L10 Stroke Treatment Flashcards
NIH Stroke Scale
can be performed by HCP who are certified
15 item neuro exam to quantify stroke related impairments
evaluates level of consciousness, language, neglect, visual field loss, extraocular movement, motor strength, ataxia, dysarthria, sensory loss
Predictive Validity/Meaning of NIH Stroke Scale
<5 = 80% will be d/c home
6-13 = require acute IPR
>14 = require LTC
Score Range of NIH Stroke Scale
from 0-42, higher scores indicate greater severity of stroke
Very severe >25
Severe = 15-24
Mild to MOd = 5-14
Mild = 1-4
Common medications prescribed to stroke victims
HR, BP, a-fib
anti-clotting (either to dissolve or prevent)
meds to control other comorbidities
Contraindications for PT after stroke
- elevated intracranial pressure
- DVT or pulmonary embolism that has not been treated
- acute changes in neuro states
- new myocardial infarction
- new and/or active brain bleeding that requires tx
- unstable vital signs
- high intensity mobility within 24 hrs of stroke
Prognostic Factors
Pathoanatomical Factors
Psychosocial Factors
Pathoanatomical prognostic factors
time to treatment (most important)
areas of brain affected, especially frontal lobe or ones that impact memory/language
Psychosocial prognostic factors
depression due to loss of function
decreased caregiver supprot
decreased resources
CPR to predict ability to ambulate after stroke
For subactue stroke
admit factors that were significant in predicting ambulation were berg balance scale and LE strength
you have to use high intensity variable gait training as the intervention for it to be valid
Biomechanical Specificty
biomechanical nature of a task similar to other tasks
Information processing
performing a task without distraction vs dual task performance
Is knowledge of results or knowledge of performance better?
knowledge of results is a better feedback mechanism
Active ingredients of motor learning
errors
feedback
practice
Practice variables
intensity, distribution
specificity
manual guidance/assistance
observational learning
mental imagery
adaptive practice
Myths for Intervention Progression
- single joint movements should be mastered before multi joint
- stability should come before mobility
Truths for Intervention progression
- Specificity of practice needs to match specificity of task
- Tasks that require mobility and stability both should be learned concurrently
- Part to whole task is not always appropriate
- Different tasks types are not necessarily easier or more difficult, they are different
Neurofacilitation Techniques
increase muscle tone and muscle activity by providing sensory input
quick tapping, stretch, vibration, fast brushing, quick icing, weightbearing, joint approx, overflow, eccentric/isometric activation, manual resistance
Overflow
use stronger manual resistance to a stronger muscle to facilitate a muscle contraction in a weaker muscle within same synergistic movement in contralateral extremity
NMES
to peripheral nerves facilitate muscle contraction, improve muscle strength, improve joint alignment and prevent disuse atrophy
helps prevent shoulder subluxation after stroke
CPG for use of AFO and FES stimulation SHOULD
provide AFO and FES to improve gait speed, balance, WOL, muscle activation, endurance
CPG for use of AFO and FES stimulation SHOULD NOT
provide AFO/FES to improve tone or spasticity
MAY be used to improve gait kinematics
Synergy
consistent ratio of muscle co-activation necessary to coordinate body segments to perform a motor task through single neural command
stroke patients are obligated to move in muscle synergy b/c they can’t isolate joint movement
Impact of hypertonicity on funciton
researchers have found decreases in strength from neuro disorders affect function more than any associated increased spasticity
important to treat the underlying strength and coordination impairments of opposing muscles and not just spasticity alone to optimize function
Functional Strengthening for UMN Pathology
facilitate strengthening of weak muscles limiting the patient’s ability to move out of synergistic pattern
utilize principles of motor learning, neuroplasticity for good outcomes
adapt task, environment, person to make the task achievable
provide support as needed
Medications for Hypertonicity and Spasticity
often coupled with PT
meds will act systemically, which causes pt with decreased force generation of all muscles
Positioning and Handling…
these techniques have not been systematically studied for effectiveness in changing functional outcome
Examples of handling and physical inhibition
deep sustained pressure
sustained long axis jt traction
rhythmic rotation
sustained stretch
warm or cold icing
biofeedback
NMES to antagonist
Restorative interventions
Encourage flexible strategies
provide appropriate sensory stimulation
use principles of neuroplasticity
Adaptive/Compensatory Interventions
modifying the environment or task as needed to address deficits
Strategies for unilateral spatial neglect
more adaptive and compensatory strategies
approach from R side to decrease frustration, increase appropriate response, ensure safety
Strategies to Maximize Communication with pts with aphasia
attention
timing
message content
Attention strategies
use alerting signals
avoid dual tasks
speak face to face
increase message saliency
clarify message
Timing strategies
slow rate of speech
interstimulus pauses
give more time
narrow down context
Message Content strategies
decrease syntactic complexity
short message length
direct wording
increase redundancy
General Intervention for pusher
assist the pt in realizing their misperceptions of upright vertical posture
provide the pt with multiple opportunities to see if current posture is oriented to upright
provide the pt with multiple opportunities to practice while performing functional tasks
For UE pusher
place patient’s intact arm on higher surface
engage patient in reaching activity with intact arm
For LE pusher
block the intact leg from migrating into abd and ext
place the intact leg on stool or cross it over the hemiplegic leg to decrease pushing and increase WB on hemiplegic side
Rescue positions for pushers
lie patient back in supine
have pt lean onto intact arm with shoulder in abduction to decrease pushing for 30-60s
