs

Question 25

whole arm strengthening

Answer 25

strengthening- simple isometric techniques such a holding/ following/ placing/ combine with taping,

Question 26

strengthening and ROM in sitting

Answer 26

approximate humerus (slight lift and LR if tight pecs), may get patient to rest hand on knee and rock side to side, then progress to sliding hands along thigh (tap triceps), may facilitate with sensory feedback

Question 27

strengthening and ROM in lying

Answer 27

lye in supine- stabilizes scap, slight approximation to 90° flex, add slight protraction, rest hand on head- tap triceps to extend arm (functional), holding (tell patient not to let you move arm)

Question 28

things to know with early UL rehab

Answer 28

alignment, know normal, early strengthening, facilitate

Question 29

what is functional electrical stimulation (FES)

Answer 29

the process of pairing stimulation simultaneously or intermittently with a functional task

Question 30

FES uses

Answer 30

strengthen and/or maintain muscle bulk, facilitating voluntary muscle contraction, gaining/maintaining ROM, increase sensory awareness, reducing spasticity, as an orthotic substitute to produce functional movement

Question 31

electrical stimulation of muscle

Answer 31

damage to nervous system produces denervation of muscle resulting in weakness or paralysis
the lack of neural innervation renders muscle unable to produce the voluntary forces needed to create joint movement

Question 32

clinical application of FES

Answer 32

foot drop (MS and CVA), hemiplegic shoulder pain, paraplegia  (standing/ cycling/ walking), exercising= decreased spasticity and adhesions, increased circulation
main use (foot drop and hemiplegic pain)

Question 33

FES- quality of human movement

Answer 33

muscle contraction- less efficient than human movement. it induces excessive neuromuscular fatigue. It should be used with other traditional therapies

Question 34

contraindications and precautions

Answer 34

patients who do not comprehend the physio instructions, electrode placement not- on trunk/pelvis/uterus during pregnancy, over eyes, epiphyseal regions of children, patients with pacemaker, skin allergies, dermatological conditions, area of tumour

Question 35

Contraindications

Answer 35

abnormal skin sensation, current/recent bleeding, compromised circulation, application over neck, area of active TB, area of devitalised skin, patients with epilepsy

Question 36

applications of microstim

Answer 36

turn to mdoe 5, attach lead to electrode, black electrode over muscle proximally, red over motor point, attach lead to stimulator, turn on and slow, increase until a contraction is elicited, move red electrode to locate optimal contraction, turn off and change to mode 6

Question 37

sensory stimulation

Answer 37

textures- different clothes, temperature- cold (cutlery) or hot (hot drink), positions

Question 38

what is mental practice

Answer 38

the process of imagining and rehearsing the performance of a skill with no related overt actions. Used for stroke patients, phantom pain, CRPS, arthritis and chronic pain after surgery. E.g. imagine picking up class

Question 39

what is mirror therapy

Answer 39

patients sits with the affected arm behind the mirror. Focuses on the reflection and imagines it is the affected limb. Recommended 10 mins a day, may cause emotional response, dizziness or nausea

Question 40

mirror therapy- without object

Answer 40

unilateral movement on the good arm only (flex, ext, pro and supinate, lumbricals), bilateral movement, guiding of the affected arm by the therapist, guiding of both arms by therapist

Question 41

mirror therapy- activities with object

Answer 41

unilateral movement of the good arm with object, bilateral movements with an object in the non-affected hand, bilateral movements while imaging objects in hand

Question 42

how does mirror therapy work

Answer 42

it increases cortical and spinal motor excitability, possibly through the effect on the mirror neuron system- these are responsive for the ability to differentiate between left and right side- activated during MT. this system is thought to use the observation of movement to stimulate the motor processes which would be involved in that movement. brain prioritises visual feedback