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PHTY3140 > L6: Physiotherapy management of movement and impairment abnormalities following stroke > Flashcards

L6: Physiotherapy management of movement and impairment abnormalities following stroke Flashcards

1
Q

What are 15 factors influencing outcome following a stroke?

A
  1. site, extent and nature of the lesion
  2. effectiveness of collateral circulation
    • chance of survival after CVA decreases with size of lesion
  3. prolonged unconsciousness
    1. chance of survival decreases with prolonged unconsciousness
  4. pre-morbid status
    • negative effect of co-existing disease
  5. age
    • negative effect of older age (Do not learn as fast when we age)
    • probably reflects influence of plasticity and co-existing conditions
  6. motivation and attitude of the patient towards recovery
    • negative effect of poor motivation
      • One study found advising the patient of the positive outcomes to recovery improved recovery!
  7. cognitive ability
    • negative effect of cognitive deficits
    • decreased ability to concentrate/ learn
  8. time interval from onset of CVA to commencement of treatment/ admission to rehabilitation unit
  9. positive effect of early ambulation
    • AVERT: A very early rehabilitation trail for stroke
  10. social support
  11. financial support
  12. initial level of motor dysfunction
    • timing / achievement of sitting balance - indicator of functional independence
    • Walking speed at discharge predicted by MAS Item 2 (lie to sit) and walking speed on admission
  13. time interval between paralysis and return of movement severe perceptual dysfunction
  14. urinary incontinence
  15. response to rehabilitation
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2
Q

First ______ months critical period with greatest recovery thought to occur here (neuroplasticity)

A

3-6

  • 4-6 weeks for the brain swelling to go down
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3
Q

What are 3 cases where physiotherapy rehabilitation should commence?

A
  1. if no progression of neurological deficits
  2. if patient is medically stable
  3. usually within 24-48 hours
  • SP –> first contact to check swallowing
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4
Q

Where do physiotherapists come into contact with clients with stroke?

A
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5
Q

What is the evidence for physiotherapy following a stroke?

A
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6
Q

Physiotherapy has been found to improve ______ function following stroke

A

sensorimotor

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7
Q

Early intervention is better than late following a _____. Even_____

A

stroke; late

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8
Q

What is ORDER movement elicitation?

A
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9
Q

What are 2 things that physiotherapists base their treatment on?

A
  1. single approach
  2. mixture of components from a number of different approachesa
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10
Q

There ______ (was/was not) significant evidence that any single approach had a better outcome than any other single approach or no treatment control

A

was not

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11
Q

What are the 3 features of Developing a Physiotherapy Management Program?

A
  1. Basic principles to deal with common problems poststroke
  2. Time management essential
  3. Must incorporate all areas of dysfunction and a range of functional activities
  • At the very end, must try again to do functional task (even after they have successful achieved small parts/components
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12
Q

What is the rehabilitation cycle following a stroke?

A
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13
Q

What are the 3 components of recovering quality movements following a stroke?

A
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14
Q

What are 5 features that will be managed with physiotherapy following a stroke when preventing and managing secondary impairments?

A
  1. Pain
  2. Joint stiffness
  3. Neural length changes
  4. Muscles length changes
  5. Disuse weakness
  • Failure will inhibit return of normal movement
  • “Drive your own recovery”
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15
Q

What are 5 key aspects of the physiotherapy management program (every treatment session) following a stroke?

A
  1. Prevent and manage secondary abnormalities
  2. Elicit selective movement recovery
  3. Retrain movement and increase “strength” in context of functional tasks – isolation and functionally
  4. Address all stroke-related primary impairments
    • Direct management
    • Modified delivery of task-oriented training
  5. Re-develop optimal musculoskeletal and cardiorespiratory endurance
  • Have them in positions where the muscle can elongate
  • Active movement is always better than passive movement
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16
Q

What is a feature that will be managed with physiotherapy following a stroke when eliciting selective movement recovery?

A

Prioritise Methods of eliciting quality muscle activity

  • Elicit muscle activity in upper limb, lower limb and trunk
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17
Q

What are 5 features that will be managed with physiotherapy following a stroke when retraining movement in context of functional tasks?

