Neuromuscular Unit 2 Exam Flashcards
the integration of information that is psychologically meaningful + the ability to select stimuli that requires attention and action
perception
the perceptual motor process is a change of events through which the individual _____, _______, and ______ stimuli from the body and the surrounding environment
selects, interprets, integrates
why is discussing perception important?
perceptual and cognitive deficits can lead to poor rehabilitation progress for patients + important for learning
screen that often co-occurs with other system screens
perceptual screen
a perceptual screen observes for:
-inattention to therapist during subjective
-inattention to half the body (neglect)
-decreased response to verbal cues
what finding would lead you to perform formal testing for perceptual deficits?
when there is functional loss unexplained by motor or sensory impairments in comprehension
what is the purpose of examining perceptual deficits?
to determine which perceptual abilities are intact vs impaired, therefore guiding to appropriate intervention
factors that influence the perceptual exam
-psychological and emotional status
-ability to detect relevant cues from the environment
-anxiety, depression, fatigue
-aphasia
how do you sequence the perceptual exam?
-sensory exam first (includes visual screen)
-cognitive screen
-hearing screen
-consult with family about usual vs unusual behaviors
true or false: perception cannot be viewed as independent of sensation
true
true or false: deficits do not lie with sensory ability itself, but rather the interpretation of sensation and the follow up response
true
awareness of stimuli through organs of special sense, peripheral cutaneous sensory system, or internal receptors
sensation
inattention or neglect of visual stimuli presented on the involved side (patient is NOT aware of the deficit)
perceptual deficit/visual neglect
example: hemianopsia
the patient IS aware of the deficit and the patient may compensate spontaneously (true field cut)
visual field impairment
one of the most common forms of sensory loss in those with hemiplegia
visual field impairment
a visual screen should include:
visual acuity
oculomotor control
visual field testing
perceptual deficits may include disorders of what 3 categories?
-body scheme/image/awareness
-spatial relations
-agnosias
the relationship of the body parts to each other and the relationship of the body to the environment
body scheme
visual and mental image of one’s body that includes feeling about one’s body
body image/awareness
impairments that have in common a difficulty in perceiving the relationship between self and two or more objects in the environment
spatial relations
inability to recognize incoming information despite intact sensory capacities
agnosias
lesions of what lobe typically produce perceptual deficits?
right parietal lobe
body scheme/body image impairments (5)
-unilateral neglect
-anosognosia
-somatagnosia
-right-left discrimination
-finger agnosia
lack of awareness of part of the body or external enviorment NOT due to sensory loss
unilateral neglect/hemineglect
patients with unilateral neglect should be observed for what?
limited use of the more involved extremity or inability to attend to an object or the environment as a whole
patient with unilateral neglect will have limited reaction to?
sensory stimuli
-visual
-auditory
-somatosensory
3 spaces of neglect
personal
peripersonal
extrapersonal
neglect of space that pertains to the body
personal space
neglect of space within arm distance from the body
peripersonal space
neglect of space beyond arm length
extrapersonal space
what does neglect look like clinically?
not dressing, eating, shaving, putting on makeup, bumping into objects on the left side
why would a patient with L hemineglect veer to the right when propelling a wheel chair?
stronger on the right side
despite no sensory loss, patients with this condition lack ability to register and integrate stimuli from one side of the body and the environment
neglect
lesion area of neglect
right parietal lobe
(inferior-posterior regions)
example for neglect of personal space
not putting makeup on the left side of the body
example of neglect of peripersonal space
failing to use objects on the contralesional/contralateral side of their plate
example for neglect of extrapersonal space
failing to negotiate obstacles, doorways, etc.
what test can be performed to determine if neglect is present?
behavioral inattention test (BIT) + ADL observation
treatment strategy for neglect?
remedial or compensatory approach (want neuroplasticity + education)
what is the overall goal of hemineglect/hemianopsia interventions?
encourage awareness and use of the environment on the hemiparetic side and use of the hemiparetic extremities
the lack of awareness, denial, of a paretic extremity as belonging to the person OR lack of insight concerning, or denial of, paralysis or disability
anosognosia
anosognosia limits the patients ability to recognize the need for what?
compensatory strategies
patients with this condition may say things such as “nothing is wrong” or “my mind has an arm of its own”
anosognosia
lesion area for anosognosia
unclear, proposal of supramarginal gyrus
testing for anosognosia
subjective interviewing and asking questions such as “what happened to your arm or leg?”
main treatment strategy of anosognosia
prioritize safety
body scheme impairment where there is a lack of awareness of the body structure and the relationship of body parts to oneself or others
somatognosia
another name for somatoagnosia
body agnosia
patients with somatagnosia often have difficulty following _______
instructions
patient with somatagnosia often report extremities as feeling _____
heavy
lesion area for somatagnosia
dominant parietal lobe (often seen with right hemiplegia)
how do you test to see if a patient has somatagnosia?
