motor recovery Flashcards
mm synergies
firing of several mm groups simultaneously
normally we move in numerous __ movement patterns
variable
after stroke we move in __ ways
stereotypical
stereotypical snergies
initial: flaccid
followed by: spasticity, hyperreflexia , stereotypical movements
-inflexible, invarient
UE flexor synergy pattern scapula shoulder elbow wrist flexrors thumb
elevates/retracts abd/ER Flex/sup flex flex/add flex/add
LE extensor synergy
Hip
knee
ankle
great toes
adducts/ IR
extends
PF/Inversin
extend
strong components of flexor synergy
elbow flexion
hip flexion
strong components of extensor synergy
shoulder adducts/ IR
knee extends
Brunnstrom stages of motor recovery
1-6
flaccid to spastic to normal
chedoke stroke assesemtn
1-7
flaccid to spastic to normal
brunstrom stages with no voluntary movement
stage 1 /2
brunstrom spastic movement levels
3-6
Motor recovery stage 1
UE
flaccid
hyporeflexic
no active reflex / mm
motor recovery 2
UE
spasticity
reflex response to facilaition
no voluntary mm
motor recovery stage 3 UE
spasticity marked
synergistic movement can be elicited volunitariy
pattern of movement within limited range
motor recovery stage 4 UE
spasticity decrease
less resistance to passive
synergy pattern can be reversed
movement possible within greater range
motor recovery stage 5
spasticity wanes but evident w rapid movement
able to reverse patterns
isolated movement possible
specific movements
motor recovery stage 6
no resistance to passive movemnt
controlled isolated movement
lacks normal speed
chedoke stage 7
normal movement, normal speed
no evidence of functional impairment
which one has stage 7 chedoke or fugl
chedoke
3 purposes of chedoke
stage the recovery
predict outcome
measure clinical important change
chedoke 2 inventories
physical (shoulder posture arm, hand leg foot)
and activity (gross and walking)
associated reactions
unintentional involuntary movements caused by lack of inhibition from CNS
can become conditioned
can occur with voluntary action of another limb
post stroke shoulder pain from
snap malignment IR humerus neglect sensory loss UE low stage in recover CMSA 123
is shoulder sublaxation common? preventable
yes n yes
relationship between shoulder subluxation and pain direct or not
not direct
can should sublax if increased mm tone
yes
how to prevent shoulder sublax
support it
education
joint approximation
maintain ROM (safe below 90)
contributing factors to shoulder sublaxation
lack of support in upright / standing
pulling on hemiplegic during transfers
improper positioning in bed / wc
joint approximation
mm stimulation
strengthening
braces
taping
complication of spastic UE
adhesive capsulitis decrease functional movement loss of scapular mobility loss of humeral alignment contracture/ loss ROM
best practice for shoulder PROM Arm
do not move shoulder past 90 of shoulder flex / abd UNELSS scapular upwardly rotated and humerus laterally rotated
