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Neuro Rehab Test 2 > Hemi UE > Flashcards

Hemi UE Flashcards

1
Q

four primary impairments with hemiplegia

A

paresis/plegia
loss of fractionated movement
tone
sensation impairments

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2
Q

four secondary impairments with hemiplegia

A

muscle/soft tissue length
alignment
edema
pain

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3
Q

how does UE control change depending on the task

A

pointing requires the arm to move as a unit vs grasping requires segmental control

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4
Q

what are the four key elements of UE function moving in space

A

locate target, reach, grasp, and hand manipulation

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5
Q

what drives UE FUNCTION

A

vision and perception

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6
Q

what drives UE ADJUSTMENTS

A

somatosensory information

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7
Q

three motor pre-requisites for functional UE use

A

trunk and proximal stability
UE joint control/strength
hand control/strength/dexterity

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8
Q

what percentage of patients cannot incorporate use of involved UE functionally into daily activities post stroke (6 m)

A

65%

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9
Q

what is the most common long term effect of neuro pathology?

A

loss of arm function

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10
Q

what predicts functional UE recovery?

A

admission level of UE function (in other words, patients with no proximal arm control on admission have poor prognosis for recovery of hand function)

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11
Q

two simple bedside tests within 72 hours of stroke can predict functional recovery of hemiplegic arm at 6 months

A

shoulder abduction (SA) and finger extension (FE) - SAFE score is a summative MMT (max score 10)

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12
Q

how does SAFE score on day 2 post stroke predict dexterity at 6 months?

A

some SAFE has 98% probabilty of some dexterity

no SAFE has 25% probability of some dexterity

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13
Q

Describe the PREP 2 algorithm

A
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14
Q

what is the prognosis and treatment focus for those who score “excellent” on the Prep 2 algorithm

A

return to normal/almost normal dexterity; promote normal use

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15
Q

what is the prognosis and treatment focus for those who score “good” on the Prep 2 algorithm

A

useful helper hand with ADLs but not dexterity; promote function

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16
Q

what is the prognosis and treatment focus for those who score “limited” on the Prep 2 algorithm

A

limited helper hand; promote function

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17
Q

what is the prognosis and treatment focus for those who score “poor” on the Prep 2 algorithm

A

no useful/may use other hand to move and place limb; promote compensation

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18
Q

T/F: pain does not immediately begin in the shoulder following stroke

A

false: it is possible for pain to begin in the shoulder particularly with overhead movements rather quickly

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19
Q

differentiate between synergy and spasticity

A

synergy occurs during volitional movement and spasticity is an involuntary response to passive movement

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20
Q

T/F: patient can mediate synergy responses

A

false: patients cannot mediate response

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21
Q

are synergies predictable? discuss

A

yes, but there may be variations in quality due to variable spasticity with each patient

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22
Q

UE flexor (dominant) synergy pattern

A

scap: elevation and retraction
shoulder: ABER (spasticity will be ADIR)
elbow: flexion
forearm: supination (spasticity will be pronation)
wrist: flexion
fingers and thumb: flexion and adduction

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23
Q

UE extensor synergy

A

scap: protraction and depression
shoulder: ADIR
elbow: extension
forearm: pronation
wrist: “relative extension”
fingers and thumb: flexion and adduction

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24
Q

how does sensory impact UE motor function after a stroke

A

patient sensory experience becomes their new normal, so PT guidance of afflicted UE can give a more normal experience

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25
Q

how does sensory experience impact tone?

A

patient may increase muscle tension for increased sensory experience and stability

26
Q

T/F: UE treatment selectively/only impact UE impairment recovery

A

false: ambulatory levels changed due to UE focused training due to UE training increasing trunk and LE control demands

27
Q

what is the grasp reflex

A

sensory stimuli in the palm elicit hand closing

28
Q

how should PT address the grasp reflex?

A

if a patient has some flexion/grasp, PT focus should be on OPENING the hand in a FUNCTIONAL CONTEXT

29
Q

what is the key to hand opening (i.e. how can you open the hand clinically)?

A

thumb extension/abduction

30
Q

what is the most common contracture post stroke

A

wrist flexion

31
Q

in what patient population should we consider lap trays and arm troughs?