ask the patient to point to certain body parts or ask them to imitate movements
what is the treatment strategy for somatoagnosia?
remedial approach to facilitate body awareness
an inability to identify the right and left sides of one’s own body or that of the examiner
right left discrimination
patient with right-left discrimination will have a difficult time verbally responding to commands that include what 2 terms?
right and left
lesion area of right left discrimination
parietal lobe of either hemisphere
how do you test to see if a patient has right left discrimination?
ask the patient to point to body parts on command
how can right left discrimination be ruled out when performing testing?
test first without using the terms right and left
what treatment approach is used for patients with right left discrimination?
compensatory approach
-avoid left and right
-point or provide other cues
an inability to identify the fingers of the hand or that of the examiners
finger agnosia
lesion area for finger agnosia
parietal lobe at the region of the angular gyrus of the left hemisphere
testing for finger agnosia includes a portion from what test?
Sauguet’s test
-touching hands
-recognition on a picture
-imitation
what treatment approach is used for patients with finger agnosia?
limited evidence but a remedial approach can be attempted to bring attention/awareness back
spatial relations syndrome impairments (6)
-figure ground discrimination
-form discrimination
-spatial relations
-position in space
-topographical disorientation
-depth and distance perception
inability to distinguish a figure from the background in which it is embedded
figure ground discrimination
difficulty ignoring irrelevant visual stimuli, increased distractibility, shortened attention span, frustration, and reduced safety
functional relevance for figure ground discrimination
lesion area for figure ground discrimination
parieto-occiptal lesion of the right hemisphere
what test can be done for figure-ground discrimination?
ayres figure ground test
treatment strategy for figure ground discrimination?
remedial + compensatory approaches
impairment of discrimination in the ability to perceive or attend to subtle differences in form and shape
form discrimination
lesion area in form discrimination
parieto-temporoccipital region of non dominant lobe
confusing pen/toothbrush, vase/water pitcher, and cane/crutch is common with what condition?
form discrimination
how do you test for form discrimination?
ask the patient to identify several items similar in shape and different in size
treatment strategies for form discrimination?
remedial + compensatory approaches
inability to perceive the relation of one object in space to another object
spatial relations disorder
what is another name for spatial relations disorder?
spatial disorientation
what type of skills are required to manage most ADLs?
spatial relation skills
what are clinical examples of spatial relation disorders?
difficulty with:
-setting the table
-reading a clock
-preparing for a transfer
lesion area for spatial relation disorders
inferior parietal lobe or parieto-occipital junction on the right
2 tests used for spatial relation disorders
-riverbed perceptual assessment battery (RPAB)
-arnadottir OT -ADL neurobehavioral evaluation (A -ONE)
what would a remedial approach treatment strategy look like for a patient with spatial relations disorder?
-provide instructions to the patient to position themselves in relation to the therapist or another object
-set up a maze
-midline crossing activities
inability to perceive and interpret spatial concepts such as up, down, over, or under
position in space impairment
lesion area for position in space impairment
non-dominant parietal lobe
what is an example for testing to see if a patient has a position in space impairment?
utilize a shoe and shoebox and ask the patient to place in the shoe in different positions in relation to the shoe box
what 3 things should be ruled out with a position in space impairment?
-figure ground difficulty
-apraxia + incoordination
-lack of comprehension
what does the retraining approach treatment strategy look like for a position in space impairment?
3 or 4 identical objects are placed in the same orientation with an additional object placed in different orientation and the patient is asked to identify the off one and place it in the same orientation
difficulty understanding + remembering the relationship of one location to another
topographical disorientation
lesion area of topographic disorientation
-right retrosplenial cortex
-bilateral parietal regions
-L parietal regions
how can a therapist test to see if a patient has topographical disorientation?
ask the patient to draw or describe a familiar route
what does the remedial approach treatment strategy look like for a patient with topographic disorientation?
practice going from one place to another
-simple to more complex
-use verbal instructions
what does the compensatory approach treatment strategy look like for a patient with topographic disorientation?
marking frequent routes with colored dots
inaccurate judgement of direction, distance, and depth
depth and distance perception disorder
lesion area of depth and distance perception disorder
posterior right hemisphere in the superior visual association cortices
how do you test to see if a patient has depth and distance perception disorder?
ask a patient to gasp an object on a table or in the air or fill a glass of water
what are some clinical examples of depth and distance perception disorder?
-missing the chair when returning to sit
-continue pouring water despite a full glass
what are some treatment strategies for depth and distance perception disorder?
-assist the patient in becoming aware of the deficit
-provide education on uneven terrain and stair negotiation
-remedial or compensatory approach
what does the remedial approach treatment strategy look like for a patient with topographic disorientation?
