Exam 2 Content Flashcards
Loss of trunk control is common in those who have had a …
Stroke
Impairments in trunk control includes…?
weakness, loss of stability, stiffness, and loss of proprioception
weakness, loss of stability, stiffness, and loss of proprioception causes?
Dysfunction in upper/lower limb control
Increased fall risk
Potential for spinal deformity/contracture
Impaired ability to interact with environment
Visual dysfunction resulting from head/neck malalignment
Dysphagia due to proximal malalignment
Decreased independence in ADLs/IADLs
Decreased sitting and standing tolerance, balance, and function
What movements are available at the trunk?
Vertebral Column ROM: Flexion Extension Lateral Flexion Rotation Normal spinal alignment and curvatures Cervical, thoracic, lumbar, and sacral curvatures (see pg. 362 for image)
Stroke patients often assume postural …?
malalignment both observed and palpated
Assessment: Trunk Control Test
Trunk Control Test
What are the 4 functional movements?
4 functional movements:
1) roll from supine to weak side,
2) roll from supine to strong side,
3)supine to sit,
4) sitting EOB 30 sec (feet off the ground)
Scored 0 = unable, 12 = able to perform but abnormal, 25 = normal
Scores 0 - 100
Assessment: Trunk Impairment Scale (A) & (B)
What the starting position?
Trunk Impairment Scale:
Starting position EOB or mat, feet flat on floor arms in lab (no back or arm support)
3 static items, 10 dynamic sitting items, 4 trunk coordination items
Scores range from 0 – 23
Assessment: PASS
Postural Assessment Scale for Stroke (PASS)
What’s assessed in the PASS?
12 items scored from 0 to 3
Higher scores = better performance
Sitting without support, standing with and without support,
standing on nonparetic leg, standing on paretic leg, supine to affected side, supine to non affected side, standing and picking up a pencil on the floor
What are the Eval Trunk Movement Patterns?
Trunk Flexion
Trunk Extension
Lateral Flexion
Rotational Control
What are some treatment for trunk control in stroke patients?
Position of Readiness
Remedial
Purposeful tasks and activities that encourages:
AROM of trunk in all degrees of freedom: rotation, lateral flexion, flexion and extension, to increase strength and endurance
Mirrors for visual feedback, self-correction (OT can ‘mirror’)
Work with client on moveable surfaces
Prevent loss of PROM of spine
Handling (AAROM)
Rote exercise
Treatment:Posturing in stroke patients?
Seated with legs crossed Seated with forearms on table Prone on elbows Kneeling Hip flexion (varied degrees)
Treatment: Pushers Syndrome
What is it?
What are signs?
Occurs when the pt pushes heavily to the affected side and resists passive correction
“Resistant to accepting weight on and actively pushing away from the nonparetic side”
Signs:
Holding on to bed or mat as if they were falling
Head turned away from affected side
Decreased ability to detect stimuli from affected side
Resistance to attempts to transfer weight to stronger side
S
Treatment: Visual Feedback & Mental Practice for Trunk control in stroke pts
success in increasing symmetrical weight bearing in CVA clients by training them with a combination of visual feedback and mental practice.
Visual Feedback = subjects stood on a platform with sensors connected to a computer screen that monitored their posture;
participants needed to try to align their posture in accordance with equal (B)
weight shifting utilizing visual feedback from the computer screen image.
Mental practice = mental imagery on proper posture and symmetrical (B) weight shift.
Treatment:Compensatory
Environmental Mods & AE for Trunk control in stroke pts
Lateral supports to maintain trunk stability during tasks
Cushions, armchairs, lab tray
Place items within reach
ADL AE: long handled AE, elastic laces, reachers, tub seat, commodes, grab bars, bed rails
What are some EPB for trunk control in stroke pts
Evidence Based Practice
Trunk Training Exercises (TTE): sitting or supine, aimed at improving trunk performance and functional sitting balance
Sitting Training Protocol
(STP): program designed to improve the ability to balance in sitting by reaching beyond arm’s length using the unaffected hand while focusing on 1) smooth coordinated motions in trunk and hand, 2) appropriate loading of the affected foot, 3) preventing maladaptive strategies
Trunk Exercises (TE): movements of the upper and lower trunk and raising UE in supine or sitting
TTE improved maximum reach using the modified Reach Test
Results: Moderate evidence to support the use of TTE to improve trunk performance and sitting balance
What is neuroplasticity?
