exam 2: UE management Flashcards
UE screening falls under the ______ ICF domain
UE exam/assessment falls under _____, _______, and ______ domain
- body structure function
- body structure and function, activity, participation
what are contributing factors to shoulder subluxation with hemiplegia? (3)
- weakness and weight of heavy arm
- unlocking mechanism of capsule is lost
- superiorly, capsule and coracohumeral ligament are taut
secondary adhesive capsulitis can be a result from shoulder pain due to ________
spasticity
proprioceptive loss and lack of muscle tone/strength reduce support of RTC to position humerus properly in glenoid cavity
this describes shoulder pain due to ______
flaccidity
3 causes of shoulder pain due to flaccidity:
1. prolonged periods of ________ from traction on soft tissues
2. malalignment during mobility causes ________
—> DO NOT use _______
3. poor ______ ________
- subluxation
- impingement ; pulleys
- patient handling
Functional Independence Measure (FIM):
- instrument used to measure ______ for _____ population
- some subtests relate to the functional use of ______ ________ —>
- disability for any
- upper extremity –> self care and transfers
Task specific analysis: ex- reach and grasp tasks:
- ICF domain:
- provides information on patient’s ability to _____, demonstrate ______ _____ ______, and functional UE _______
activity
move
anticipatory postural control
mobility
what are examples of task analysis?
stacking blocks, placing shapes in shape sorter, household tasks like folding clothes
Action Research Arm Test (ARAT):
- ICF domain:
- specific for:
- what are the 4 subscales?
- on a 0-3 scale, 3 means?
- ARAT has been found to be more responsive than ______ w/ increased UE function in chronic stroke
- body structure and function
- UE function in adults with neurologic dysfunction, including poststroke
- grasp, grip, pinch, gross movement
- 3 = performs test normally
- FMA-UE
9 hole peg test:
- ICF domain:
- what is it?
- what does it measure?
- normative values are made for _______ populations
- body function and structure and activity
- speed-oriented, move pegs into 9 holes. then remove them.
- finger dexterity
- non neurologic pop. (general pop)
Box and Blocks test:
- ICF domain:
- what is it?
- what does it measure?
- normative values are made for ____ pop.
- body function and structure and activity
- box with divider contains 150 colored blocks. move as many to the other compartment in 60 sec.
- manual dexterity
- general pop
Fugl-Meyer assessment of motor performance:
- ICF domain:
- _____ specific outcome measure
- used primarily for _____
- scores range 0-2. 0 = ___ 2 = _____ so ____ score is better
- max score for FMA-UE ______
- may demonstrate ceiling effects for fine motor skills in ________
- body function and structure
- stroke
- research
- 0 = cannot be performed. 2 = fully performed. high score is better
- higher functioning patients
Wolf Motor Function Test (WMFT):
- ICF domain:
- performance on ____ timed tasks and _____ strength measures
- tasks are arranged in order of _______
- rating scale 0-5. 0 = ? 5 = ?
- max rating of ____ points
- provides insight into _____
- body function and structure
- 15 ; 2
- complexity
- 0= no use of affected side ; 5= normal
- 75
- neural recovery mechanisms
Stroke impact scale (SIS):
- mainly used in ____ setting
- ICF domain:
- _____ specific outcome, ______ report
- ____ point scale. final item scale is ____ to ____
- not sensitive to _____ or _____ weakness of upper limb after stroke
- outpatient
- participation
- stroke, self
- ; 0-100
- mild or moderate
what are functional consequences due to maladaptive movement and multifactorial impairments? (4)
learned nonuse
learned bad use
forgetting to use
secondary consequences
learned _______:
does NOT learn to use more involved extremities due to movement ________ of less involved side
nonuse
substitution (compensation)
initially, what are 5 reasons a patient does not use the affected limb?
weakness or paresis
altered force production
sensory loss
spasticity
stroke-related pain (commonly shoulder pain)
what is learned bad use?
when normal movement of the paretic limb is prevented, compensatory strategies are used to complete the tasks
what two principles of neuroplasticity relate to “forgetting to use”
use it or lose it
repetition matters
during which phase do therapeutic interventions focus on reducing secondary impairments?
chronic
gadupe
what are things to consider when choosing the interventions to use?
- which impairments are contributing to the functional status
- stage of recovery
- learned nonuse (restorative interventions)
- if the UE is flaccid (WB & support)
- task-oriented approach (make it salient)
- facilitation (but only what is needed)
- trunk stability is a prerequisite
why is soft tissue/joint mobilization and ROM initiated early in poststroke patients?
encourage AROM and prevent contracture
in ranges of 90 deg shoulder flexion be careful not to perform _________ of ________
distraction of humerus
scapula should be mobilized with emphasis of ________ and ________
upward rotation and protraction
should you use shoulder pulleys with neurologic patients? why or why not?
no
they do not facilitate appropriate scapulohumeral rhythm
what ICF domain do performing purposeful activities fall under?
activity domain
having an intrinsic motivator falls under which two principles of neuroplasticity?
specificity and salience
how do you use the upper limb as a stabilizer?
–> early or later stage intervention?
increase WBing and approximation of joints
–> early stroke intervention
how do you use the upper limb as a manipulator?
–> early or later stage intervention?
reaching and grasping objects & performing ADLs – need finger extension
–> later stroke intervention
what phase do you start to initiate constraint-induced movement therapy?
subacute –> require distal motor function
what is the protocol for using CIMT?
- restraint unaffected arm with mitt, sling, or glove for 90% of working hours for a 2-3 week period
- therapy sessions are intense, repetitive task training for 6-8 hours a day
the ideal shoulder sling:
- helps maintain _____ alignment with allowed _____
- ______ tendency of humerus to IR
- takes some weight of the arm off the ______
- normal ; freedom of movement
- decreases
- upper trunk
what are general rules for sling use to support UE?
- minimize use during rehab
- useful for initial transfer and gait training
- stay away from traditional slings if you can
what are effective alternatives to sling use?
taping/strapping
electrotherapy
studies show the arm trough ______ the subluxation vs shoulder sling
overcorrects
what is a WC arm trough?
board or lap tray attached to WC to provide support for flaccid arm
gadupe
what are pros for resting hand splint?
what is a con?
pros:
- limits contractures with spasticity return
- prevents extreme wrist flexion
con:
- enforces learned non-use
in a patient using a 4WW or RW, if grip strength is an issue what can you add to assist them?
arm trough
or therapist facilitates hand over hand facilitation
tapping with Ace bandage
what is a pro of using unilateral devices?
what is some cons?
pros:
- offers independence
cons:
- encourages compensatory gait pattern –> usually step to gait pattern is used
what is the SAFE model?
SAFE patients by day 2 after stroke had _____ probability of achieving upper limb function
Some arm & finger ext.
98%
