Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTY3140 > L14-15: Functional recovery post ABI - linking impairments to observation and treatment evidence > Flashcards

L14-15: Functional recovery post ABI - linking impairments to observation and treatment evidence Flashcards

1
Q

What are 3 treatment techniques for the facilitation of muscle activity of key muscles for gait post stroke?

A
  1. Activation of paralysed muscles
  2. Developing selective control
  3. Strengthening through motor unit recruitment optimising timings and speed with quality

Having tone is better than being flaccid (has some output –> just need to refine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 5 treatment techniques post stroke?

A
  1. Elimination of gravity / eccentric /misometric
  2. Early weight bearing!!!!
  3. Supported / unsupported
  4. Sensorimotor stimulation (early weight shift & weight bearing)
    • Using the limb in the way that is was designed for
  5. Electical stimulation ( strength, length & connective tissue build-up + enables correct practice)
  6. Biofeedback
    • Tactile (best)
    • Visual (mirrors)
    • Auditory (cuing, beep, physio, patient)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 7 areas to work on in treatment post stroke?

A
  1. Muscle strengthening (resistance, repetitions, functional)
  2. Increase range of motion (muscle length and joint)
    • Prevent sedentary adaptions
  3. Balance re-education (lateral & anteroposterior stability)
    • How they control shifts of the body?
  4. Context-specificity (speed, length & synergy of contractions)
  5. Practice (correct & successful tasks)
  6. Somato-sensory stimulation
  7. Perceptual problems (pusher, neglect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 5 considerations when choosing the best exercise when treating the impairments post stroke?

A
  1. What is your goal (Think of a movement goal (while it is for a functional task))
  2. Is the patient doing it correctly
  3. Target calf muscles**
  4. Consider the range of motion, type of contraction and speed required for walking
  5. Closed chain vs open chain (Esp. upper limb) – how this can change the type of contraction, the quality and the feedback.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 7 conditions` when preventing secondary complications post stroke?

A
  1. Learned non-use and habitual abnormal patterns
  2. Over activity of unaffected side
  3. Muscle length (Plantar flexors and hip flexors)
  4. Muscle stiffness
  5. Shortening of tendons and connective tissues
  6. Joint contractures- Becomes stiff –> hard to reverse these complications
  7. Secondary muscle weakness
  8. Compensatory strategies
  9. General deconditioning (unfit)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 5 considerations of functional demands post stroke?

A
  1. Speed of movement
    1. Just make it a bit more challenging once patient has relatively good quality
  2. Intersegmental interactions, influence of two joint muscles
  3. Range of movement required at joint
  4. Type of muscle contractions and movement range
  5. Somatosensory integration strategies used by the brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 3 critical muscle groups for gait?

A
  1. Hip, knee and ankle extensors
  2. Hip, knee flexors, dorsiflexors
  3. Hip abductors

When? Phases of gait cycle, how are they working? What range of movement? Joint movement? Intersegmental alignments? Speed of movement? Sensory integration used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the problem solving approach of treatment post stroke?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 3 characteristics of stance to support the hip and knee extension?

A
  1. Manually
  2. Othoses, E.g AFO support
  3. Tape
  • Role of compensation /adaption while optimising neuro-restoration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 2 considerations for imporving swing?

A
  1. Set up from stance
  2. Generation capacity

Need to start activating gastrocs for initial swing (otherwise they lift leg rather than push off)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 4 characteristics of swing?

A
  1. Manually- Bend knee, heels up, toes down
  2. Stepping onto blocks/ over obstacles
  3. AFO for dorsiflexion
  4. FES - Bioness

Role of compensation / adaption while optimising neuro-restoration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the swing phase for part practice?

A

For stairs

  • More flexion in knee (heel to bottom –> then –> hip flexion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are ways to modify activities to achieve desired results?

A

Know how you are going to make the tasks/ practice easier and harder

Make it more challenging/progression:

  • Increase speed (follow external cues)
  • Obstacle course
  • Increase height of stairs

Regression:

  1. Add more enhancement or replacement
  2. More support
    3.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 3 ways to varying directions for gait?

