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PHTY3140 > L13: Management and prevention of adaptive changes > Flashcards

L13: Management and prevention of adaptive changes Flashcards

1
Q

What are 6 adaptive features in UMN syndrome?

A
  1. Musculoskeletal adaptations (bio-mechanical and physiological)
  2. Hypertonia - increased resistance to passive movement
  3. Decline in endurance and physical fitness
  4. Learned non-use
  5. Poor neuroplasticity adaptation
    • Can be beneficial or harmful (more or less functional)
  6. Extension of central dysfunction
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2
Q

What are 3 causes of poor movement recovery post UMN syndrome?

A
  1. Previously thought to be due to Positive features e.g. Spasticity
  2. Negative features e.g. weakness
  3. Adaptive features e.g. muscle shortening
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3
Q

What are 3 processes that occur with immobility and disuse?

A
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4
Q

What are 3 adaptive features here?

A
  1. Elbow
  2. Wrist
  3. Fingers
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5
Q

What is an adaptive feature here?

A

Shorter, flexed forward, internally rotated and scapula retracted (reinforce subluxed presentation)

SHOULDER

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6
Q

What are 8 musculoskeletal changes in UMN syndrome? What does this result in?

A
  1. Muscle and connective tissue stiffness
  2. Shortening and lengthening of muscles
  3. Change in the length tension curves
  4. Loss of joint range of motion.
  5. Loss or addition of sarcomeres
  6. Muscle atrophy / wasting
  7. Changes in muscle fibre type
  8. Changes in excitation contraction coupling

ALTERED JOINT BIOMECHANICS

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7
Q

What is the measurement between hypertonia and spasticity?

A
  1. Quantify overall resistance to passive stretch (Ashworth and Tardieu scales)
  2. Quantify EMG activity in response to stretch
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8
Q

What does the Ashworth scale measure?

A

grades resistance to passive movement during a passive muscle stretch. Does not discriminate spasticity vs hypertonia

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9
Q

What does the Tardieu measure?

A

assesses muscle reaction at different velocities

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10
Q

What are 4 research findings about hypertonia?

A
  1. Contracture produced an increase in muscle
  2. stiffness
  3. Contracture contributed to stiffness at slow speed, spasticity only at fast speed
  4. Hypertonia was associated with contracture but not with reflex-hyperexcitability in stroke patients 1 year post stroke
  5. Early moderate spasticity correlates with later development of contracture
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11
Q

What is the prevalence of shoulder pain post stroke? Why?

A
  • Prevalence up to 85% of patients post stroke
  • Consequence of a combination of adaptive and other features, as well as other factors.
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12
Q

Wat are 11 causes of shoulder pain post stroke?

A
  1. Hypertonia esp subscapularis and pectoralis muscles
  2. Weakness or poor shoulder/scapula control
  3. Glenohumeral subluxation
  4. Sustained hemiplegic posture
  5. Immobilisation -> loss of Sh ER and Abd
    • Caused by lack of ER (more correlated than subluxation –> unless pulled)
  6. Frozen or contracted shoulder changes in muscle, capsule / ligament length, adhesive capsulitis
  7. Shoulder-hand Syndrome (Reflex Sympathetic Dystrophy)
  8. Pre-existing injury or degenerative disease e.g. arthritis
  9. Poor manual handling
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13
Q

What is glenohumeral subluxation?

A
  1. A palpable gap between the acromion & humeral head.
  2. Change in the mechanical integrity of the GHJ
  3. Stretching of capsule and associate muscle
  4. can occur
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14
Q

How does a glenohumeral subluxation occur post stroke? Is there any way to prevent this?

A
  • Can occur in unsupported arms as early as 2 weeks post-stroke and is irreversible after 8 weeks
  • No evidence that it can be reduced prevention is therefore paramoun
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15
Q

What are 5 features of learned non-use?

A
  1. Unsuccessful attempts to use impaired arm and leg
  2. Learn to use unimpaired arm for functional tasks
  3. Learn to weight bear predominantly on unimpaired leg
  4. Learned non-use
  5. Residual capacity in affected hand and leg may be lost
  6. Reduction in cortical representation occurs
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16
Q

What is an adaptation of motor performance?

A

When the task is attempted, the movement patterns observed reflect the ‘best’ attempts for their current system

17
Q

What is an adaptation of motor performance caused by?

A

Repetitive movements, associated reactions, weakness, etc…

18
Q

What are 2 secondary complications post stroke?

A
  1. Fall rates are as high as 50% in communitydwelling stroke survivors
  2. Cardiovascular deconditioning occurs as a result of the immobility imposed early after stroke
19
Q

What are 3 features to anticipate and prevent strokes?

A
  1. Get active from Day 1 (Within 48 hrs not 24 hrs)
  2. Get people as active as possible as soon as possible
  3. Implement strategies to prevent 20 changes
20
Q

What are 3 things to do to prevent shoulder pain post stroke?

A
  1. Get active
  2. Support
  3. Flexibility
21
Q

What are 4 features to improve motor control (shoulder/scapular functional retraining) when preventing shoulder pain (get active)?

A
  1. Apply intramuscular stimulation in acute to subacute phase post stroke
  2. Facilitating motor activity
  3. Facilitated practice
  4. Goal directed, task oriented retraining
22
Q

What can be done to improve flexibility when preventing shoulder pain?

A

Stretches

23
Q

What can be done to improve support when preventing shoulder pain?

A
24
Q

What can be done to prevent non-use?

A

Involve the arm

25
Q

What can be done to prevent adaptive changes?

A

Flexibility habits

26
Q

What are 5 features of prolonged static positioning when preventing adaptive changes post stroke?

A
  1. Static prolonged stretches use when:
    • functional practice not possible
    • poor positions has caused changes
    • limitation in ability to participate actively e.g. reduced cognition, behavioural issues
  2. If patient is unable to free self from positioning, nearby assistance required should pain arises
  3. Some evidence demonstrates no benefits
  4. NSF 2010 - Stroke survivors at risk of or have developed contractures and undergoing comprehensive rehab … routine use of splints / prolonged positioning of muscles in lengthened position NOT recommended.
  5. Work actively is preferred
27
Q

What are 3 situations (when) is prolonged static stretches when preventing adaptive changes post stroke?

A
  1. functional practice not possible
  2. poor positions has caused changes
  3. limitation in ability to participate actively e.g. reduced cognition, behavioural issues
28
Q

What should be limited/ no effective of prolonged static positioning when preventing adaptive changes?

A

Resting splints: Limited evidence to show usefulness.

29
Q

What are 2 features of serial casting for prolonged static positioning when preventing adaptive changes post stroke?

A
  1. “the process of successively applying and removing corrective casts to increase extensibility in the soft tissues surrounding the casted joint’
  2. prevent loss of and/or to restore joint range or muscle extensibility in the presence of spasticity, associated reactions etc…
30
Q

What are 7 features of seating when preventing adaptive changes post stroke?

A
  1. Maximise function
  2. Reduce sustained postures
  3. Prevent pressure sores
  4. Maintain soft tissue length
  5. Reduce discomfort and noxious stimuli
  6. Reduce influence / development of spastic patterns
  7. Promote socialisation
31
Q

Meta-analysis noted benefits of fitness training to improve _____, ____ and _____. Only small

evidence for fitness training to improve _____ capacity

A

maximal workload; gait speed; walking distance aerobic

32
Q

What are 4 education features for stroke survivor, family, hospital and support staff?

A
  1. mobility level (to optimise activity)
  2. handling precautions E.g. for the upper limb
  3. level of functional independence
  4. ward program

PHTY3140 (28 decks)

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