Neuroplasticity is the brain’s ability to change (for better or worse)
The process of neuroplasticity involves …?
forming neuronal connections in response to sensory stimuli from the environment and normal development
Cortical Maps:
Changes in the cortex occur in association with adaptive responses to the environment through everyday activities
Neurogenesis
Adult stem cells can generate new differentiated neurons in the hippocampus, dentate gyrus, and olfactory bulbs
Born with a number of neurons and them build more, this is then pruned off (branches/synapses)
The production of new neurons in the brain
Amplified by certain mental activities: Such as what?
Synaptogenesis
The formation of synapses between neurons in the nervous system
Explosion
Synaptic Pruning
Types of Neuroplasticity: Experience/Practice Dependent
What’s Hebb’s rule?
Hebb’s Rule: it is a learning rule that describes how the neuronal activities influence the connection between neurons, i.e., the synaptic plasticity
Occurs when a person performs a task repeatedly to learn or re-learn a skill
“Neurons that fire together, wire together”
Types of Neuroplasticity:
Competitive Plasticity
Positive Plasticity
Compensatory changes that take place at the cellular and molecular level that form new pathways for function
Natural selection process that occurs with use or disuse.
“Use it or lose it”
Types of Neuroplasticity:
Negative/Positive Plasticity
Compensatory changes that
Negative plasticity: learn things negatively, rigidity, neurons that fire out of sync and fail to link ( fear of falling after 1st fall, follow the same routine/rutt/increase tone/)
Example: bus drivers
Positive Plasticity: take place at the cellular and molecular level that form new pathways for function (ex: taxi drivers- different route compare to bus drivers)
Types of Neuroplasticity:
Competitive Plasticity
Natural selection process that occurs with use or disuse.
“Use it or lose it”
7 Tenets of Neuroplasticity
1) Change can only occur when the brain is in the mood
2) Change strengthens connections between neurons at the same time
3) Neurons that fire together wire together
4) Initial changes are just temporary
5) Brain plasticity is a two way street (Positive and Negative)
6) Memory is crucial to learning
7) Motivation is key
What are 4 Tips for Optimal Plasticity ?
Think how the following can be applied to OT Practice:
(as we get older
1) Heart needs to be in shape: heart supplies O2 Cardio is needed to help develop neuron)
2) Training should be incremental (occur in steps- just right challenge)
3) Taxing, systematically improving (be challenging but successful).
4) Should be interesting to engage the motivation circuits in your brain (motivation)
Process of Recovery
1) Diaschisis – sudden change of function in a portion of the brain connected to a distant, but damaged, brain area
2) Behavioral compensation –
3) Adaptive plasticity –
Edema
Denervation Supersensitivity
Regenerative Synaptogenesis
Collateral Sprouting
Motor relearning and recovery is possible via the ….. of the brain
plasticity
With …. skill is gained and less areas of the brain are recruited to perform a task
repetition
Repetition also stores a motion in…
memory
Limbic system: critical for generating … and … with other areas of the brain
motor tasks and communicating
Cerebellum: critical for …
communicating with frontal lobe
Basal ganglia: critical for …
habit formation
Types of learning:
Procedural learning
Occurs for tasks that are particularly automatic (without attention or consciousness).
Learn through repeated practice in varying contexts
Verbal instruction little help, need hands on practice, practice
Learning is expressed through performance
Appropriate for who?
Types of learning:
Declarative Learning
Created knowledge that can be recalled.
Learning can be verbalized by naming the steps of the task
Mental rehearsing is commonly used (review the activity mentally or by verbalizing the steps/process
With repetition declarative learning can become procedural
Appropriate for who?
Application to OT
The process of …, engaging in tasks (ideally motivating, and, novel), facilitates positive neuroplasticity!
doing
Application to OT
Conversely, …., leads one down the path to negative plasticity – apoptosis (death of neurons).
not doing
Application to OT
…….. – doing again and again (Hebb’s rule) repetition - automaticity
Practice - dependent plasticity
Application to OT
…….. – doing again and again (Hebb’s rule) repetition - automaticity
Practice - dependent plasticity
Increasing the … of a task - enhanced neuroplasticity
complexity
Other types of Application to OT
Virtual Reality/ Computer Gaming
Neurofeedback Trainings
About87%of all strokes are…., in which blood flow to the brain is blocked.
ischemic strokes
Stroke is a leading cause of serious long-term….
disability.
What is stroke?
preventable disease with known risk factors:
What are the risk factors for stroke?
CVA/ Stroke:
TIA: Transient Ischemic Attack:
Infarct:
What’s CVA/ Stroke
a disease of the cerebral vasculature where there is a failure to supply oxygen to the brain
What’s TIA: Transient Ischemic Attack?
Either thrombic or embolic with reversible defects, effects must resolve in less than 24 hrs
Define Infarct:
a localized area of tissue that is dying or dead, having been deprived of its blood supply because of an obstruction by.
What are the types of stroke
Ischemic
Hemorrhagic
Types of Strokes: Ischemic
Embolic
Most common type of ischemic stroke.
Abrupt onset, usually no warning, often caused by emboli that originate in cardiac system, 2nd most common is emboli from atherthrombic lesions (artery to artery)
Thrombic
Most commonly caused by abnormal arterial vessel walls (athersclerosis).
Occlusion of a vessel due to a clot forming in the brain
Usually a more gradual onset, may have warning signs (TIA)
Describe a Hemorrhagic stroke
A hemorrhagic stroke is when blood from an artery begins bleeding into the brain.
This happens when a weakened blood vessel bursts and bleeds into the surrounding brain. Pressure from the leaked blood damages brains cells, and, as a result, the damaged area is unable to function properly
What are the types of Hemorrhagic
Deep Hypertensive Intracerebral
Spontaneous Lobar
Ruptured saccular aneurysms
Bleeding from an arteriovenous malformation
What type of hemorrhagic stroke is described below:
Found throughout the body and can occur in any part of the brain.
Usually congenital.
Headaches and seizures are common
Bleeding from an arteriovenous malformation
What type of hemorrhagic stroke is described below:
Characterized by acute, abrupt onset of a severe headache, brief loss of consciousness, nausea, vomiting, focal neurologic deficits, and stiff neck.
Ruptured saccular aneurysms
What type of hemorrhagic stroke is described below:
Occur outside of the basal ganglia and thalamus in the white matter of the cerebral cortex.
Often associated with clients with AVMs (arteriovenous malformation), bleeding diatheses, tumors, aneurysms in the circle of Willis.
Acute onset of symptoms, coma/stupor much less common, headaches common
Spontaneous Lobar
What type of hemorrhagic stroke is described below:
Small penetrating arteries in the deep brain that have damage from HTN.
Develops in minutes to an hour. Rapid recovery in first 2-3 months.
Pt usually awake and under emotional distress when it occurs. Vomiting and headache common.
Deep Hypertensive Intracerebral
What does FAST stand for?
F: Facial drooping
A: arm weakness
S: Speech difficulties
T: Time (call 911 ASAP)
What are other symptoms to watch for due to a stroke other than FAST
Other Symptoms to watch for:
Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
Sudden CONFUSION, trouble speaking or understanding speech
Sudden TROUBLE SEEING in one or both eyes
Sudden TROUBLE WALKING, dizziness, loss of balance or coordination
Sudden SEVERE HEADACHE with no known cause
What does a CT (Computed Axial Tomography)
scan rules out, helps determine but what may it not rule out?
Readily available, often the standard. Rules out other conditions and helps determine if there is evidence of a bleed. An acute CT scan may not show stroke but may rule out non stroke (tumors).