-ask the patient to place their feet on a designed spot during gait training
-ask the patient to touch foot to a pile to reestablish sense of depth and distance
what does the compensatory approach treatment strategy look like for a patient with a depth and distance perception impairment?
utilize UE support to sit squarely within a chair
disordered perception of what is vertical
vertical disorientation
lesion area of vertical disorientation
non dominant parietal lobe
how would a therapist test for vertical disorientation?
therapist holds a cane sideways in a horizontal position and the patient is asked to return the cane back to the original vertical position
what is the treatment strategy for vertical disorientation?
enhance awareness and cue tactile input to assist in orienting back to normal
motor behavior characterized by active pushing with the strongest extremities toward the hemiparetic side with a lateral postural imbalance
pusher’s syndrome
pusher’s syndrome results in a loss of balance towards the ________ side
hemiparetic side
what misperception is involved in pusher’s syndrome?
subjective postural vertical
what area is affected with pusher’s syndrome that results in altered perception of the body’s orientation in relation to gravity?
posterolateral thalamus
individuals with pusher’s syndrome will actively + strongly resist any attempt at passive correction to _______
midline
true or false: the brain can compensate with therapeutic training with pusher’s syndrome
true
what are the 2 therapeutic management goals for patients with pusher’s syndrome?
-reorienting patients to true vertical
-manage environment to optimize visual cues
with pusher’s syndrome, what side pushes?
strong side pushes to weak side = imbalance on weak side
the inability to recognize or make sense of incoming information despite intact sensory capacities
agnosia
3 agnosia impairments
-visual object agnosia
-auditory agnosia
-tactile agnosia
an inability to recognize familiar objects despite normal function of the eyes + optic tracts
visual object agnosia
lesion area of visual object agnosia
occipito-temporo-parietal association areas of either hemisphere
3 types of visual object agnosia (difficulty recognizing people, progressions, and common objects)
-simultanagnosia
-prosopagnosia
-coloragnosia
how can a therapist test for visual object agnosia?
place several common objects in front of a patient with instruction to name, point to, or demonstrate the use of each object
______ and ______ can make it difficult to recognize visual object agnosia
aphasia and apraxia
what does the remedial approach treatment strategy look like for visual object agnosia?
practice drills to discriminate between colors and common objects
what does the compensatory approach treatment strategy look like for visual object agnosia?
encourage the use of intact sensory modalities to distinguish people and objects
an inability to recognize non-speech sounds or to discriminate between them
auditory agnosia
what are some clinical examples of auditory agnosia?
inability to distinguish ring of doorbell/telephone or the dog bark/thunder
lesion area of auditory agnosia
dominant temporal lobe
which profession tests for auditory agnosia?
SLP
what treatment strategy can be used for patients with auditory agnosia?
drill the patient on sounds, but reduced effectiveness overall
the inability to recognize forms by handling them although tactile, proprioceptive, and thermal sensations may be intact
tactile agnosia
what is a clinical example of tactile agnosia?
patient inability to recognize a familiar object when it is handed to them
lesion area of tactile agnosia
parieto-temporo-occipital lobe of either hemisphere (posterior association areas)
how would a therapist test for tactile agnosia?
have the patient identify objects when placed in their hand WITHOUT visual cues
what would the remedial approach treatment strategy look like for tactile agnosia?
instruct the patient to feel objects placed in their hand followed by immediate visual feedback
what would the compensatory approach treatment strategy look like for tactile agnosia?
visual compensation
perceptual and planning problem
apraxia
what are ways the therapist can mitigate these impairments?
-use verbal cues
-closed environment
-limited distractions
-adequate lighting
-collaboration with OT + speech
4 CVA time periods
hyper acute
acute
subacute
chronic
CVA time period for hyper acute phase
0-24 hours
CVA time period for acute phase
1-7 days
CVA time period for subacute phase
early: 7 days-3 months post
late: 3-6 months post
CVA time period for chronic phase
> 6 months post
setting of acute phase post stroke
ICU or specialized stroke care unit
goals of the acute phase post stroke
-early mobilization
-functional reorganization of hemiparetic side
-encourage positive outlook
-instruction, education, and training
interventions of acute phase post stroke
-bed mobility
-sitting
-transfers
-locomotion
-ADL training
-ROM
-splinting
-positioning
frequency of subacute phase sessions
2 professions 3 hrs/day 6x/week
setting of subacute phase post stroke
inpatient rehab or transitional care unit (TCU) within skilled nursing facility
setting of chronic phase post stroke
outpatient, community setting, or home
true or false: the fastest recovery takes place in the first few weeks and months after onset, however improvements can continue thereafter
true
recovery variability occurs due to what 3 things
-level of language/visuospatial function
-impairment involvement
-stroke severity
5 parts of the patient-client management model
-examination
-evaluation
-diagnosis
-prognosis
-intervention
factor that allows for the ability of the brain to modify in function + repair itself
neural plasticity
3 mechanisms of neural plasticity
-neuroanatomical
-neurochemical
-neuroreceptive
sprouting of the injured axons to innervate previously innervated synapses
regenerative synaptogenesis
collateral sprouting/reclaiming of synaptic sites of the injured axon by dendritic fibers from neighboring axons
reactive synaptogenesis
synaptic plasticity occurs through the release + receptive sensitivity of what?
