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6 Neurological Dysfunction > L10 Stroke Treatment > Flashcards

L10 Stroke Treatment Flashcards

1
Q

NIH Stroke Scale

A

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

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2
Q

Predictive Validity/Meaning of NIH Stroke Scale

A

<5 = 80% will be d/c home
6-13 = require acute IPR
>14 = require LTC

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3
Q

Score Range of NIH Stroke Scale

A

from 0-42, higher scores indicate greater severity of stroke

Very severe >25
Severe = 15-24
Mild to MOd = 5-14
Mild = 1-4

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4
Q

Common medications prescribed to stroke victims

A

HR, BP, a-fib

anti-clotting (either to dissolve or prevent)

meds to control other comorbidities

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5
Q

Contraindications for PT after stroke

A
  1. elevated intracranial pressure
  2. DVT or pulmonary embolism that has not been treated
  3. acute changes in neuro states
  4. new myocardial infarction
  5. new and/or active brain bleeding that requires tx
  6. unstable vital signs
  7. high intensity mobility within 24 hrs of stroke
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6
Q

Prognostic Factors

A

Pathoanatomical Factors
Psychosocial Factors

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7
Q

Pathoanatomical prognostic factors

A

time to treatment (most important)

areas of brain affected, especially frontal lobe or ones that impact memory/language

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8
Q

Psychosocial prognostic factors

A

depression due to loss of function
decreased caregiver supprot
decreased resources

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9
Q

CPR to predict ability to ambulate after stroke

A

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

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10
Q

Biomechanical Specificty

A

biomechanical nature of a task similar to other tasks

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11
Q

Information processing

A

performing a task without distraction vs dual task performance

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12
Q

Is knowledge of results or knowledge of performance better?

A

knowledge of results is a better feedback mechanism

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13
Q

Active ingredients of motor learning

A

errors
feedback
practice

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14
Q

Practice variables

A

intensity, distribution
specificity
manual guidance/assistance
observational learning
mental imagery
adaptive practice

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15
Q

Myths for Intervention Progression

A
  1. single joint movements should be mastered before multi joint
  2. stability should come before mobility
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16
Q

Truths for Intervention progression

A
  1. Specificity of practice needs to match specificity of task
  2. Tasks that require mobility and stability both should be learned concurrently
  3. Part to whole task is not always appropriate
  4. Different tasks types are not necessarily easier or more difficult, they are different
17
Q

Neurofacilitation Techniques

A

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

18
Q

Overflow

A

use stronger manual resistance to a stronger muscle to facilitate a muscle contraction in a weaker muscle within same synergistic movement in contralateral extremity

19
Q

NMES

A

to peripheral nerves facilitate muscle contraction, improve muscle strength, improve joint alignment and prevent disuse atrophy

helps prevent shoulder subluxation after stroke

20
Q

CPG for use of AFO and FES stimulation SHOULD

A

provide AFO and FES to improve gait speed, balance, WOL, muscle activation, endurance

21
Q

CPG for use of AFO and FES stimulation SHOULD NOT

A

provide AFO/FES to improve tone or spasticity

MAY be used to improve gait kinematics

22
Q

Synergy

A

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

23
Q

Impact of hypertonicity on funciton

A

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

24
Q

Functional Strengthening for UMN Pathology

A

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

25
Q

Medications for Hypertonicity and Spasticity

A

often coupled with PT

meds will act systemically, which causes pt with decreased force generation of all muscles

26
Q

Positioning and Handling…

A

these techniques have not been systematically studied for effectiveness in changing functional outcome

27
Q

Examples of handling and physical inhibition

A

deep sustained pressure
sustained long axis jt traction
rhythmic rotation
sustained stretch
warm or cold icing
biofeedback
NMES to antagonist

28
Q

Restorative interventions

A

Encourage flexible strategies
provide appropriate sensory stimulation
use principles of neuroplasticity

29
Q

Adaptive/Compensatory Interventions

A

modifying the environment or task as needed to address deficits

30
Q

Strategies for unilateral spatial neglect

A

more adaptive and compensatory strategies

approach from R side to decrease frustration, increase appropriate response, ensure safety

31
Q

Strategies to Maximize Communication with pts with aphasia

A

attention
timing
message content

32
Q

Attention strategies

A

use alerting signals
avoid dual tasks
speak face to face
increase message saliency
clarify message

33
Q

Timing strategies

A

slow rate of speech
interstimulus pauses
give more time
narrow down context

34
Q

Message Content strategies

A

decrease syntactic complexity
short message length
direct wording
increase redundancy

35
Q

General Intervention for pusher

A

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

36
Q

For UE pusher

A

place patient’s intact arm on higher surface

engage patient in reaching activity with intact arm

37
Q

For LE pusher

A

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

38
Q

Rescue positions for pushers

A

lie patient back in supine

have pt lean onto intact arm with shoulder in abduction to decrease pushing for 30-60s

6 Neurological Dysfunction (16 decks)

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