A

for any patient with shoulder subluxation

32
Q

why choose a lap tray over an arm trough?

A

when we have movement that we want to integrate into function

33
Q

what is a benefit and a drawback to self-assisted UE activities?

A

benefit: bilateral and sensory experience
drawback: compensatory

34
Q

what are three strategies to facilitate UE function?

A

PNF
functional training in various positions
integrate effected UE in mobility/transfers

35
Q

what is CIMT

A

constraint induced movement therapy: (1) forced use (2) shaping the task to be appropriate, challenging, and rewarding (3) repetitive massed practice

36
Q

prerequisites for CIMT

A

10 deg active wrist extension, thumb abd/ext, and ext of at least 2 digits

37
Q

evidence to support CIMT?

A

meh at best

38
Q

Despite the weak evidence for bimanual arm training, how does it work?

A
  1. do just the weak arm
  2. do the task bimanually
  3. do the function
39
Q

what is the best part of CIMT?

A

facilitates awareness and force the use of the UE

40
Q

what is the best part of bimanual arm training?

A

easier to perform for the patient and more functional

41
Q

evidence supports the use of mirror tx as useful adjuvant therapy for the hemiplegic UE… what are the three most important components?

A

large mirror
no manipulation tasks
unilateral v bilateral effort

42
Q

in comparison with conventional therapy, Robot Assisted Rehab (RAR) is …. more/less…. effective in improving UE motor recovery

A

more!

43
Q

T/F: RAR shows significant improvements in ADLs

A

false

44
Q

T/F: change in outcome measure of UE function represents change in daily function

A

false

45
Q

Shoulder subluxation occurs in 60-73% of hemiplegic patients, in which direction is subluxation most common? least common?

A

most - inferior; least - superior

46
Q

how would you quantify shoulder subluxation?

A

finger width of separation between the acromion and humerus

47
Q

what are three clinical management strategies for shoulder subluxation?

A
  1. prevent - restore alignment to trunk and scapulae
  2. fix - manually reset the humerus
  3. maintain - hold alignment during tx
48
Q

how do you manually reset a humerus?

A

ER and approximation

49
Q

T/F: every shoulder subluxation in the stroke population is painless

A

false - may be painful or pain free

50
Q

pain and loss of ROM in the shoulder may begin as early as ____

A

1-2 weeks post-stroke

51
Q

which muscle is implicated in the flaccid phase of stroke with regards to shoulder stability

A

supraspinatus

52
Q

which muscles are implicated in the spastic phase with regards to shoulder subluxation

A

subscapularis and pectoralis major

53
Q

Painful hemiplegic shoulder is associated with __(3)___

A

subluxation, spasticity, and poor functional outcome

54
Q

what does the evidence say for treatment of shoulder subluxation? (Arya 2018)

A
  1. FES for reducing subluxation
  2. slings/orthotics for temporary effect
  3. nothing impacts/facilitates UE functional recovery
55
Q

How do you use FES for hemiplegic shoulders? (Vafadar 2015)?

A
  • 1 and only goal: reduce subluxation
  • target supraspinatus and deltoid
  • dont expect carryover, pain relief, or functional improvement
56
Q

so if FES only reduces chances of subluxation and doesn’t impact any other aspect of care… why do you even want to use it?

A

it can help free up the provider’s hands to allow treatment to be more effective

57
Q

What are the benefits to slings/orthotics (2)

A
  1. supports UE/frees up the PT

2. good for standing/transitions in a nonfunctional UE

58
Q

what are the drawbacks to slings/orthotics? (4)

A
  1. non functional
  2. discourages use
  3. contractures
  4. no lasting effect
59
Q

what about taping for shoulder sublux prevention?

A

new, but promising - no good evidence

60
Q

what are three outcome measures associated with UE hemiplegics?

A

Action Research Arm Test (ARAT) - recommend for exposure

Fugl-Meyer Motor Assessment - recommended for students

60
Q

what are three outcome measures associated with UE hemiplegics?

A

Action Research Arm Test (ARAT) - recommend for exposure
Fugl-Meyer Motor Assessment - recommended for students
Wolf Motor Function Test

Neuro Rehab Test 2 (11 decks)

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