MOTOR RECOVERY AND FUNCTION Flashcards
What synergy dominants in UE?
Flexion
What synergy dominates in LE
Etension
Stage 1 of Brunnstrom
Flacid paralysis
Stage 2 of Brunnstrom
Increase in ton, no voluntary movement
Stage 3 Of Brunnstorm
Increase in tone
Obligatory patterns of movment within limited range
Spastic movement within lmited range
How many stages are on the Chedoke?
7
Is there voluntary movement at stage 2 of chedoke?
no
Stage 3 Chedoke
Spasticity quite marked
Synnergistic movements can be elicited voluntarily but are obigatory
Stage 4 Chedoke
Spasticity decreased
Can move from weaker to stronger synergy and back and forth
Way more functional
Stage 5 Chedoke
Spasticity waning
In rapid movements still some spasticity
Less interference with function
Stage 6 Chedoke
Coordination and patterns of movement are near normal
Stage 7 Chedoke
Normal
Stage 7 Chedoke
Normal
Motor recovery stage 1 UE
flaccid paralysis is present
Hyporeflexic
No active movement elicited by reflex or voluntary movement
Motor recovery stage 2 UE
Spasticity is present, flet as a resistance to passive movement
Reflex response to facilitate
No voluntary movement
Motor recovery stage 3 UE
Spasticity is marked
Synergistic movement can be elicited voluntarily
Pattern of movement within limited range
Motor recovery stage 4 UE
Spasticity decreases
Less resistance to passive movement
Synergy patterns can be reverse if movement takes place in weaker synergy first
MOvement possible within greater range
Motor recovery stage 4 LE
Spasticity decreases
Less resistance to passive movement
Synergy patterns can be reverse if movememnt takes place in weaker synergy first
Movement possible within greater range
Motor recovery stage 5
Spasticity wanes, but is evident with rapid movement
Able to reverse patterns
Isolated movements possible
Movement becoming more specific
Motor recovery stage 6
No resistance to passive movement
Controlled isolate movement
lacks normal speed
What is the Chedoke McMaster Stroke assessment
A screening and assessment tool to measure physical impairment and disability of an individual following a stroke
- Valid and Reliable
3 main purposes of the Chedoke?
- To stage motor recovery
- To predict rehabilitation outcomes
- To measure clinically important change in physical function
what are the 2 inventories of the chedoke
- Physical impairement inventory - 6 domains
2. Activity inventory - 2 domains: gross motor function + walking function
What are associated reactions
Unintentional/involuntary movements caused by a lack of inhibition from the CNS
When do Associated reactions occur?
With a voluntary action of another limb or by another stimuli such as: yawning, sneezing, effort
What occurs when an associated reaction is repeated
Can become a conditioned response: Reinforces neural circuits supporting the invariant pattern & potentially lead to biomechanical limitations and/or fixed deformity
What is a muscle synergy?
Shortcut system in a normal CNS that allows us to do tasks that require firing of several muscle groups that contract simultaneously to work as a single functional unit
- Does not control each muscle individually but rather as a group
What occurs to muscle synergies after stroke?
They change - in an abnormal, stereotypical way (movement pattern that impact the performance of ADLs)
What is seen in a flexor synergy in UE?
- Elevated + retracted scap
- Abduction and ER of GH
- Flexes and supinates elbow
- Flexes wrist and fingers
- Adducts fingers
What is seen in a flexor synergy in LE
- Elevates and retracts pelvis
- Adducts, flexes, and ER hip
- Flexes knee
- DF and Inversion at ankle
- Extend great toe and flexes other toes
What occurs in the UE in extensor synergies?
- Depress + protract scap
- Adducts + IR GH
- Extends + pronates elbow
- Somewhat extends wrist
- Flex and adduct fingers
What occurs in the LE in extensor synergies?
- Adducts, extends, and IR Hip
- Extends knee
- PF and Inversion
- May extend great toe
What increases the likelyhood of developping post stroke shoulder pain
- Poor prognostic indicators
- UE in low stage of recovery CMSA 1,2,3
- Scapular malalignment
- IR of humerus in resting position
- Posturing of arm in IR adduction
- PROM limitations of abd<90, ET<60
- Neglect
- Sensory loss
- Incidence of shoulder pain varies between studies; estimates range from 9% to 84%
What will you have initially post stroke for presenation of hemiplegic shoulder
- Cerebral shock
- Flaccid presentation
- Present in >90% of individuals
What is continued flaccid paralysis
- Remains at stage 1 CMSA
What are precautions for continued flaccid paralysis
- Development of shoulder pain
- Tends to result in subluxation - inferior direction
- Weakness in shoulder girdle
- weights of unsupported arm, and gravitational pull, causes traction on various nerves, muscles, ligs
is post stroke shoulder subluxation common?
yes
How do you prevent post stroke shoulder subluxation
- Adequately support at all times in stages 1,2,3
- Education
- Never pull on arm
- Do not force ROM of affected arm
- Support during transfers
- Remove sling with Pt is sitting and support on solid surface
What are some treatment strategy for joint approximation? (in hemiplegic flaccid UE)
- Muscle stimulation
- Strengthening - shoulder girdle
- Hemiplegic shoulder approximation braces
- Taping
- Supports throughout the day
What is the strategy for positing in bed/wc/sitting for post-stroke hemiplegic flaccid UE
Hemi side always supported with pillows
What are the strategies to maintain ROM/Muscle extensibility post stroke in hemiplegic flaccid UE
- maintain pain free functional ROm (maybe below 90 if not safe to go above)
- Monitor pain - overstretching of lig and tendon, gravity keeping them on stretch
- Monitor any tone development
- For hyertonic UE, Position/stretch in position opposite to flexor synergy
- Teach fam and caregivers to safely maintain
- Self-management/self ROM by client
- Do not use pulleys
What are complications of spastic UE
- Shoulder pain , adhesive capsulitis
- Decrease in functional movement patterns, hygiene, dressing
- Loss of scap mobility
- Loss of humeral aligment in GH joint (pulling into IR)
- Contributes to risk of impingement of AROM and PROM
- Humeral head may also be pulled anteriorly - ant dislocation
- Contracture
- Change to balance, postural control
Treatment for spasticity UE
Same for tone Additionally - Prevent shoulder pain - Positioning program - Joint protection/education (shoulder subluxation prevention) - Maintain ROM (Especially ER) - Maintain scap mobility - promot adequate ER of GH - muscle stretch strategies - strengthening exercises - CV training