A
  1. Improve control of movement
  2. Increase muscle strength required for task
  3. Train muscle activation specificity
    • Power
    • Endurance
    • Fractional contral
  4. Repetitive practice with feedback
  5. Must incorporate all relevant functional activities
    • Eg. training DF ballistically for walking as in walking ankle DF very quickly
  6. There is now considerable high level evidence for the effectiveness of a task-oriented training approach post stroke… As long as task movement is quality and dose based
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18
Q

What are 11 activities that will be managed with physiotherapy following a stroke when retraining movement in context of functional tasks?

A
  1. (Bed mobility tasks 1-5)
  2. Rolling
  3. Bridging
  4. Sitting up from
  5. Lying
  6. Lying down
  7. Sitting balance
  8. Sit to stand
  9. Stand to sit
  10. Standing balance
  11. Walking
  12. Higher level gait activities
  13. Preparation for walking (weight transfer and stepping)
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19
Q

What are 2 features that will be managed with physiotherapy following a stroke when addressing all stroke-related primary abnormalities?

A
  1. Direct management
    • Sensory retraining
    • Perceptual training e.g. strategies for management of Unilateral Neglect
    • Evidence sensory integration optimises recovery for longer outcomes
  2. Modified delivery of task-oriented training
    • Motor planning impairment
    • Perceptual impairment
    • Communication impairment
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20
Q

What are 3 features that will be managed with physiotherapy following a stroke when addressing all stroke-related primary abnormalities (Modified delivery of task-oriented training)?

A
  1. Motor planning impairment
  2. Perceptual impairment
  3. Communication impairment
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21
Q

What are 3 features that will be managed with physiotherapy following a stroke when addressing all stroke-related primary abnormalities (Direct management)?

A
  1. Sensory retraining
  2. Perceptual training e.g. strategies for management of Unilateral Neglect
  3. Evidence sensory integration optimises recovery for longer outcomes
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22
Q

What is a feature that will be managed with physiotherapy following a stroke when maintaining/improving cardiovascular fitness?

A

Functional aerobic capacity among persons with stroke is severely

compromised and may limit their full participation in community living

  • Cannot use heart rate as an objective measure
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23
Q

What are 2 clinical implications that will be managed with physiotherapy following a stroke when maintaining/improving cardiovascular fitness?

A
  1. There is good evidence to support the use of aerobic exercise to improve aerobic capacity in individuals with stroke
  2. The results can be generalized to those who are mildly or moderately impaired by stroke and who have relatively low risk of cardiaccomplications with exercise
24
Q

What are 2 ways to train endurance and CV responses ithat will be managed with physiotherapy following a stroke when maintaining/improving cardiovascular fitness?

A
  1. increasing number of repetitions of task / exercise
  2. increasing distance / time / speed of exercise e.g. walking
25
Q

What is the treatment technique selection influenced by following a stroke?

A

Combination of primary and secondary impairments the client present’s with

26
Q

What are 2 stages of recovery in the treatment technique selection following a stroke?

A
  1. endurance
  2. functional level
27
Q

What 3 factors will influence the treatment technique selection?

A
  1. priority of treatment items
  2. time spent on parts of the program
  3. Intensity required and achievable
28
Q

How do we increase the intensity of physiotherapy followinga stroke?

A

Circuits classes

  • Demonstrating benefits in the acute and chronic setting
29
Q

What are 5 factors that enhance a training environment following a stroke?

A
  1. Speed
  2. Objects
  3. Complexity of mvt
  4. Distractions
  5. Longevity of mvt
30
Q

What are 4 flexible approaches to communication methods following a stroke?

A
  1. Instruction
  2. Demonstration
  3. Cueing
  4. Feedback

Depending on the client’s impairments

31
Q

What are 5 uses of technical devices following a stroke?

A
  1. Treadmill
  2. Electrical stimulation
  3. EMG
  4. Positional biofeedback
  5. SMART ARM
32
Q

What are 2 characteristics in the prescription of orthoses following a stroke?

A
  1. Orthoses can be prescribed for temporary orpermanent use – substitution / compensation
  2. Use of orthoses to provide augmented somatosensory input will be discussed in eliciting movement recovery lecture
33
Q

What are 4 characteristics of ankle-foot orthoses (prescription of orthoses) following a stroke?

