Module 3 Flashcards
What is information from the client is important to tie into your treatment plan? Why?
Hobbies/ Interests
Increases compliance
Orientation (name, place, time, circumstance), ability to follow 1-3 step commands, perseveration (patients gets stuck with a certain task or question) and mini-mental status exam are all examples of? Can be difficult if? How should you approach?
All examples of cognitive status assessments
Can be difficult to assess if they have speech issues
Allow them time to answer
Cognitive status assessment, emotional and behavioral status assessment, checking of vital signs, assessing any changes to bowel or bladder function, checking the skin for abnormal color, texture or for wounds, checking for signs/ symptoms of DVT, checking sensory integrity, vision and perception testing, and examination of CN integrity are all part of the _ _ and _ _ of _ _ which part of the _ examination.
All part of the systems review and testing measures of Impairment portion of the physical examination.
What 3 things should be looked at during the emotional and behavioral status portion of the PE?
ADE
Apathy
Depression
Emotional lability
Emotional lability or the _ _ is common in patients with _ CVA
Psuedobulbar affect is common in patients with a left CVA
What vital signs is it important to check with examining a stroke patient? (6)
RB H POT
Respiratory rate Blood pressure Heart rate Pain Oxygen saturation Temperature
3 pain conditions that can result from stroke: _ _ _ pain which is most common in the _. _ pain and _ which occurs _, _ stimulus.
Central Post Stroke Pain (CPSP) with is most common in the shoulder
Thalamic pain and hyperalgesia which occurs spontaneously without stimulus
2 common visual impairments that occur in stroke patients: _ _ which is most common with _ _ brain injuries. _ _ which is where 1/2 of the visual field is absent in both eyes.
Visual neglect, most common in right sided brain injuries
Homonymous hemianopsia
/ and / are alterations in tone that affect motor function.
Flaccidity/ hypotonicity
Spasticity/ hypertonicity
With increases in the level of spasticity the risk of _ and _ _ also increases
Risk of contracture and skin breakdown also increases
How many levels are there in the Brunnstrom stage of motor recovery? Is used to assess? What stage do many patients ‘get stuck’ in?
Level range from 1-6 (in order of decreasing severity)
Used to assess motor function
Many patients get stuck at a level 3
What Brunnstrum level is being described: flaccid? Minimal voluntary synergistic movement, spasticity emerges
Level1- flaccid
Level2- minimal voluntary synergistic movement, spasticity emerges
What Brunnstrom level is being described: more voluntary synergistic movement, spasticity is maximal
Level 3
What Brunnstrom level is being described: some movements out of synergy, spasticity declines
Level 4
What Brunnstrom level is being described: synergy patterns lose dominance but there is still some evidence of
Level 5
Brunnstrom level 6: _ spasticity, and individual joint movements _
No spasticity, individual joint movements possible
What is another common system used to assess motor function? Levels/ range?
Modified Ashworth Scale (MAS)
Scale: 0, 1, 1+, 2, 3, 4
- 0= no increase in muscle tone; 4=rigid
_ _ is the ability to plan and execute coordinated movement
Motor praxis
2 types of altered motor programming include _ apraxia and _ apraxia. Define each.
Ideational apraxia (inability to perform automatically or on command)
Ideomotor apraxia (can perform automatically but NOT on command)
4 types of abnormal (obligatory) synergy patterns
UE flexion and extension patterns
LE flexion and extension patterns
Scapular retraction and elevation, shoulder abduction and ER, elbow flexion, forearm supination and wrist and finger flexion are characteristic of a _ _ _ _.
Upper extremity flexion pattern
Upper extremity extension pattern has: scapular _, shoulder _ and _ _, elbow _, forearm _ and wrist & finger _.
Scapular protraction, shoulder adduction and internal rotation, elbow extension, forearm pronation, and wrist & finger FLEXION
Lower extremity flexion pattern consists of: Hip _, _, and _ _ Knee _ Ankle _ and _ Toe _
Hip flexion, abduction, and ER
Knee flexion
Ankle Dorsiflexion and inversion
Toe Dorsiflexion
Lower extremity extension pattern includes: Hip _, _ and _ _ Knee _ Ankle _ and _ Toe _
Hip extension, adduction and internal rotation
Knee FLEXION
Ankle plantar flexion and INVERSION
Toe plantar flexion
4 examples of abnormal reflexes
H HAT
Hyporeflexia
Hyperreflexia
Associated reactions
Tonic reflexes
ATNR and flexor withdrawal are examples of? Clonus, clasp knife response, babinski sign are examples of?
ATNR/ flexor withdrawal: tonic reflexes
Clonus, etc: hyperreflexia
Examples of altered coordination and associated area of lesion: Ataxia? Bradykinesia? Choreoathetosis? Hemiballismus?
Ataxia- cerebellar lesion
Bradykinesia, choreoathetosis, hemiballismus- basil ganglia lesions
What is being described: patient’s perception of vertical is absent, therefore they are not aware if they have fallen or if they are standing
Ipsilateral Pushing/ Pusher syndrome
Which 6 outcome measures (StrokEDGE) are commonly used to assess function in stroke patients?
BFD 6-10
Berg balance test
Functional reach test
Dynamic gait index
6 minute walk test
10 meter walk test
What other outcome measures will we be looking at in this class? (7)
AA F STOP
Action research arm test
Ashworth scale
Fugl-Meyer (motor performance) test
Stroke impact scale
Tardieu spasticity scale
Orpington prognostic scale
Postural assessment scale for stroke
Identifying: strength, sensory and perceptual, coordination, and balance impairments is outlined in the? What two parts of the ICF does it address
Guide to physical therapy practice
ICF: activity and participation roles
What APTA preferred practice pattern is described and associated with stroke rehab: Impaired function and sensory integrity associated with non-progressive disorders of the CNS- acquired in adolescence or adulthood
Pattern 5D
What are the 4 essential elements that must be included when writing patient goals?
Individual (who)
Behavior/ activity (What)
Condition (how)
Time (when/ by)
What level of the modified Ashworth scale is being described: Minimal increase in muscle tone at the end of range
1
What level of MAS is being described: minimal increase in muscle tone (less than 1/2 PROM)
1+
What level of the MAS is being described: more marked increase in muscle tone (most PROM)
2
What level of the MAS is being described: considerable increase in muscle tone (PROM difficult)
3
What type of abnormal reflex is characteristic of UMN lesions? LMN lesions?
UMN- hyperreflexia
LMN- hyporeflexia
