Exam 3: Stroke Examination Flashcards
Is it necessary to test reflexes when examining a stroke patient?
No because we already know that they have a central pathology
What are the three prognostic indicators for shoulder pain?
- Low stage of motor recovery
- Scapular malalignment
- Loss of shoulder movement
What shoulder motions are likely limited following stroke?
Flexion less than 90
Abduction less than 90
ER less than 60
What are the two precautions to protect shoulder joint integrity in stroke patients?
- Do not force ROM
- No ABD or flexion above 90 if the patient has limited scapular mobility or lack of ER
If you move a pt’s shoulder above 90 degrees of flexion or abduction, what else must you do to ensure the patient’s safety?
Passively assist with scapular mobility
Should you assess for motor control or strength first?
Motor control assessment should always precede a strength assessment
How do you assess voluntary movements in stroke patients?
Assess synergy dominance, Fugl-Meyer, Chedoke-McMaster, or isolated active movement against gravity
Should MMT be used as the standard to assess strength in stroke patients? Why or why not?
No, MMT is not valid due to strong spasticity, reflex, and synergy dominance
How should you assess strength in patients in the early stages of stroke recovery?
Functional strength testing
How should you assess strength in patients in the late stages of stroke recovery?
MMT or handheld dynamometer
How should you assess the trunk of a stroke patient?
Anterior pelvic tilt paired with lumbar extension, posterior pelvic tilt paired with lumbar flexion, bilateral lumbar lateral flexion
What would you expect to find when examining trunk function in a patient in the early stages of stroke recovery?
Impaired motor recruitment
What would you expect to find when examining trunk function in a patient in the late stages of stroke recovery?
Impaired motor recruitment and ROM restrictions
What is the NIH Stroke Scale?
A systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit
Why is the NIH Stroke Scale used?
As an early prognostic assessment, to evaluation acuity, determine appropriate treatments, predict outcome
What does the NIH Stroke Scale assess?
LOC, language, neglect, visual field loss, eye movement, motor strength, ataxia, dysarthria, sensory loss
What is the score range for the NIH Stroke Scale?
1 is mild and 42 is very severe
If a pt scored between 1-5 on the NIH Stroke Scale, what severity are they classified as?
Mild
If a pt scored between 5-14 on the NIH Stroke Scale, what severity are they classified as?
Moderate
If a pt scored between 15-24 on the NIH Stroke Scale, what severity are they classified as?
Severe
If a pt scored between 25-42 on the NIH Stroke Scale, what severity are they classified as?
Very severe
If a pt scores between 1-5 on the NIH Stroke Scale, what rehab setting is recommended?
Pt will likely be able to be discharged
If a pt scores between 6-13 on the NIH Stroke Scale, what rehab setting is recommended?
Inpatient rehab
If a pt scores a 14 or higher on the NIH Stroke Scale, what rehab setting is recommended?
Acute, subacute, or long-term care
What is the purpose of the Fugl-Meyer Assessment?
Evaluate recovery in post-stroke hemiplegic patients
What is the gold standard assessment for stroke rehabilitation?
Fugl-Meyer Assessment
What are the five domains assessed by the Fugl-Meyer Assessment?
- Motor function of UE and LE
- Sensory function
- Balance
- Joint range and motion
- Joint pain
What are the core measures to assess gait, balance, and transfers according to the APTA?
6 Minute Walk Test
10 Meter Walk Test
Berg Balance Scale
Functional Gait Assessment
Activities-Specific Balance Confidence Scale
5 Time Sit to Stand Test
