Goals And Interventions (Resnick) Flashcards
What is neuroplasticity? (2)
- The central nervous system’s ability to adapt and modify its own organization and function
- The ability of a neuron to respond to environmental changes
______ underlies ALL learning.
Plasticity
What is experience dependent plasticity?
CNS remodeling in response to PRACTICE
What is functional recovery? List 4 things that cause functional recovery.
Reacquisition of elemental motor patterns present prior to CNS injury
- Spontaneous recovery
- Experience-dependent motor training
- Increased involvement of contralateral hemisphere
- Axonal remodeling of corticospinal system
What is the difference between compensation and substitution?
Compensation – appearance of new motor patterns from the adaptation of remaining motor elements
Substitution – integration of alternative motor elements from different end effectors
List the 10 principles of experience dependent plasticity.
- Use it or lose it
- Use it and improve it
- Specificity
- Repetition matters
- Intensity matters
- Time matters
- Salience matters
- Age matters
- Transference
- Interference
Ideally, what inpatient setting should stroke patients receive care in?
Inpatient rehabilitation facility
True or False: High-dose, very early mobilization within 24 hours of stroke is recommended.
FALSE
High-dose, very early mobilization within 24 hours of stroke is NOT RECOMMENDED.
WHY?: Reduces the odds of favorable outcome at 3 months (may increase ischemia)
A Braden score of _____ signifies increased risk for developing pressure ulcers.
< 18
What is the PTs role in prevention of skin breakdown and contracture? (2)
- Transfer training
2. Positioning W/C cushions and mattresses
What positions should be emphasized when positioning a hemiplegic shoulder to prevent skin breakdown/contracture? (2)
- Approximation
2. Shoulder ER
List 2 recommendations for DVT prevention.
- UFH or LWMH (heparin)
2. Intermittent compression when in bed
_______ are not useful for DVT prevention.
Elastic stockings
_______ can be useful to reduce severe hypertonicity after stroke.
Botox
_______ exercises are not recommended when treating hemiplegic shoulder pain.
Overhead pulley exercises
List 4 interventions that are recommended for fall prevention.
- Balance training
- Formal fall prevention programs
- Annual fall risk evaluations
- Tai Chi
________ should be used to asses the patient’s perception of impairments, activity limitations, and participation.
Standardized questionnaires
List 7 repeated top-down and bottom-up interventions used to treat hemi spatial neglect or hemi-inattention.
- Prism adaptation
- Visual scanning training
- Optokinetic stimulation
- Virtual reality
- Limb activation
- Mental imagery
- Neck vibration
_______ and ______ are not recommended for wrist and finger spasticity.
- Splints
2. Taping
What is one limitation of using oral anti-spasticity medications?
Can have dose limiting sedation effects
______ is recommended in individuals with remediable gait impairments (foot drop) to compensate and improve mobility and kinematics
AFO
What 4 things must be considered prior to writing goals for the POC?
- Patient’s roles
- Patient’s self-reported goals
- Therapist’s goals
- Multi-Dimensional approach to functional mobility
Goals must be _____ and ______.
Objective
Measurable
List the 7 components that should be included in a goal. (2 are optional)
- Audience: who is the learner?
- Behavior: what is the skill or task to be completed?
- Condition: assistance level, assistive devices
- Degree: to what extent are they performing the skill/task? (percentage, time, # of trials, etc.)
- Expected Time: timeframe for achievement of goal
OPTIONAL:
- Environment
- Rationale
List 6 types of long term goals that should be included in a neurologic plan of care.
- Transfers
- Bed mobility
- Balance – sitting and standing (can incorporate standardized measures)
- Ambulation (if appropriate)
- Elevations (if appropriate) – stairs, curbs, ramps
- Wheelchair Management/Propulsion (if appropriate)
What is a key difference between LTG and STG?
LTGs must always be FUNCTIONAL and ACTIVITY/TASK BASED
STGs do not always have to be function or activity/task based
What are 2 types of STGs?
- Component goals
2. Impairments goals
Selecting compensatory training vs. remediation is based on _____.
PROGNOSIS
