INTRO TO HEALTH PROMOTION Flashcards
Nearly ___ of patients with stroke experience recurrent stroke within __ years and comorbidities CV conditions represent leading cause of death.
1/3 within 5 years
Fast twitch fibers are ____ sensitive to insulin
Patients after stroke experience decrease in __ fibers
Fast twitch are less sensitive to insulin
Post stroke: more fast twitch due to decrease in slow twitch
Paretic limb fat content is _____, muscle mass is ___%
Fat is 25% higher
Mm is 20% lower
Causing increase energy cost of gait
Decreased fitness more than age, sex
What are health behaviors?
Actions that are intentional or unintentional, that affect health of individuals or others
Greatest physical activity benefits in mortality risk are in ___hrs a week
0-7.5 (20% drop in mortality)
7.5-15 is also good (11% drop in mortality)
Up to 40-75 hours BENEFITS
What is most common way to do a home eval?
Give patient/family a worksheet to complete and draw a simple floorplan
*you can do a home eval with the patient and family present ideally
What can patients with tetraplegia use on their wheelchair to prevent rolling backwards?
Grade aids
___ people post stroke may prefer to go up backwards on a ramp, pushing with quads
Foot propellers, pushing with quads
What is progression for K levels of Wheelchair qualifying process?
- Standard manual WC
- Lightweight WC
- Power operated vehicle (scooter)
- Motorized WC
Scooters are more or less expensive?
More or less trunk control needed?
Do they have armrests and seatbelts?
Scooters are less expensive,
Less stable side-to side
More trunk/upper body control needed for scooter
Scooter seat may or may not not have armrests and seatbelts
Scooter has fewer seating options
For any WC prescription, the person has to sit a min of ___hours per day ___ their home to qualify for Medicare coverage
4 hours INSIDE
Motorized wheelchairs are only covered if they are needed to perform
ADLs in home/routine! (If patient can’t walk to kitchen to eat)
Need to be required at least 4 hours a day. FACE TO FACE VISIT WITH PHYSICIAN REQUIRED
Will Medicare pay for an electric bed?
Fully electric: no not at all
SEMI-ELECTRIC: (ADJUST HEAD AND FOOT OF BED WITH CONTROL, bed height is adjusted MANUALLY at foot of the bed)
When does SCAT6 have good clinical utility/best able to discriminate between concussed and non concussed athletes in acute stages…
First 72 hours post injury, up to 5-7 days
Functional balance problems
STEADI 4 STAGE, FSST, mini best
MOTOR AND SENSORY STRATEGY PROBLMES ARE
REACTIVE POSTURAL CONTROL ISSUES
Anticipatory postural control issues are
Ability to recover stability after external perturbations (strategies)
Shifting COM before voluntary movement like stepping-lift leg, arm raise, head turn
Sensory organization issue
Individual balance is what 3 things
Motor
Sensory cognitive
Task balance is
- Steady state
- Proactive
- Reactive
Environment components of balance
- Support surfaces
- Sensory context
- Cognitive load
Stages of motor learning for balance in the individual
Skill acquisition
Refinement
Retention
Environment balance sensory context
- Visual conditions
- Sensory agreement
- Sensory conflict
For patients with PD, ___ when performing concurrent verbal task
CVA/TBI ___ sway with dual task
Decreased postural stability
Increased sway
Postural adaptation problems are due to
Decreased ability to recruit agonist mm in response to big perturbation (strength)
Decreased modulation of response amplitude to different perturbation sizes (cerebellar)
Increased compensatory sway in opposite direction (anterior cerebellar lesions and MS)
Impaired central set
Inability to change movement strategies quickly to adapt to changes in demands
BASAL GANGLIA
Reactive balance retraining
Multi directions, different perturbations
Goal: strategies! Hip ankle, step
Anticipatory balance retraining
Voluntary sway
Self initiated sway
Wobble board, bosu ball, dyna discs
Treatment of timing problem for balance
BWSTT, FES
Treatment of timing problem for balance
BWSTT, FES
Treatment of amp problem
Start small perturbations then progress to large
Scaling problem: computerized program like balance master
What can we do with patients who have dyssynergia?
- Stability: rhythmic stabilization/alternating isometrics
- Slow reversal/holds for controlled mobility
FRENKEL IS FOR
DYSMETRIA
Strokes where cause hemiparesis of arm?
MCA
BG
Internal capsule
Subcortical white matter
Pyramidal tracts in brainstem
Which joint in the shoulder is a major contributor to pain/disability?
GH
_% of stroke survivors experience at least one episode of shoulder pain within first year of post stroke
72%
What can cause painful hemiplegic shoulder?
Frozen shoulder
Neuropathy traction/compression
CPRS
Shoulder trauma
Bursitis/tendinitis
Rotator cuff tear
HO
Inferior subluxation due to
Scapula downward rotation (low rotator cuff, Serratus)
Glenoid fossa downward
Humoral internal rotation when elbow extended
Anterior GH subluxation due to
Down pull of lats
Vertical orientation of glenoid
Scapula elevation on thorax
Humerus hyperextends, internal rotation
Superior subluxation is due to
Deltoid spasticity/biceps
Scapula rotate down, elevate on thorax
Humoral head internally rotates and pull up under acromion
Bad things about shoulder supports
Not permanent
Reinforce flexion synergy patterns
Facilitation of contractures
Good and bad about FES for shoulder subluxation
Good: reduce subluxation, pain immediately
Bad: not permanent changes
With frozen shoulder, what are possible treatments?
