Lab: CHEDOKE

Question 1

The Chedoke Assessment (CMSA) can be used the day after a stroke (T/F).

Answer 1

False - the CMSA has not been validated for use earlier than one week post stroke

Question 2

The assessment should ideally be completed within __ days in case the patient’s abilities change.

Answer 2

2 days

Question 3

The start of shoulder pain assessment begins with an assessment of the prognostic indicators. Name all three.

Answer 3

(1) arm is in Stage 1 or 2
(2) scapula is elevated, depressed, protracted or retracted (misaligned).
(3) shoulder cannot reach past 90 in flex or abduction, or past 60 in ER.

Question 4

At which stage of shoulder pain do the prognostic indicators become very relevant?

Answer 4

Stage 6 - it prevents the patient from being in stage 7 despite no pain.

For reference: Stage 1 and 2 are pain on the whole hemi side, 3 & 4 are only in the shoulder, 5 is pain but not affecting ADLs, 6 no pain but at least one prognostic indicator, 7 is normal.

Question 5

What does stage 1 indicate?

Answer 5

flaccid, no reflexes, no voluntary movement.

Question 6

Describe stage 2

Answer 6

no voluntary movement, but spasticity is felt with passive movement and facilitory stimuli can elicit reflex movements in flexion and extension synergy patterns. Facilitory stimuli can include associated reactions by moving good limb.

Question 7

Describe stage 3

Answer 7

marked spasticity, voluntary movement but only in flexor and extensor synergies. One synergy usually dominates per limb, with strong and weak components within each one.

Question 8

describe stage 4

Answer 8

spasticity is decreasing, can move from weak to strong synergy but difficult to move it back. Simple movements out of synergy possible if prime movers are strong in other synergy?

Question 9

describe stage 5

Answer 9

spasticity is only felt with rapid movement or at extremes of range, can move from strong to weak now. Most movement is environmentally specific, but movement not in flexor or extensor synergies (ie thumb extension) is not in full range yet.

Question 10

describe stage 6

Answer 10

near normal, no more spasticity, lots of environmentally specific patterns now possible, rapid or complex movements still not performed well.

Question 11

when can an assessment task be performed more than twice?

Answer 11

if the patient did not understand the instructions