A
  1. Walking sideways
  2. Backwards
  3. Obstacle course

Left hemi –> Side walking

  • Need more refinement (add enhancement –> tactile or external (eg. wall))
  • Leading with hip flexors
  • Toes facing forward
  • Glute med and max –> concentric (leading) or eccentric (accepting)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is one type of verbal cueing?

A

Use of voice

  • Better outcome when you give patient concrete target (rather than “just do you best”)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 2 types of visual cueing?

A
  1. Step length
  2. Cadence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 5 characteristics of task specific practice for stepping?

A
  1. Visual feedback
  2. Appropriate and timely verbal feedback
  3. Tactile cueing / facilitation
  4. Concrete goals
  5. Practice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is sometimes a problem with slow gait speed?

A

Sometimes some biomechanics will be lacking due to slow speed (might improve with speed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 4 characteristics when practicing walking in the problem-solving approach to gait retraining?

A
  1. Link steps to full gait cycle
  2. First step with unaffected leg
  3. All treatment components
    • treating the impairments
    • Consider range and speed of use
    • Practicing the missing components
    • Practice walking
  4. All can be done in one session
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 4 treatment components in the problem-solving approach to gait retraining?

A
  1. treating the impairments
  2. Consider range and speed of use
  3. Practicing the missing components
  4. Practice walking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What leg do you need to start with for gait? Why?

A
  • Always start and step forward with the unaffected leg.
  • Know whether affected leg can take the weight (if need more facilitation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the mechanisms for treadmill training?

A

Biomechanical stimulus (central pattern generators)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is eliminated when walking on an electric treadmill?

A

Gives propulsion (rather then getting gastrocs to propel their own body)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 11 advantages of treadmill training for gait?

A
  1. Early and late rehabilitation use
  2. Any neurological condition
  3. Increase speed (pace & stride length)
  4. Sensory feedback
  5. Forced use
  6. Stretch to hip and plantar flexors
  7. Allows earlier, safe gait retraining
  8. Allows more practice – longer distances walked
    • (due to less propulsion of gastrocs needed)
  9. Allows for less us of upper limbs for balance/support
  10. Improved cardiovascular fitness & endurance
  11. Need sitting balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are 5 disadvantages of treadmill training for gait?

A
  1. Externally paced
  2. Reduced need for push off phase
  3. Shortens step length
  4. Clients tend to increase cadence over step length
  5. Non- variable to fatigue, pain, clients current state
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are 6 characteristics of body weight support systems?

A
  1. Use the minimum body weight support required to achieve normalised gait kinematics
  2. Reduce body weight support as gait improves
  3. Maximum 30% BWS at any time
  4. Reduce arm support
  5. Use in overground walking
  6. Excellent efficacy for improving gait and community walking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

_____ and _____ of gait are very important to translate to normal function in community

A

Dose; speed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are 3 conditions were treadmill walking is effective?

A
  1. Acute stroke
  2. Chronic stroke – community dwelling
  3. Stroke patients who have plateued
  4. May not be better than walking outdoors (indep) in
  5. chronic strokes, yet improvements if training assisted O/D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are 4 aids to achieve functional goals for practicing walking?

A
  1. Wheelchair
  2. Home modifications
  3. Walking aids
  4. Orthosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are 4 reasons for using a wheelchair?

A
  1. To improve community accessibility
  2. To moderate fatigue
  3. To allow independent living
  4. Decrease risk of falls
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When are manual wheelchairs a good idea and when are they not?

A

Manual wheelchairs –> good for CV fitness but can be very tiring for long term (might not be realistic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are things that walking aids include?

A
  1. Parallel bars
  2. All types of sticks: single, quad, crutches, wheeled walkers, pick up frame (hopper), elbow support frame, light gait system, assistance

Do not give quad stick

33
Q

What are 4 consequences for walking aids?

A
  1. Unload weight-bearing of lower limbs/ increase muscle activity and support of upper-limbs
  2. May reduce speed
  3. Increases energy consumption
  4. Alter biomechanics
34
Q

4-point sticks _____ (rarely/very) advantageous

A

rarely

  • Do not prescribe
35
Q

Single stick may increase _____, _______ and _______.

