exam 2: stroke rehab interventions pt 3 Flashcards
PTs select interventions based on _______
- use _____ model
accurate examination and evaluation
- ICF/Schenkman’s
what are the intervention selections (3) used based on the patient’s resources, capabilities, and affect?
remediation
compensation
prevention
things to consider when choosing to make your intervention restorative, compensatory or preventatory:
- stage of recovery
- task specific/environment specific
- patient’s available resources
- identify attainable goals
things to be mindful of when choosing interventions regarding the environment, learning variables and dose:
- stage of learning
- type of task, practice schedule, and feedback
Considerations for evidence based interventions:
- evidence based interventions __(are/are not)___ representative of the scope of physical therapy interventions
- focus on exercises that ______
- gaps in ______ still exist
- all strokes are _____
- ____ ____ is supported universally
- best interventions are ______
- are not
- improve movement or motor relearning/control
- literature
- different
- early mobilization
- multimodal (focus on multiple facets and deficits)
the choice of the intervention should take into consideration the individuals:
phase of poststroke recovery
severity of stroke
age
comorbidities
cognitive abilities
communication status
affective status
social and financial resources
potential discharge plan
what is task specific training?
training that involves practice of functional task where individuals attempt to reach a goal in the environment
task specific training follows the contemporary task-oriented model. what is that?
considers all theories of motor control - normal movement is also an interaction among different systems, organized around behavioral goal and constrained by environment
what is the rationale for the contemporary task oriented model?
salient goals
enhanced sensory experience
motor control is goal based
patients have varying abilities
what is Neuro IFRAH? (integrative functional rehabilitation and habituation)
a whole person approach to rehabilitation; restoring function and making that function functional to return that individual to independent living and resume life roles
functional mobility training uses interventions to ________.
most often used in acute care/IP/subacute facility
restore functional status
functional mobility includes:
bed mobility
transfers
—> supine to sit, sit to stand, bed to chair
sitting
standing
stroke survivors have deficits in _____, ______, _____ of muscle activity along with low balance ________
latency, amplitude, and timing
self-efficacy
why is it important to work on balance and postural control to prevent falls in stroke patients?
falls can lead to further morbidity and loss of self confidence
which ICF domain is static and dynamic postural control?
which ICF domain is performing a task with postural control?
body structure and function
activity domain
what are 2 things to be aware of with perceptual awareness postural control activities?
symmetry of posture
encourage vertical orientation awareness
WBing into LEs
- improves _____ & _____
- increases _____
- limb proprioceptive awareness and strengthening
- sensory inputs
enhanced feedback associated with ________, the overall sensory experience, and _________ of a purposeful activity enhanced subject performance opposed to postural control alone
dual task manipulation of the object
meaningfulness
Visual biofeedback:
- reduces _____
- improves _______ and _______
- what is the rationale behind it?
sway
postural symmetry and dynamic stability
movement control is organized around achieving goal of postural control and real time feedback allows for internal cueing to self correct
are internal or external cues better at gaining back postural control?
internal
how would a patient with pusher syndrome appear?
sits/stands asymmetrically with most weight sifted toward weaker side
what are two treatment options for pusher syndrome to help with midline reorientation?
- use mirror to “look at posture” for awareness of midline and use of vertical structures in environment
- pt may lean nonaffected side toward wall or therapist if they are on nonaffected side. “perform activity with shoulder touching the wall”
what is the rationale for reorientation of midline through use of environmental prompts?
improves perceptual and visuospatial awareness of body
compare/contrast aerobic training vs physical activity
aerobic training:
- more strenuous
- not appropriate during acute phase due to hemodynamic instability
physical activity:
- appropriate in acute phase –> early mobilization
why would you want to incorporate aerobic training into your plan with your stroke patient?
