Exam 3- stroke part 2 Flashcards
After a stroke, pt revert a
synergistic pattern
synergistic pattern (details)
~Good bc there is a contraction (not flaccid)
~does not mean that they are very functional
~Important bc if there is a synergy be there is some form of a contraction (not flaccid)
~They can appear fast; can use it if you know it is there/ avoid it
UE flexor synergy
~Scapular/ retraction/ elevation or hyperextension ~Shoulder abduction, ER ~Elbow flexion ~Forearm supination ~Wrist and finger flexion
UE extensor synergy
~Scapular protraction ~Shoulder adduction, IR ~Elbow extension ~Forearm pronation ~Wrist and finger flexion
LE flexor synergy
~Hip flexion, abduction, ER
~Knee flexion
~Ankle DF, inversion
~Toe DF
LE extensor synergy
~Hip extension, adduction, IR
~Knee extension
~Ankle PF, inversion
~Toe PF
Combined for UE
~Shoulder IR/adduction
~Elbow flexion
~pronation
weight bearing for LE
~knee extension
~hip adduction
~inversion
synergistic pattern- UE
~Flexion is the stronger
~test extension first
synergistic pattern- LE
~extension is stronger
~Flexor not seen that often- test this first
~triggered by weight bearing
Can classify the level of motor ability post stroke on the ____ scale
Bronnstrom Scale
Bronnstrom Scale- lvl 1
~1 is your lowest ~no movement of the limbs ~flaccid ~no associated reactions ~"Recovery from hemiplegia occurs in a stereotyped sequence of events that begins with a period of flaccidity immediately following the acute episode. No movement of the limbs can be elicited"
Bronnstrom Scale- lvl 2
~minimal voluntary movements, small synergistic movement can be made
~not all components are there
~spasticity can begin to develop
~associated reaction can be invoked
~”As recovery begin, the basic limb synergies or some of their components may appear as associated reactions, or minimal voluntary movement responses may be present. At this time, spasticity begins to develop”
Bronnstrom Scale- lvl 3
~voluntary movement of the synergistic movement- we don’t have to do anything to cox the movement
~full extent of spasticity
~”The pt gains voluntary control of the movement synergies, although full range of all synergy components does not necessarily develop. Spasticity has further increased and may become severe”
Bronnstrom Scale- lvl 4
~combinations that do not follow the path of either synergy pattern
~can do either ext or flexor contraction or a movement that is a combination of both
~can begin to do the other movement (if you can do flex, can begin to do ext)
~”Some movements combinations that do not follow the paths of either synergy are mastered, first with difficulty, then with more ease, and spasticity begins to decline”
Bronnstrom Scale- lvl 5
~can move even more out of the synergistic pattern
~”If progress continues, more difficult movement combinations are learned s the basic limb synergies lose their dominance over motor acts.”
Bronnstrom Scale- lvl 6
~can do complex tasks outside of the synergistic patterns
~”With the disappearance of spasticity, individual jt movements become possible and coordination approaches normal. From here on, as the last recovery step, normal motor function is restored, but this last stage is not achieved by all, for the recovery process can plateau at any stage.”
Bronnstrom Scale- lvl 7***
~some books have this- completely normal
Bronnstrom Scale- other info
~If you stress them enough (give them too many tasks) you can have them go backwards on the scale
IMPORTANT!! TEST ____ FIRST IN UE
Test the ext in UE first!!
need to always test the weaker side first. Bringman said he would take off point on practical if we do it backwards
IMPORTANT!! TEST ____ FIRST IN LE
Test the flex in LE first!!
need to always test the weaker side first. Bringman said he would take off point on practical if we do it backwards
Abnormal Associated reactions- the types
~ General
~Raimiste’s phenomenon
~Souques phenomenon
~Bechterew’s reflex
Abnormal Associated reactions- general
~Not really abnormal- we may have these
~Will not be enough be enough for joint movement, but is a slight contraction of the muscle
Abnormal Associated reactions- general UE
UE resisted flexion of uninvolved side evokes flexion on involved (extension= extension)
Abnormal Associated reactions- general LE
LE resisted flexion of uninvolved side evoked extension on involved (extension= flexion)
Abnormal Associated reactions- Raimiste’s phenomenon
LE resisted abduction of uninvolved evokes abduction in involved (adduction- adduction)
Abnormal Associated reactions- Souques phenomenon
Elevation of the involved UE above 90* inhibits flexor tone of fingers
Abnormal Associated reactions- Bechterew’s reflex
Passive PF of the great toes evokes massive flexion of LE
Attitudinal/ Postural reflexes- types
~ATNR (Asymmetrical tonic neck reflex)
~STNR (symmetrical tonic neck reflex)
~TLR (tonic labyrinthine reflex)
~PSR (positive supporting reflex)
Attitudinal/ Postural reflexes- ATNR
~How our head is in relation to hands
~where you are looking is an ext arm
~away face is flexion
~You can position the person to increase the desire for the body to want to go into the position
~Increase extensor tome on face side; increase flexor tone on the skull side
~*right hemi head to the right has increased extensor tome, left side less influenced
Attitudinal/ Postural reflexes-STNR
~Flexor/ext neck in mid line
Attitudinal/ Postural reflexes- STNR- flexion
Neck flexion- UE flex and LE ext (the two strongest synergies)
Attitudinal/ Postural reflexes- STNR extension
Neck extension- increase UE extension and LE flexion tone
Attitudinal/ Postural reflexes- TLR
Head position changes tonal response
Attitudinal/ Postural reflexes- TLR Supine
increase extensor tone
Attitudinal/ Postural reflexes- TLR Prone
increase flexor tone
Attitudinal/ Postural reflexes- TLR Sidelying
~wt bearing limbs increase ext tone
~non wt bearing increases flexor tone
Attitudinal/ Postural reflexes- PSR
~Stand on the ball of the foot- causes the extensor syn
~Can help to turn or you fall
~Pressure on ball of involved foot
~Cocontraction in ext with PF
Positioning of stroke pt
~Side to side (one side they will feel/ one they will be able to move)
~They have enough strength on the sound side to move out of the position
~Need to educate on not moving their position
~2 hour rotations
Positioning of stroke pt- Hemiplegic shoulder
if there is flaccidity..
pt’s shoulder can sublux
Positioning of stroke pt- Hemiplegic shoulder
How to check for sublux
NEED TO CHECK sulcus sign (check bilaterally!!)
Positioning of stroke pt- Hemiplegic shoulder
important to make sure…
~it does not getting worse/ not subluxing / getting trapped
~Gravity dependent position can make it worsen
Positioning of stroke pt- Hemiplegic shoulder
important info for bed
~make sure that is being tended to
~if you laying on the involved side- not laying on actual arm, arm is not protracted
~if are lying on opposite side- make sure arm is not behind
Positioning of stroke pt- Hemiplegic shoulder
Important info for sitting/ wheelchair
make sure the hand is not getting trapped in the wheel chair wheels
Positioning of stroke pt- Hemiplegic shoulder
PROM
~make sure that you are moving them in the correct movement
~if not you may be creating impingement
