Exam 4 Flashcards
What is Pushers Syndrome?
When a patient who has had a stroke leans toward the hemiplegic side.
What are the characteristics of a Left CVA?
-Aphasia (Language involvement)
-Apraxia (Difficulty with motor planning)
-Difficulty with sequencing
What is the Modified Ashworth Scale used for?
Grading Spasticity
What are the Modified Ashworth Scale grades and what do they mean?
0 = No increase in muscle tone
1 = Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part is moved in flexion or extension
1+ = Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the range of motion
2 = More marked increase in muscle tone through most of the range of motion, but affected part easily moved.
3 = Considerable increase in muscle tone, passive movement difficult
4 = Affected part rigid in flexion or extension
What are the Brunnstrom Stages of Recovery?
The accepted 7 stages of stroke recovery
Name the Brunnstrom Stages of Recovery
I = Flaccidity: No voluntary or reflex activity is present in the involved extremity
II = Spasticity begins to develop: Synergy patterns begin to develop. Some of the synergy components may appear as associated reactions
III = Spasticity increases and reaches its peak: Movement synergies of the involved upper or lower extremity can be performed voluntarily
IV = Spasticity begins to decrease: Deviation from the movement synergies is possible. Limited combinations of movement may be evident.
V = Spasticity continues to decrease: Movement synergies are less dominant. More complex combinations of movements are possible.
VI = Spasticity is essentially absent: Isolated movements and combinations of movements are evident. Coordination deficits may be present with rapid activities
VII = Return to normal function: Return of fine motor skills
What is the definition of Associated Reactions?
Automatic movements that occur as a result of active or resisted movement in another part of the body.
What is Souques Phenomenon in terms of associated reactions?
Flexion of the involved arm above 150 degrees which facilitates extension and abduction of the fingers
What is Raimiste Phenomenon in terms of associated reactions?
Resistance applied to hip abduction or adduction of the uninvolved LE causes a similar response in the involved LE.
What is Homolateral Limb Synkinesis in terms of associated reactions?
Flexion of the involved UE elicits flexion of the involved LE
What is the Clinical Presentation of a patient with an Acute CVA?
-Flaccidity/Hypotonicity
-GH subluxation
-Pain and edema distally
-SC/Brainstem level reflexes (ATNR, STNR, Tonic Lab)
-Aphasia (L CVA)
What are the safety concerns for a patient with an Acute CVA?
-GH subluxation
-Bed sores/ skin integrity
-Increased ICP
-Decreased sensation
-Seizures
-Fall risk
-Pain
What are the Treatment Considerations for a patient with an Acute CVA?
-Positioning and handling (work on involved side) (make sure to leave call bell, food, water on uninvolved side)
-Skin protection
-Early ROM
-Weight bearing on affected side
-Sensory neglect
What are some suggestions for interventions or related motor control techniques for a patient with an Acute CVA?
-Early mobilization
-Ramiste Phenomenon (for AROM)
-Clasped hands with affected thumb on outside
-Supine hook lying
-Bed mobility and positioning
What is the Clinical Presentation of a patient with a Subacute CVA?
-Instability in joints
-Synergistic patterns
-Volitional overflow
-Elbow flexion synergy
-Re-emergence of primitive reflexes
-Pushing tone into the involved extremity
What are the Tone and Gait patterns for a patient with a Subacute CVA?
-Synergistic tone
-Circumducted gait
What are the safety concerns for a patient with a Subacute CVA?
-Increased ICP
-Decreased sensation
-Seizures
-Fall risk
-GH subluxation
-Pain
What are the Treatment Considerations for a patient with a Subacute CVA?
-More upright posturing
-Improve muscle function and strength
-Enhance neuroplasticity/prevent maladaptive neuroplasticity
-Enhance motor control (recovery vs. compensation)
-Compensatory teaching for sensory involvement
-Functional skills (bed mobs, transfers, amb)
-Cardiovascular training
What are some suggestions for Interventions or Related Motor Control techniques for a patient with a Subacute CVA?
-Symmetrical positioning
-Motor control (iso, ecc, con) (start movement over if synergy starts to kick in)
-Gait training, starting with stance and loading
-Stairs: Up with uninvolved, down coming backwards
What is the Ranchos Los Amigos Scale?
It’s a scale for cognitive functioning
What is the patient presentation for Ranchos Los Amigos Cognitive scale Level 1 and what are the Therapy Implications?
Coma/No Response
Patient Presentation
-Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular, or painful stimuli
-No sleep/wake cycles, all behaviors reflexive, no evidence of eyes opening (spontaneous or stimulus induced)
Therapy Implications
-PROM and flexibility
-Positioning with emphasis on arousal
-Use of splints and braces to prevent contractures
-Monitor emerging changes with CRS-R
What is the patient presentation for Ranchos Los Amigos Cognitive scale Level 2 and what are the Therapy Implications?
Vegetative State/Generalized Response
Patient Presentation
-Demonstrates generalized reflex response to painful stimuli
-Responds to repeated auditory stimuli with increased or decreased activity
-Responds to external stimuli with physiologic changes generalized, gross body movement, and/or non-purposeful vocalization
-Responses noted above may be the same regardless of type and location of stimulation
-Responses may be significantly delayed
Therapy Implications
-Out of bed activity
-Ongoing positioning considerations in wheelchair and bed
-Transfer training with healthcare team
-1-2 step command following activities
-Develop consistent communication system
-PROM/AAROM/AROM when possible
What is the patient presentation for Ranchos Los Amigos Cognitive scale Level 3 and what are the Therapy Implications?
Minimally Conscious State/Localized Response
Patient Presentation
-Demonstrates withdrawal or vocalization to painful stimuli
-Turns toward or away from auditory stimuli
-Blinks when strong light crosses visual field
-Follows moving object passed within visual field
-Responds to discomfort by pulling tubes or restraints
-Responds inconsistently to simple commands
-Responses directly related to type of stimulus
-May respond to some persons (especially family and friends), but not to others
Therapy Implications
-Consistent environment and schedule
-Activities that work on tracking
-Object manipulation tasks
-Ongoing orientation
-Allow for extra time to respond
-Low stimulation environment
-Engage in familiar activities
