Lecture 6: Stroke Rehab Flashcards
What is typical recovery for ischemic stroke?
rapid in first month, typically steady for 3 months, functional status after 6 months usually constant
What is typical recovery for hemorrhagic stroke?
slow initial rate of recovery followed by rapid rate 6 months post
survivors usually have less long term disability and better functional outcomes
What is prognosis for CVA recovery?
70% regain functional independence, 10 % completely recover,
poor prognosis if no motor return 4 weeks post stroke
What is PT goal for post stroke in acute care?
pt education, prevent 2ndary complications, positioning, assess functional abilities, early mobilizations
What is average acute care stay after CVA?
5 days
What are goals of subacute PT after stroke?
maximize functional status and independence , can they return to home? work? community?
provide adaptive equipment gif necessary
What are goals for PT in chronic phase post stroke?
6 months and beyond, home care, community rehab, outpatient, home exercise program
What is the NDT method of rehab?
reflexes work through development
What contemporary method of stroke rehab?
evidence based concepts of motor control and neuroplasticity
functional movement re-education, neuromuscular re-ed
What is step 1 in the stroke rehab process?
task analysis of movements
What is step 2 and 3 of stroke rehab?
- part practice- practice missing components
3. practice whole task
What are examples of task that relate to activity on ICF model?
UE reaching, gripping, placing
bed mobility, sitting to stand balance activities, transfer practice, ambulation, stairs
What is important to remember in step 3 of stroke rehab?
re-evaluate often, variability of practice, repetition without repetition, encourage problem solving
What is step 4 of stroke rehab?
transfer of training
What are primary UE stroke impairments?
impaired motor control, muscle tone, sensation, neglect
2nd- weakness, subluxation, ROM
What is important about positioning in bed for UE?
pt should always be able to see limb and shoulder its always in neutral positions
Why is it so important to monitor shoulder jt integrity?
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
What are FES guidelines for prevention of subluxation post stroke?
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….
What period in rehab has FES shown to be most successful for subluxation prevention?
subacute, after 6 weeks or more of tx
Why should a PT be cautious with a sling?
promotes flexor synergy, alters COM which can affect balance, can lead to muscle shortenings or contractures, and promote learned disuse of affected hand
What percentage of pts experience hemiplegic shoulder pain?
38-84% from subluxation, impingement syndrome, frozen shoulder, complex regional pain syndrome