A
  1. It is common practice to use splints in the hemiplegic lower extremity in an attempt to improve gait quality
  2. AFO use has not been well studied in the hemiplegic lower extremity
  3. Effect on Gait:
    • AFOs might improve velocity, stride length, gait pattern and walking efficiency
    • In people who:
      • Can walk without an ankle-foot orthosis
      • Have dynamic or spastic foot drop
  4. Effect on muscle activity in the paretic lower limb:
    • Weak evidence and inconclusive
34
Q

What are 4 evidence to insuffienciently conclude whether slings and wheelchair attachments following a stroke?

A
  1. prevent subluxation
  2. decrease pain
  3. increase function
  4. or adversely increase contracture in the shoulder after stroke
  • Use FES scale
  • Flaccid shoulder = high risk of subluxation but does not get pain
35
Q

What are 4 evidence to suffienciently conclude strapping the shoulder following a stroke?

A
  1. delays the onset of pain
  2. does not decrease pain
  3. does not increase function
  4. Does not adversely increase contracture
36
Q

What are 3 characteristics in the prescription of walking aids following a stroke?

A
  1. Not introduced at all if independent gait predictable
  2. Was an aid used pre stroke?
  3. What if client is depressed or frustrated about their walking ability?
37
Q

What are 2 reasons for using the single stick as a prescription for walking aids following a stroke? Should 4 point stick be used?

A
  1. Balance and confidence
  2. Pre-discharge to community
  • 4 point stick – Never!!! – encourages asymmetry —- AVOID
38
Q

When are hopper and wheeled frames used following a stroke? Why?

A

rarely used

  • Need both arms to use this (not as possible)
39
Q

When are temporary wheelchairs used?

A
  1. Transit only ?
  2. For independent use by stroke patient ?
    • i.e. self propulsion
40
Q

What are 4 characteristics of temporary wheelchairs (self-propulsion)?

A
  1. standard backwheel drive
  2. must use sound arm and leg on one side of chair
  3. effortful and encourages abnormal patterning
  4. encourages non use of the affected side
41
Q

What are 2 characteristics of permanent wheelchairs?

A
  1. One arm drives
  2. Electric wheelchair
42
Q

What are 2 things to maximise when using a variety of training formats each day (ideal)?

A
  1. intensity of rehabilitation
  2. dose of rehabilitation / activity
43
Q

What are 3 types of training format following a stroke?

A
  1. Group training
  2. Individual sessions with the therapist
  3. Independent practice
44
Q

What are 3 features of group training following a stroke?

A
  1. balance
  2. mobility
  3. upper limb
45
Q

What are 2 features of independent practice following a stroke?

A
  1. Self monitored practice or
  2. Supervised practice
    • family
    • nursing staff
    • therapy assistant
46
Q

What are 3 features of location (training format) following a stroke?

A
  1. Therapy gym
  2. Dedicated ward areas
  3. Home
47
Q

What are 2 features of practice record (training format) following a stroke?

A
  1. Essential to record exact activities
  2. To improve and monitor compliance
48
Q

What are 2 features of setting up workstations (training format) following a stroke?

A
  1. in therapy gyms or allocated ward areas
  2. for independent practice or for work in pairs or circuit classes
49
Q

What are 3 features of carer training following a stroke?

A

Specific training for carers prior to discharge home from rehabilitation

  1. Physical handling techniques
  2. Ongoing prevention of secondary changes
  3. Education re other specific stroke-related problems
50
Q

What ar ethe 4 criteria defined for independnt community ambulation following a stroke?

A
  1. gait velocity 48 m/min
  2. endurance 500m
  3. locomotion domain of the FIM (score of 5)
  4. Functional Ambulation Classification (score of 6)

Recommend clinical practice should be modified to improve community ambulation outcomes for stroke patients

51
Q

_____ are common when people return home after stroke

A

Falls

  • In an Australian study 46% of stroke patients had a fall in the 6 months after discharge home
52
Q

It is important that the physiotherapist identifies and manages ____ risk factors in clients being discharged home

A

fall

  • Fear-avoidance behaviour
53
Q

Physiotherapists described clients as being _____, _____, _____ and ______ once discharged home

A

fatigued, frustrated, depressed, and scared

54
Q

What are 4 things that physios aim build in order to reach optimal independent functioning?

A
  1. Confidence
  2. Self-responsibility
  3. Problem-solving skills
  4. While ensuring patient safety
55
Q

What are 2 aims of therapy-based rehabilitation services at selected patients resident in the community after stroke?

A
  1. improve ability to undertake personal activities of daily living
  2. reduce risk of deterioration in ability

PHTY3140 (28 decks)

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