A

step / stride length and reduce base of width & cadence

36
Q

Pick-up frame limits stride, stops/ start gait. What is the problem with it though?

A

Hemiplegics will find it hard to pick up

37
Q

______ requires less balance, with potential for better gait pattern

A

Wheeled walker

38
Q

______ may encourage non-use

A

Parallel bars

39
Q

What are 3 considerations of orthoses?

A
  1. Consider the biomechanical effects on other structures
  2. Negative effect of learned non-use
  3. AFO’s can improve toe clearance, speed, gait pattern and efficiency, however can reduce calf muscle power and flexibility

Limits muscle activation and increase energy output

40
Q

What are 6 considerations in the prescription of orthoses?

A
  1. Understand biomechanical gait defect
  2. Understand contribution of active and passive soft tissue components
  3. Fits correctly (allows wanted movement and restricts unwanted movement)
  4. Improves the performance of the functional task
  5. May be used early in rehabilitation to augment gait pattern, however negative impacts need to be managed, with active treatment.
  6. Overall goals should be full muscle activation and control
41
Q

What is the effect of bioness (before and after)?

A
42
Q

What is electrical stimulation used for?

A

Electrical stimulation adjunct therapy not

stand alone….

  • Used to improve performance of muscle contraction in isolation or during walking
  • Functional Electrical stimulation
43
Q

What does the choice of technique in manual assistance (therapeutic handling) depend on?

A

Choice of technique depends on many factors including size/shape of patient/therapist, impairments including cognition, aims of task etc…

44
Q

What are 4 characteristics of starting early in the delivery of service for gait retraining?

A
  1. Prevent secondary complications/adaptations
  2. Potential for brain reorganisation
  3. Gait before standing balance
  4. Early weight bearing

First 4 weeks (??) –> next 3 months after best time for improvement

45
Q

What are the 3 characteristics in the delivery of service?

A
  1. Feedback
    • Timing of functional task or counting maximum repetitions
  2. Enriched environment
    • Motivation
    • Attention
    • Specificity of practice
  3. Education
46
Q

What are 10 types of Retraining functional activities?

A
  1. Walking:
  2. Speed
  3. Environments
  4. Surfaces
  5. Stairs
  6. Starts, stops, turns
  7. Running
  8. Attention
  9. Vision
  10. Vestibular
    • Drives better motor control recovery
    • Cerebellar turns on –> refines movement
    • Train vestibular with vision and attention
47
Q

What are 6 features of maximising skills in retraining gait?

A
  1. Increase complexity of task- Add dual task (eg. scanning)
  2. Sideways, backwards,
  3. High level
  4. Practice ++++
  5. Indoors, outdoors, grass, rocks, kerbs
  6. Turning, talking, carrying things

Progress task to functional real world activities quickly

48
Q

Why should slopes be trained in the clinic?

A

High shear forces on slopes and ramps increasing risk of slips

Should train this in clinic –> has a big difference compared to on flat ground

49
Q

What are 2 characteristics of going up in slopes?

A
  1. Reduced speed, cadence and step length
  2. Increased hip and knee flexion during late stance and early swing
50
Q

What are 3 characteristics of going down in slopes?

A
  1. Reduced step length
  2. Increased knee flexion in stance
  3. Increased flexion at ankle and hip during swing
51
Q

What are 4 characteristics of obstacles and kerbs?

A
  1. Preparation begins a long way back
  2. Little if any loss of speed
  3. Modifications to gait
    • include changes to foot clearance, step length, step time, gait speed
  4. Clear the lead leg and the trail leg

Helps with knee flexion by place object in their path (obstacle course)

52
Q

What are 2 characteristics of stairs?

A
  1. Greater demands on balance
  2. Greater movement, increased intensity muscle force, increased, joint forces
53
Q

What are 2 characteristics of going up stairs?

A
  1. forward movement of the body at ankle (DF)
  2. Increased extensor force to push up; concentric muscles
54
Q

What is a characteristic of going down stairs?

