Lecture 6: Stroke Rehab

Question 1

What is typical recovery for ischemic stroke?

Answer 1

rapid in first month, typically steady for 3 months, functional status after 6 months usually constant

Question 2

What is typical recovery for hemorrhagic stroke?

Answer 2

slow initial rate of recovery followed by rapid rate 6 months post

survivors usually have less long term disability and better functional outcomes

Question 3

What is prognosis for CVA recovery?

Answer 3

70% regain functional independence, 10 % completely recover,

poor prognosis if no motor return 4 weeks post stroke

Question 4

What is PT goal for post stroke in acute care?

Answer 4

pt education, prevent 2ndary complications, positioning, assess functional abilities, early mobilizations

Question 5

What is average acute care stay after CVA?

Answer 5

5 days

Question 6

What are goals of subacute PT after stroke?

Answer 6

maximize functional status and independence , can they return to home? work? community?

provide adaptive equipment gif necessary

Question 7

What are goals for PT in chronic phase post stroke?

Answer 7

6 months and beyond, home care, community rehab, outpatient, home exercise program

Question 8

What is the NDT method of rehab?

Answer 8

reflexes work through development

Question 9

What contemporary method of stroke rehab?

Answer 9

evidence based concepts of motor control and neuroplasticity

functional movement re-education, neuromuscular re-ed

Question 10

What is step 1 in the stroke rehab process?

Answer 10

task analysis of movements

Question 11

What is step 2 and 3 of stroke rehab?

Answer 11

2. part practice- practice missing components

3. practice whole task

Question 12

What are examples of task that relate to activity on ICF model?

Answer 12

UE reaching, gripping, placing

bed mobility, sitting to stand balance activities, transfer practice, ambulation, stairs

Question 13

What is important to remember in step 3 of stroke rehab?

Answer 13

re-evaluate often, variability of practice, repetition without repetition, encourage problem solving

Question 14

What is step 4 of stroke rehab?

Answer 14

transfer of training

Question 15

What are primary UE stroke impairments?

Answer 15

impaired motor control, muscle tone, sensation, neglect

2nd- weakness, subluxation, ROM

Question 16

What is important about positioning in bed for UE?

Answer 16

pt should always be able to see limb and shoulder its always in neutral positions

Question 17

Why is it so important to monitor shoulder jt integrity?

Answer 17

shoulder subluxations are very common (inferiorly), due to weakness, hypo tone, surrounding GH joint and gravitational pull leads to downward rotation of scap and glenoid fossa

Question 18

What are FES guidelines for prevention of subluxation post stroke?

Answer 18

pads: supraspinatus and posterior and middle deltoids

pulse frequency: 1-45 hz

pulse duration- 300-350 us, 15 sec on/off, 2-3 second ramp/up down

-5-60 mins, 2-4 times a day….

Question 19

What period in rehab has FES shown to be most successful for subluxation prevention?

Answer 19

subacute, after 6 weeks or more of tx

Question 20

Why should a PT be cautious with a sling?

Answer 20

promotes flexor synergy, alters COM which can affect balance, can lead to muscle shortenings or contractures, and promote learned disuse of affected hand

Question 21

What percentage of pts experience hemiplegic shoulder pain?

Answer 21

38-84% from subluxation, impingement syndrome, frozen shoulder, complex regional pain syndrome