Neglect/ Pushing Flashcards

1
Q

Vital inputs for standing

A

vision, vestibular, and somatosensory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

stable position of standing

A
  • impact of BOS on LOS - foot position matters, UE support matters
  • LOS affected by feet support and UE support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

the greater the balance dysfunction…

A

the lower the discharge functional scores are likely to be

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is postural control dependent on?

A

patient, environment, and task

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does postural control involve?

A

controlling the body’s position in space - including both orientation and stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when working on postural control, what should you consider?

A

the ability to maintain COM within BOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what might compromise ankle strategy?

A

tone, AFO, contracture, weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what might compromise hip strategy?

A
  • weakness, tone, decreased trunk control, timing, initiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what might compromise stepping strategy?

A

weakness, trunk control, tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

following neurologic incident patients may have:

A

problems in timing, motor activation, sensory input, cognitive processing, adaptation, sensory organization, learning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UE balance control

A

Monitor patient use of trying to grab furniture,
parallel bars- utilizing UE support for balance control which is not where we want to provide intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

steady state control considerations

A
  • Alignment
  • Muscle tone
  • Stability limits- sway strategies (motor control/coordination)
  • Visual, vestibular, somatosensory inputs with integration
  • Task-dependent weighting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does anticipatory control require?

A
  • Recognition of need for postural response
  • APAs for movement
  • UE, Trunk, LE –Strength, Isolation of muscle
    activity, Timing
  • Sensory input to provide accurate information to
    system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when should you focus on impairments?

A
  • If they are interfering with balance or balance reactions
  • prevent new impairments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when thinking about ankle strategy, what should you do?

A

consider ankle ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

influence of impairments - strength

A

relationship of improving strength and its impact on balance is mixed
- a threshold of strength is needed for stability and movement components of balance and balance reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Interventions to improve strategies of postural control

A

facilitate development of sensory, motor, and cognitive strategies that are effective in balance control –> alignment –> sensory strategies –> cognitive strategies –> balance training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

alignment

A

maintain COM within BOS, move COM within stable BOS, move COM in moving BOS

19
Q

sensory strategies

A

learning to organize and select most appropriate sensory input

20
Q

cognitive strategies

A

attentions need fro postural control, carry over of learning from one task to another

21
Q

balance training

A

practice progressively challenging tasks that facilitate the development of postural control and behaviors

22
Q

context of intervention

A
  • predicable vs unpredictable
  • simple or choice of reaction
  • predictable vs unpredictable environment
23
Q

neglect of body

A

◦ May not recognize parts of body as a part of them
◦ Reorient them to limbs on involved side
◦ Continual emphasis of attention to the limb

24
Q

neglect of environment

A

◦ Decreased attention to side of environment
◦ Will not eat food if on side of neglect, may run into obstacles/doors on side of neglect
◦ Increased awareness to side of neglect, activities/cues to encourage attention to that side

25
neglect is primarily a disorder of what?
Primarily a disorder of attention where patient fails to orientate, report, or respond to simuli on contralateral side
26
what is unilateral spatial neglect correlated with?
increased length of stay in inpatient rehabilitation facility, spending an average of 11 days longer
27
patients with unilateral neglect have a slower what?
progress and less functional improvement per day compared to individuals following stroke with a similar admission status
28
when is recovery of neglect most rapid
over the first 10 days and plateaus around the 3 month mark with a majority of patients demonstrating recovery
29
what does neglect negatively affect?
disability one year post stroke and is a valid predictor for dependency but not of death one year post stroke
30
does neglect have to occur directly at midline?
nope
31
common interventions for neglect
Visual interventions Prism Adaptation Body Awareness Mental Function Movement interventions Non-Invasive Brain Stimulation Electrical Stimulation Acupuncture Reward
32
CPG for neglect
Clinicians should provide rehabilitation for neglect that enables people to meet their goals
33
Contraversive Pushing: Pusher Syndrome
- Perception of body posture in relation to gravity is altered. - No disturbed processing of visual or vestibular inputs determining visual vertical.
34
what is pusher syndrome typically associated with?
lesion to the posterolateral thalamus
35
Clinical Presentation of Contraversive Pushing Behaviors
◦ Perception of body as upright when actually tiled towards brain lesion ◦ Tendency to push with non-affected extremities into abduction and extension toward hemiparetic side ◦ Resistance to external correction
36
Are patients with pusher syndrome capable of reaching same functional outcomes
◦ Yes, can take up to 3.6 weeks longer ◦ Insurance and Medicare does not automatically give longer time in therapy to patients with contraversive pushing, however level of assistance needed at admission, may impact
37
If given the same length of stay at those with stroke without pushing behavior?
◦ Poorer functional outcomes ◦ Increased caregiver burden ◦ More likely to discharge to SNF
38
Scale for Pushing Syndrome
Burke Lateropulsion Scale 5 Testing Positions ◦ Supine ◦ Sitting ◦ Standing ◦ Transfers ◦ Walking 0= no evidence of lateropulsion 17= maximum lateropulsion
39
Initial treatment for pusher syndrome
Initially help them realize their disturbed perception of erect body position
40
treatment for pusher syndrome in sitting
- permit contraversive body tilt within safety limits - As they perceive the body tilt or fall ask patient to find a way to get upright again ◦ Support them if unable to return to upright.
41
What should you encourage for patents with pusher syndrome
- active exploration of visual surroundings. - Have them align with visual vertical environmental cues - Windows, pillars, pictures, mirror, door frames, therapist’s arm (vertical)
42
Progression
If pushing, the therapist may be able to subvert this maladaptive action by having the patient perform an action toward the non-paretic side (reach for an object and use auditory cues to direct attention).
43
How to optimize pusher syndrome training:
- maintaining vertical while distracted or performing other activities - Use conversation and/or head or arm movements while maintaining vertical.
44
what do most recent studies continue to emphasize for pusher syndrome?
visual feedback for orientation to vertical