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PHTH 544 -Neuro > MOTOR RECOVERY AND FUNCTION > Flashcards

MOTOR RECOVERY AND FUNCTION Flashcards

1
Q

What synergy dominants in UE?

A

Flexion

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2
Q

What synergy dominates in LE

A

Etension

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3
Q

Stage 1 of Brunnstrom

A

Flacid paralysis

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4
Q

Stage 2 of Brunnstrom

A

Increase in ton, no voluntary movement

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5
Q

Stage 3 Of Brunnstorm

A

Increase in tone
Obligatory patterns of movment within limited range
Spastic movement within lmited range

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6
Q

How many stages are on the Chedoke?

A

7

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7
Q

Is there voluntary movement at stage 2 of chedoke?

A

no

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8
Q

Stage 3 Chedoke

A

Spasticity quite marked

Synnergistic movements can be elicited voluntarily but are obigatory

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9
Q

Stage 4 Chedoke

A

Spasticity decreased
Can move from weaker to stronger synergy and back and forth
Way more functional

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10
Q

Stage 5 Chedoke

A

Spasticity waning
In rapid movements still some spasticity
Less interference with function

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11
Q

Stage 6 Chedoke

A

Coordination and patterns of movement are near normal

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12
Q

Stage 7 Chedoke

A

Normal

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13
Q

Stage 7 Chedoke

A

Normal

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14
Q

Motor recovery stage 1 UE

A

flaccid paralysis is present
Hyporeflexic
No active movement elicited by reflex or voluntary movement

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15
Q

Motor recovery stage 2 UE

A

Spasticity is present, flet as a resistance to passive movement
Reflex response to facilitate
No voluntary movement

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16
Q

Motor recovery stage 3 UE

A

Spasticity is marked
Synergistic movement can be elicited voluntarily
Pattern of movement within limited range

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17
Q

Motor recovery stage 4 UE

A

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

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18
Q

Motor recovery stage 4 LE

A

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

19
Q

Motor recovery stage 5

A

Spasticity wanes, but is evident with rapid movement
Able to reverse patterns
Isolated movements possible
Movement becoming more specific

20
Q

Motor recovery stage 6

A

No resistance to passive movement
Controlled isolate movement
lacks normal speed

21
Q

What is the Chedoke McMaster Stroke assessment

A

A screening and assessment tool to measure physical impairment and disability of an individual following a stroke
- Valid and Reliable

22
Q

3 main purposes of the Chedoke?

A
  1. To stage motor recovery
  2. To predict rehabilitation outcomes
  3. To measure clinically important change in physical function
23
Q

what are the 2 inventories of the chedoke

A
  1. Physical impairement inventory - 6 domains

2. Activity inventory - 2 domains: gross motor function + walking function

24
Q

What are associated reactions

A

Unintentional/involuntary movements caused by a lack of inhibition from the CNS

25
Q

When do Associated reactions occur?

A

With a voluntary action of another limb or by another stimuli such as: yawning, sneezing, effort

26
Q

What occurs when an associated reaction is repeated

A

Can become a conditioned response: Reinforces neural circuits supporting the invariant pattern & potentially lead to biomechanical limitations and/or fixed deformity

27
Q

What is a muscle synergy?

A

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

28
Q

What occurs to muscle synergies after stroke?

A

They change - in an abnormal, stereotypical way (movement pattern that impact the performance of ADLs)

29
Q

What is seen in a flexor synergy in UE?

A
  • Elevated + retracted scap
  • Abduction and ER of GH
  • Flexes and supinates elbow
  • Flexes wrist and fingers
  • Adducts fingers
30
Q

What is seen in a flexor synergy in LE

A
  • Elevates and retracts pelvis
  • Adducts, flexes, and ER hip
  • Flexes knee
  • DF and Inversion at ankle
  • Extend great toe and flexes other toes
31
Q

What occurs in the UE in extensor synergies?

A
  • Depress + protract scap
  • Adducts + IR GH
  • Extends + pronates elbow
  • Somewhat extends wrist
  • Flex and adduct fingers
32
Q

What occurs in the LE in extensor synergies?

A
  • Adducts, extends, and IR Hip
  • Extends knee
  • PF and Inversion
  • May extend great toe
33
Q

What increases the likelyhood of developping post stroke shoulder pain

A
  • 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%
34
Q

What will you have initially post stroke for presenation of hemiplegic shoulder

A
  • Cerebral shock
  • Flaccid presentation
  • Present in >90% of individuals
35
Q

What is continued flaccid paralysis

A
  • Remains at stage 1 CMSA
36
Q

What are precautions for continued flaccid paralysis

A
  • 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
37
Q

is post stroke shoulder subluxation common?

A

yes

38
Q

How do you prevent post stroke shoulder subluxation

A
  • 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
39
Q

What are some treatment strategy for joint approximation? (in hemiplegic flaccid UE)

A
  • Muscle stimulation
  • Strengthening - shoulder girdle
  • Hemiplegic shoulder approximation braces
  • Taping
  • Supports throughout the day
40
Q

What is the strategy for positing in bed/wc/sitting for post-stroke hemiplegic flaccid UE

A

Hemi side always supported with pillows

41
Q

What are the strategies to maintain ROM/Muscle extensibility post stroke in hemiplegic flaccid UE

A
  • 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
42
Q

What are complications of spastic UE

A
  • 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
43
Q

Treatment for spasticity UE

A 
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

PHTH 544 -Neuro (5 decks)

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