Neurological Rehabilitation Flashcards
What is the time frame
for most stroke recovery?
3-6 months
At what point in time
do physical therapists predict
how much stroke recovery is possible?
1 month post-stroke
When do you start stroke rehab?
First 24 hours
What are two key concerns/worries
when recovering from stroke?
- Deep Vein Thrombosis to Pulmonary Embolism
- Aspiration of food to pneumonia
Describe the
Functional Independence Measure (FIM)
parameters for:
- Total Assist
- Maximal Assist
- Moderate Assist
- Minimal Assist
- Supervision
- Independence
- Total Assist Patient does less than 25% of work or 2 persons required
- Maximal Assist Pt. does 25%-50% of work. Helper provides lifting assist.
- Moderate Assist Pt. does 50%-75% of work. Helper provides lifting assist.
- Minimal Assist/ Contact Guard Pt. does 75%-100% of work. Helper provides guiding and/or contact guard.
- Supervision Pt. requires verbal instruction or cues for safety. No physical contact.
- Independence Pt. able to perform 100% of task safely and in expected timeframe. No helper or equipment.
Describe the difference in focus for:
- PT
- OT
- SLP
- NGT
- PT: Bed to chair transfer Toilet transfer Shower transfer Locomotion (amb; w/c) Stairs
- OT: Eating Grooming Bathing Upper body dressing Lower body dressing Toileting
- SLP: Cognitive comprehension Expression Social interaction Problem solving Memory (Swallowing)
- NGT: Bladder and Bowel management
According to the International Classification of Functioning, Disability & Health (ICF) Model,
what are the five areas a PT evaluates
when coming up with a Plan of Care?
- Body Function & Structures: muscle performance, sensory, reflexes, range of motion, balance, aerobic
- Activities: bed mobility, transfers, ambulation, stairs, community skills
- Participation: Subjective history questions about: family, work, social roles
- Personal Factors: age, gender, ethnicity, personality, coping strategies, health behaviors, fall history
- Environental Factors: home environment, family/social support, insurance, economic resources
Differentiate between
recovery, compensatory and prevention approaches/strategies to physical therapy
- Recovery: restoration to previous level of function; assumes neuroplasticity of the brain (eg: stroke)
- Compensation: acheive optimal function with residual abilities; assumes no potential for repair (eg: complete spinal cord injury)
- Prevention: prevent more damage, especially secondary impairments and integumantary damages
Note: Recovery and Compensation lie on a continuum, while prevention is a constant concern regardless of treatment strategy.
What is neuroplasticity?
How/where does it happen?
Ability of the brain to learn and change
based on environment and activities
Structural changes: dendritic arborization, dendritic spine density, synapse size, synapse number, axonal arborization
What are eight principles or guidelines
physical therapists keep in mind?
- Use it or lose it
- Use it and improve it
- Specificity
- Repetition matters
- Intensity matters
- Time matters
- Salience matters
- Age matters
What are some health conditions
amenable to recovery strategies
with potential for neuroplasticity?
- Brain injury
- Cerebrovascular accident (stroke)
- Spinal cord injury (incomplete)
- Multiple sclerosis (early, relapsing-remitting)
- Vestibular disorders
- Parkinson’s Disease (early)
- Concussion
What are some health conditions
requiring more of a compensatory approach?
- Spinal cord injury (complete)
- Parkinson’s (late stage)
- Multiple Sclerosis (late stage)
- ALS
- Dementia/Alzheimer’s Disease
- Stroke (severe)
- Brain injury (severe)
- Amputation
What are some secondary impairments
of neurological conditions?
Muscle/joint contractures
Respiratory compromise
Pressure sores
DVT
Infection
Pain
What is the key challenge for cerebellar stroke:
Weakness or balance?
Balance, ataxia, numbness