- cardiovascular disease and CVA go hand in hand
- deconditioned after stroke and predisposed to sedentary lifestyle
–> increase risk of falls
–> decline in ambulation
–> harming CV efficiency due to fatigue and muscle weakness
–> inactivity leads to secondary complications
what are 3 big challenges you may face with trying to incorporate aerobic training into a post-stroke plan?
- non-ambulatory –> limited mobility or independence
- poor self efficacy –> greater dependence and reduced societal interactions
- poor baseline of activity –> inactivity possibly led to stroke
aerobic training leads to:
improved O2 consumption
improved workload tolerance
decreased fatiguability
improved VS
improved functional activities
improved self concept
what is progressive resistive strength training?
application of external load in addition to force of gravity during repetitive movements to overload the muscles generating the movement
resistance training is correlated to improved _______ in stroke survivors and counteracts _______
motor
hemiplegia
true or false. strength alone is sufficient enough to overcome functional limitations
false
strength does NOT equal function
for patients who are very weak (less than 3/5 strength), how can you implement resistive training?
gravity minimized exercises using powder boards, sling suspension, or aquatic exercise
–> can do concentric, eccentric, and isometric
what are precautions with resistive training?
- _____ is often affected
- pts with _____ _____ are at increased risk for injury
- safely ______ pts with postural deficits
- avoid _______ for pts with unstable BP
- start with ________ protocols using _____ intensity exercises
- grasp
- impaired sensation
- position
- sustained max effort
- submaximal ; low
those with MCA CVA should do interventions if they achieve some recovery of ___________
–> training strategies should focus on _____, _______ practice
voluntary movement
repetitive, task-specific
UE management treatment focuses on _____ and _______
restoration and prevention
what are some evidence based upper limb interventions?
- passive positioning/WBing strategies (PROM)
- PNF patterns (AAROM)
- CIMT (forced use AROM)
- slings/subluxation prevention (nonuse/compensation)
why is it important to position your patient in bed correctly?
- maintains soft tissue length
- encourages proper joint alignment
- whole body intervention –> malalignment of LEs and trunk could influence position of UEs
what position should the elbow be in when performing assisted stabilization WBing?
full extension –> avoid elbow flexors contractures due to flexor spasticity
how should the UE be positioned to perform assisted stabilization WBing?
shoulder extended, abducted, and ER with elbow, wrist and fingers extended
Rationale for UE WB:
- sustained stretching include relaxation through mechanisms of ____ ______
- slow rocking movements can be added to _______ relaxation effects from influences of slow _____ ______
- ______ proprioceptive awareness through joint compression
- autogenic inhibition
- increase ; vestibular stimulation
- increased
what is the rationale for using PNF techniques?
- which neuroplasticity rule?
hands-on treatment to facilitate active movement patterns
- use it and improve it
what are challenges to using PNF? (3)
- reliance upon therapist to perform movement
- not related to functional task (not salient)
- active movement needs to occur outside of synergy patterns
what is constraint-induced movement therapy?
specific protocol that involves a 2 week period of timed interval training where the unaffected limb is constrained by a sling or mitt and the affected limb is challenged through therapeutic task training
what is the rationale for using CIMT?
- counteract learned nonuse
- massed practice helps with neuroplastic changes
why does timing matter with CIMT?
performance of therapy too soon after stroke may create frustration and overuse syndromes creating neuroplastic damage
what is the purpose of using a sling for UE?
to protect the shoulder joint to prevent shoulder subluxation and damage to flaccid UE during movement when arm is in a dependent position
some evidence suggests that ________ can assist with shoulder subluxation management
electrotherapy such as NMES
good considerations for use of sling:
- support _____ of arm
- assist with shoulder ______ and prevent _______
- free up therapist to attend to _____
- weight
- approximation ; subluxation
- postural/trunk control during functional activities
bad considerations for use of sling:
- prolonged use can lead to ______
- contributes to _____ ____ disorders and body neglect
- blocks spontaneous use and contributes to ____ _____
- formation of contractures and increased flexor tone
- body scheme
- learned nonuse