- Maximize ROM
- Meds for pain
- Ice for acute, heat for stretch
- STM
- Estim
- Motor block to sub scap and pecs for spasticity
Treatment of brachial plexus injury
AROM/PROM avoiding traction
45 degree shoulder abduction sling for night
Shoulder support while walking
Armrest in wheelchair
(Heal 8-12 months)
HO usually occurs where in the hemiplegic shoulder?
Infrequent but happens
Extensor side of elbow
Gentle mobilization, ETRIDONATE/indomethacin
If lateral zone is damaged, what do you see in cerebellum clinical signs
- Dysdiadochokinesia
- Dysmetria
- Dyssynergia
- Decomposition
HYPOTONIA
Oculomotor deficits
Imbalance
Falls
Gait ataxia
*signs of cerebellar __ zone damaged
Medial (vermis, fastigial)
Flocculonodular lobe damage leads to
- Nystagmus
- Impaired VOR
- Imbalance
Intermediate zone (spine cerebellum globose and emboli form)
Imbalance
Gait ataxia
Tremor
Lack of check
Dysdiadochokinesia
Dysmetria
Cerebellar Dysmetria is greatly exacerbated by
Multi joint movements
(Graph with elbow movement is fine, elbow and shoulder is hypermetria)
Cerebellar tremor is caused by insufficient ____ and excessive _____
Insufficient anticipatory effects of movement
Excessive reliance on feedback (SENSORY CONDITIONS)
*reduced when vision is removed, during isometric conditions
Individuals with cerebellar damage need to use ___ instead of adaptive motor learning (also called trial and error-sensory prediction error) bc they can’t do it
Conscious control strategies (think more, less distractions)
Use dependent motor learning (repeated practice of a movement pattern)
Reward/reinforcement learning
Tests for limb coordination in cerebellum
Finger to nose
Alternating forearm sup-pron
Hand finger tapping
Heel to knee, foot or toe tapping
*compare both sides, repeat multiple times on same limb
*as fast as possible and SLOW
*compare with or without vision
*
When testing limb in coordination, be careful to distinguish from
- Balance deficits (maybe can’t sit in unsupport sitting)
- Vision/diplopia
What should you look out for with testing posture/balance in cerebellum patients?
- Nausea/vertigo
- Observe for postural tremor=TITUBATION
- Lack of check
Why is endurance in CV and MSK system for cerebellum so important?
Movements are often exaggerated and effortful, so they need good endurance for safe ADLs
What two scales are used for cerebellar ataxia?
ICARS
SARA
How often to schedule interventions for cerebellum dysfunction
Frequent 10 hours/week
Long: 6 months
What compensations help cerebellum dysfunction?
Slow
Wide BOS
Visual cues
Maybe AD? Could be too hard to coordinate
NO DISTRACTIONS
GG codes
6: independent
5: set up/clean up
4: supervision
3: partial/mod assist
2. Substantial/max assist
1: dependent
TBI outcome measures
JFK
GCS
Goat
Ranches
FIM
DRS
Orpington Prognostic Scale for stroke
Less than 3.2 mild
Over 5.2-6.8 severe (dependent)
Organization of movement for MCML and task analysis:
Individual: 3 parts
Task: 3 parts
Environment: reg/non reg
Individual: perception, action, cognition (PAC)
Task: mobility, manipulation, stability (MMS)
Environment: stationary or MOTION
Task categories 1-4
Closed
Variable motionless: stationary objects, but different sizes/shapes
Consistent motion (escalator)
Open
Task categories 1-4
Closed
Variable motionless: stationary objects, but different sizes/shapes
Consistent motion (escalator)
Open
7 commandments of PNF
- Manual contacts
- Commands
- Stretch
- Traction: movement, approx: stability
- Max resistance
- Normal timing
- Reinforcement (timing for emphasis)
Elements of postural control
- Trunk
- Midline orientation
- Weight shift over BOS
- Head control
- Limb function
Predictors of walking post stroke
80% do walk! 98% walked at 6 months IF
1. Independent sitting first 3 days
LE strength 1/5 hip flex, knee extension, ankle DF in 3 days
If BBS below 20 and FIM 1-2, then
20x more likely to be home bound
Recovery for UE post stroke
Shoulder and mid finger in first 3 months
Essential neuroanatomy for walking
- Mm and peripheral nerves
- SCPG
- Medullary reticular formation: decision to walk, driving center *symmetrical and gait speed!
- Mesencephalic locomotor region: cats! Modulate speed
- Subthalamic locomotor region: goal
Core outcome measures post stroke
BBS
FGA
ABC
10meter walk
6MWT
5xSTS
MAS
0 none
1 slight increase, catch and release
1+ more increase, catch and more tone
2 more increase but easily moved
3 difficult PROM
4 CONTRACTURE
TARDIEU SCALE
V1,2 3 (VELOCITY 1 slow, 2, gravity 3 fast)
X: 0 no resistance 4 unfatigable clonus
Y: angle R1, R2
Adverse effects of baclofen pump
Sedation
Respiratory depression
Decreased cardiac function
Hypotonia
Mm weakness
Confusion, disorientation
Nausea/vomit
Coma
Signs of sympathetic storming
Agitation
Diaphoresis
HTN
High heart rate, breathing
Posturing
Dilated pupils
*15-33% of patients with severe TBI
DRS scale is for
Coma to community
BFS, disability/activity and participation
0 -29 (high disability: vegetative state)
___ is normal score for O log (progress out of PTA)
25/30
1 hour-1 day PTA is considered
Moderate
1-7 days severe
0-60 min is mild
Verbal apraxia
Aphemia