A

mass kept behind over supporting leg; eccentric muscles (quads)

  • Let yourself fall forward on toes and then drive forward
55
Q

What does uneven surfaces look like?

A

Need to train patient to adjust cadence length to clear objects

56
Q

What is an example of dual practice in gait?

A

Target box to control ball (must keep ball in this area)

  • Weight shift (step forward, back)
57
Q

What are 5 final considerations for gait retraining?

A
  1. Would the patient be better off using a wheelchair for mobility?
  2. How far does the person need to or want to be able to walk?
  3. Does the patient have the cognitive ability to walk independently?
  4. Is the condition stable or deteriorating?
  5. Sometimes you have to teach or allow compensatory strategies eg scanning to compensate for visual field deficit, looking at feet to compensate for somatosensory loss, allow wide base for poor balance
58
Q

What are the 3 roles of endurance training?

A
  1. Maximal exercise capacity reduces with age but improvements with training have been shown in the elderly
    • Severely deconditioned –> can be very quick to get deconditioned
  2. Detraining occurs rapidly when a person ceases or markedly reduces activity levels (Reversibility Principle)
  3. Following a neurological event, cardiorespiratory fitness may be so low that training may show > average improvement
59
Q

Cardiorespiratory Fitness decline occurs within first _____ weeks after stroke

A

6

60
Q

What are 5 things that fitness training (CV training) can do?

A
  1. Minimise secondary effects on muscle fibre transformation by enhancing motor unit recruitment and favouring formation of high oxidative fibres
  2. Increase exercise tolerance
  3. Reduce risk of further cardiovascular complications
  4. Improve functional abilities
  5. Improve general health and well-being

Need to investigate risk factors for each patient to establish testing protocols

61
Q

What is the aim for pre- exercise testing?

A
  1. Oxygen uptake is gold standard
  2. Alternative - establish a baseline value (eg. walking distance, HR response to a particular workload) and use the same test to compare over time
  3. Aiming to reach a target heart rate zone with any possible exercise modality (eg. sit to stand, step ups, cycling, walking) may be more practical
62
Q

Why is HR sometimes not a good baseline for pre-exercise testing? What do you use instead?

A

Careful with HR as some conditions will not increase due to medication

  • Use Borg’s instead (RPE)
  • Use functional movement to drive CV output
63
Q

What are 2 characteristics of exercise prescription?

A
  1. Aerobic exercise needs to be individualised to improve fitness
  2. Exercise prescription includes appropriate mode(s), intensity, duration and progression of physical activity
64
Q

What are the FITT principles for exercise prescription?

A
  • Mode: large muscle groups for prolonged periods; consider safety and compliance
  • Duration: 20-60 minutes; little as 5 mins to start
  • Intensity: 40%-60% HRR; RPE 11-14
  • Frequency: 3-5 times per week
65
Q

What are 4 characteristics of program maintenance?

A
  1. Realistic expectations - correct if overly optimistic or pessimistic
  2. Inform individuals of the length of training required to achieve cardiorespiratory fitness
  3. Start low and progress slowly
  4. Make exercise a routine activity - a routine time and place for exercise provides a stimulus

Eg. even sit to stand for 1 min (with speed) –> good for CV fitness

66
Q

What are 4 tips for program maintenance for gait retraining?

A
  1. Home program is needed and should be monitored (eg. HR, RPE, walking distance)
  2. Social support from the outset
  3. Establish good exercise habits in hospital that can be continued into the community
  4. Exercise partner/ exercise group may be useful
67
Q

Endurance training should be incorporated as part of an overall physical activity program designed to maintain or improve___, ____ and ____ of the elderly

A

function, wellbeing; independence

68
Q

What are 6 common deficits in movement control?

A
  1. Reduced weight loading to weaker side
  2. Feet uneven alignment
  3. Reduced forward knee translation
  4. Quick extension of knee post thighs off
  5. Reduced hip extension in final standing alignment
  6. Hip retraction and knee hyperextension on weaker side.
69
Q

What are the degrees of movement for the hip, knee and ankle for sit to stand- weight shift (pre-thighs off)?

