Goals and Interventions Flashcards
All candidates of post acute rehab should receive
organized, coordinated, interprofessional care.
Those who qualify for or have access to inpatient rehab should receive care in
IRF over a SNF
What is not recommended for stroke ?
high-dose, very early mobilization within 24 hours of stroke.
reduces odds of favorable outcome at 3 mo.
Why is high dose not recommended early on?
could increase ischemia.
What is used to do skin assessment?
Braden Scale
<18 signifies increase risk of developing ulcer.
For hemiplegic shoulder positioning, what is emphasized?
approximation and shoulder ER
What is PT role in Prevention?
Transfer Training
Positioning
Wheelchair cushion
Mattress.
What should be used for spasticity/contractures?
Resting Hand splints
Ankle Splints
Casting
Tendon Release.
What are principles of experience dependent plasticity
Use/lose it use/improve it Specificity Repetition matters Intensity Matters Time matter Salience Age Transference Interference
DVT prophylaxis should be initiated and maintained until patient regains___
what to use and whats not useful?
mobility.
intermittent compression
elastic socks.
What is recommended for management of hemiplegic shoulder pain?
- edu on ROM and position
- Botox to reduce spasticity
- neuro pain meds
- devices/slings for sublux
- NMES
- NO PULLEYS
What causes central pain in stroke
thalamus (thalamic pain syndrome)
Fall prevention hacks?
- exercise program with balance training after d/c
- fall prevention program before discharge
- annual eval
- edu
- tai chi
What is done for assessment of Disability/rehab needs?
-assess condition/impairements/function/ADL
make goals.
followup 30 days after.
What to do to assess motor impairment/activity/mobility?
- use standardizes tools
- questionnaires
- technology
- compare with reassessment.
What should be provided for hemispatial neglect?
prism adaptation visual scanning training optokinetic stimulation virtual reality mental imagery stim.
What can be done for spasticity?
-Botox
-oral meds
-NMES
-Intrathecal baclofen
Splint/taping. (not fingers/wrist)
Why is botox better than oral meds
meds have side effects and make person sedated. botox is local.
What is a baclofen?
catheter inserted to CSF to give med bypassing digestive system
What done for Balance/Ataxia
balance training program
AD or orthosis
Posture training.
What done for mobility?
- mobility task-training
- circuit training/TM
- robot assisted/ VR
- NMES
What to note for chronic care management?
- individual POC to improve cardio and reduce risk of stoke
- participate in exercise AFTER d/c
Nervous systems ability to adapt and modify its own organization and function
Neuroplasticity
CNS remodeling in response to practice
Experience-dependent plasticity
Integration of alternative motor elements from different end effectors
Substitution
new motor patterns from adaptation of remaining motor elements
compensation
reacquisition of elemental motor patterns present prior to CNS injury
Functional Recovery
Functional recovery occurs as result of
spontaneous recovery
experience-dec motor training
-increased involved contralateral hemisphere
-axonal remodeling
