neuro treatments Flashcards
What are exercises to improve sitting balance?
Sitting hold with 1 arm, without both arms
Seated reaches for cups and move
Weight shifts in sitting
Rotations
Leg lifts
What is evidence for strength training in neuro conditions?
Evidence by systematic review by Kjolhede et al
RTC by Kanegusuku found parkinsons resistance training beneficial.
ALS Kalron et al find that aerobic with strenth was superior to simple flexibility
Stroke various systematic reviews such as Veldema and Jansen which found resistance training can have positive impact on stroke patients.
What kind of exercises should be provided to stroke patients
Power training recommended for conventional strength
Exercises should be performed with speed
Exercise has to be specific to groups
What are contraindications to exercise in stroke?
Recent significant change in ECG indicating ischaemia
Unstable angina
severe symptomatic aortic stenosis
Regurgitant valvular heart disease
Acute pulmonary embolism or pulmonary infarction
Acute myoacarditis
Acute aortic dissection
Acute infections
Acute deep vein thrombosis
Uncontrolled visual or vestibular disturbances
What exercises can be done to improve sensation?
Feeling different textures - texture hunting, velcro strips, cotton, marbles, coins, towels
- try to find objects by texture without looking
Texture recognition
- Observe how different objects feel in hands
- Keep cycling through
Temperature differentiation - cloth in hot and cold water
Touch localisation - eyes closed say where something is
What areas of balance control are needed in ADLs?
Steady state balance
reactive balance control
Proactive or anticipatory balance
what are exercises for lower limb strengthening?
sit to stands
squats
Leg extensions
Calf raises
toe raises
How is upper limb therapeutic positioning performed in sitting?
Place arm abducted in line with shoulder joint and on 1-2 pillows to help elevate
Using a towel under the wrist can aid with creating a functional position and comfort
Why is therapeutic positioning important after strokes for the upper limb?
Stroke can lead to weakness around muscles of the shoulder cuff which aid in keeping the head of the humerus within the acromion
Weakness means that the humeral head could partially dislocate or subluxed.
what may happen to a shoulder joint if therapeutic positioning is not used?
Could lead to chronic pain in that shoulder
Can also be painful in the rehab process so when handling should have hand under elbow and under wrist
Why are pillows used in therapeutic positioning?
The elevation created by them can help with swelling that may develop from lack of use.
How is therapeutic positioning performed in lying?
In lying with 45 degree
Ensure patient in neutral aligned position
May need one or two pillows
With hand under wrist and elbow bring arm into alignment with shoulder
If uncomfortable can cross arm over the body.
What are possible upper limb strengthening exercises?
Over head press
Reaching
Putting things onto shelf
Bicep curls
Frontal raise
Putty
Abducted rotations
When might there be contraindications to prone positioning?
Unstable spinal fracture / spinal instability
Acute bleeding
Raised intracranial pressure >30mmHg
Tracheal surgery or sternotomy within 2 weeks
Relative:
Haemodynamic instability
Unstable pelvic or long bone fractures
Open abdominal wounds
What are contraindications to Trendelenburg positioning?
Intracranial pressure >20mmHg
If intracranial pressure increases need to be avoided
Uncontrolled hypertension
Distended abdomen
Oesophageal surgery
Recent gros haemoptysis related to lung carcinoma or with radiation therapy
Uncontrolled airway at risk for aspiration