EXAM QUESTION

A
  1. Hip flexion (ant pelvic tilt) 80-120 degrees
    1. Weak concentric hip flexors / ecc hip extensors / overactive hip extensors
  2. Knee flexion 90/100 – 120 degrees
    • Weak concentric hamstrings / ecc quads / overactive quads.
  3. Ankle dorsiflexion neutral/+5 to 10 degrees
    • Weak concentric DF / ecc PF / overactive - tight PF (soleus)
70
Q

What are the degrees of movement for the hip, knee and ankle for sit to stand (thighs off)?

EXAM QUESTION

A
  1. Hip extension from 120 to neutral
    • Weak concentric hip extensors / ecc hip flexors / overactive - tight hip flexors (end range)
  2. Knee extension 120 – just off full extension
    • Weak concentric knee extensors / flexors eccentrically /overactive knee flexors - tight post capsul knee (end range)
  3. Ankle platarflexion 10 degrees DF to neutral
    • Weak plantar flexors concentrically / DF eccentrically overactive DF.
  4. Knee hyper-extension
    • Weak concentric knee extensors / flexors eccentrically /overactive knee extensors – overactive / short tricep surae
71
Q

What are 2 temporal features of STS (other considerations)?

A
  1. Slow when assisted
  2. Assisted to independent
    • Normalise joint movements but not symmetry
    • Still slower to achieve movement
    • Fatigue easily
    • Unable to transfer to variable instance of STS/Stand to Sit
  • Need to get hands off now –> less handling
  • So they can get normal controls, and allow them to learn
  • Become more independent
72
Q

What are the 3 evidence for STS?

A
  1. ***Task specific training – encouraging symmetry – loading improves symmetry of WS in sitting and STS symmetry / capacity (Dean et al……..).
  2. Use of preferential loading to drive weight bearing and muscle activity (Kim K et al 15)
  3. ***Preferential / forced loading improves symetry and balance in chronic stroke
  4. **Progressive strength training improves STS but not walking as measured by TUG
73
Q

What are 5 ways to improve STS in progressions?

A
  1. Reduce rest
  2. Increase load
  3. More reps (more endurance but still muscle to fatigue)
  4. Increase speed (more power)
  5. Change task (add task –> punch, or alter - hover, unable to sit down, have to lower in squat position)
74
Q

What is important for symmetry in the pre-thighs off stage?

A

Symmetry –> need to get this in the pre-thighs off stage

  • Muscle timing activation
  • Kinematic links

Try to make them unload unaffected leg so they have to use affected leg

75
Q

What are the 4 key goals for STS?

A
  1. Effect of interventions that alter the starting posture
    • Chair height
    • Foot position – Britton et al 08
    • Hand rest
  2. Determine intervention aimed to improve symmetry of WB
    • Reaching
    • Biofeedback
  3. Determine intervention aim to improve lateral movement of COP during STS
76
Q

What are 6 key take home messages of standing up symmetry to drive motor activation?

A
  1. Use reaching beyond arm length to affected side
    • Alter distance; speed of movement; object being reached for; hold of reach; repetitions
  2. Use biofeedback – auditory, visual, pressure,
  3. Alter height of seat
    • Lower more challenging
    • Progress into task specificity training
  4. Alter foot position
  5. Use weight shift in standing
  6. Dose minimum – 3-5 times per week up to 60 minutes each session – 3-4 weeks of training minimum.
77
Q

What are 6 characteristics of stepping- weight bearing in symmetry?

A
  1. Start early- If medically stable
  2. Support the hip and knee if required (WB)
  3. Target the patient’s particular needs as to part of function – Early stance, Late stance – optimise multi joint control as required
  4. Include mediolateral direction (Task Specific)
    • Reaching and standing –> different feet positions and different reach positions (up, down, behind)
  5. Suitable level for patient (able to do correctly but not too easy)
  6. Consider adding cues or concrete targets for optimal performance… pathological influences
78
Q

What are 2 treatment options for gait retraining?

A
  1. Quality movement required
  2. Use multiple methods to engage quality and longevity
    • Load
    • Constrain
    • Force
    • Repeat

PHTY3140 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions