exam 2: stroke rehab interventions & considerations Flashcards
What are some important considerations to make when determining
restoration vs compensation vs prevention: (4)
stage of recovery
task-specific/environment-specific
Patients’ available resources (family support, PLOF, CLOF)
Identify attainable goals (DC Plan)
What are the 3 types of interventions:
prevention
remediation
compensation
_______ stage of recovery: a period of inflammation and scarring 1 to 7 days post-stroke - spontaneous recovery dominates
acute phase
Acute Phase:
Often first encounter with a patient who is in the acute phase is in the _______
-early intervention and ________
-______ hours to begin intervention
ICU
prevention
24-48
Which of the neuroplasticity principles are essential in the acute phase
timing matters
Benefits of early mobilization in the acute phase:
prevents harmful effects of bed rest
increase patient’s level of A&O
reduce the risk of depression
reduce leaned nonuse of hemi side
tilt table - promote OOB and WB therapy
Acute Phase: Goals = _________
prevention
List the conditions of prevention during the Acute Phase:
contracture
edema
seizures
infection
UTI
stroke reoccurrence
What is the PT’s Role in the Acute Phase:
Early mobilization
Monitor patient’s status and VS
Prevent compensation and learned helplessness
Inpatient Acute Care: Role of PT in this setting
-______> walking
-prevention of secondary complications such as ______
-prepare for ______
out of bed
bed sores
discharge
True or False:
In the acute phase, you should discharge pt. as early as possible.
False; higher risk of medical complications during subacute rehab or at home
Do not initiate _______training during the acute phase
Early ___________ should encouraged
It is important to establish effective _______ due to aphasia or visual neglect
aerobic- CV system is reacclimating
mobilization
communication
What are the 3 main focus for PT interventions in the Acute Phase:
Functional mobility/ADL training
ROM/Splinting/Positioning
Family/caregiver education
Acute Phase Interventions:
Changes in position can prevent
postural hypotension and skin breakdown
Acute Phase Interventions:
Move extremities ______x/day to maintain _________
AROM promotes ________ and prevents ______
______ rule for rolling to prevent ulcers
Ankle contracture boots for flaccid ankle to maintain _____
3-5x/day; tissue extensibility
blood flow; DVT
2- hour
neutral
What is the subacute phase:
-peak:
-plateau:
Period of neuroplasticity that starts in the acute phase, peaks in the early subacute phase 7 days to 3 months and plateaus in the late subacute (3 to 6 months)
What is the high level of physical rehabilitation a patient can receive compared to SNF, nursing homes, and outpatient therapy services?
Inpatient rehab (IPR)/sub-acute rehab
If a patient is considered medically “stable” what stage of recovery are they most likely in?
subacute phase
IPR is an intense, multi-disciplinary approach pts. must tolerate:
3 hours of therapy 5 days a week (intensity matters)
What are some factors that influence the transition from acute rehab to subacute rehab:
medically stable
severity of cognitive-perceptual deficits
behavior, affect, motivation
patient endurance/activity tolerance
prognosis
Subacute facilities can prevent failure at _______ and readmission.
Inpatient rehabilitation (IPR) vs. SNF vs Home:
-_________of service
-_________ tolerance
-pts. available _______
home
intensity
activity
resources
What setting houses patients who are unable to care for themselves for both short-term and long-term care?
SNF
SNF Qualifications:
less intense compared to______
_____ hour of therapy per day - ____ days a week
IPR
1; 7
What is the primary goal for PT in the subacute phase:
return to functional independence
-restoration vs. compensation
As a PT when should you start promoting weight bearing through the affected (hemiparetic limb)?
-UE
-LE
the subacute phase
seated weight shifting into UEs
standing weight shifting into LEs
Is the following statement true or false?
You may begin aerobic training in the acute phase.
False: subacute
What is learned nonuse:
failure to use the limb despite some motor functions remaining intact
During learned nonuse, a patient will learn ______ measures to improve function and independence
compensatory
PT interventions in Subacute Phase:
postural control and balnce
cont. to progress functional mobility/ADLs
locomotor training
UE limb use
Chronic phase:
> 6 months, neuroplastic changes still occur however the rate at which recovery may occur begins to decline
6 months poststroke =
-after 2-3 months pts. have now been DC’d from IPR to _______ or ______
chronic
home health or outpatient therapy
Chronic Phase: Goals
-cont. to meet goals set in _______, and progress toward independence or lowest level of ______burden
-avoid _________
IPR; caregiver
readmission
PT considerations for pts. in the chronic phase:
-goal: (2)
-HEP implementation:
return to participation in roles; assistance in resuming rec activities
edu pt/family prn; daily therapy without PT present