neurotransmitters
10 principles of neuroplasticity
-use it or lose it
-use it and improve it
-salience
-repetition
-intensity
-specificity
-age
-time
-transference
-interference
promote ______ first
neural plasticity
the ability of the nervous system to modify itself in response to changes in activity and new experiences by use-dependent reorganization
function induced recovery
the brain is most responsive to improvements from motor training during what period?
critical/sensitive period
type of training that uses repetitive task practice
task-oriented training
3 interventions to promote neuroplasticity
-restorative
-compensatory
-preventative
interventions directed towards remediating or improving the patient’s status in terms of impairments, activity limitations, participation restrictions, and recovery of function
restorative interventions
target areas of restorative interventions
involved extremities or trunk
interventions direct toward promoting optimal function using new motor patterns
compensatory interventions
2 considerations for compensatory interventions
adaptation and substitution
using involved segments and adapting with remaining motor elements
adaptation
functions are replaced or taken over by different body segments using different motor patterns
substitution
target of compensatory interventions
less involved or uninvolved extremities
interventions directed towards minimizing potential problems and maintaining health
preventative interventions
the reappearance of motor patterns that were present before CNS injury
restoration
the reappearance of new motor patterns resulting from the adaptation of remaining motor elements or substitutions of alternative motto strategies and body segments
compensation
type of training where the patient is made aware of movement deficiencies and the changes required to complete the functional task
substitution training
focusing on the less involved segments with substitution training may suppress recovery and contribute to learned ______ of impaired segments
nonuse
skills acquired in a manner inconsistent with skills the individual already possesses
splinter skills
learned nonuse can lead to ____ skills
splinter skills
what type of training is recommended for a patient who presents with significant comorbidities, impairments, and functional limitations with little or no expectation for additional recovery
substitution training
_____ and _______ deficits have the greatest impact on functional performance
motor and perceptual deficits
understanding of the neural, physical, and behavioral aspects of biological movement
motor control
coordinated movement strategies with a goal or attaining and action + require voluntary control
motor skill
2 categories of motor skill
mobility and stability
requires the individual to move the body from one posture to another in a controlled manner (BOS and COG are moving)
mobility
static postural control and dynamic postural control
stability
maintaining posture with unchanging COM and BOS
static postural control
posture adjusted and maintained while extremities are moving
dynamic postural control
motor skills requiring large muscle groups and body parts acquired in early childhood (examples: rolling, crawling, standing)
gross motor skills
motor skills requiring control of small muscle groups, smaller movements with precision (examples: ADLs, eating, buttoning, writing)
fine motor skills
motor skills that have a recognized beginning and end (examples: STS, lying down, throwing a ball)
discrete motor skills
series of discrete motor skills with specific order
(example: bed to wheelchair transfer)
serial motor skills
motor skills with no recognizable beginning or end (examples: swimming or running)
continuous motor skills
motor skills in a stable and predictable environment
closed motor skills
motor skills in a constantly changing and unpredictable environment
open motor skills
motor skills that are simple and produce an individual movement response
simple motor skills
motor skills that involve multiple actions and motor programs combined to create coordinated movement
complex motor skills
motor skills that also involve a cognitive or physical task
dual task skills
3 stages of motor learning
-cognitive
-associative
-autonomous
stage of motor learning of understanding the task
cognitive stage
stage of motor learning of practice movements + refining motor PROGRAMS
associative stage
stage of motor learning of practice movement + refining motor PROCESSES
autonomous stage
_______ is more effective in slower positional tasks and less effective in ballistic tasks
guidance
which 2 stages can dual tasks be initiated?
associated and autonomous
as the patient progresses to associative and autonomous stages, the patient should now be focusing on more ___________ feedback rather than verbal or guided movements
proprioceptive
increased practice = increased ______ _________
motor learning
information given by the body
intrinsic feedback
information given by external sources
extrinsic feedback
information about the movement outcome
knowledge of results
information about the nature or quality of the movement
knowledge of performance
frequent _______ feedback can slow retention and foster dependence on an external source
extrinsic
new learners need more ______ feedback, but as the learner improves they need less frequent feedback
immediate
interventions for motor control/motor skills
-flexibility
-strengthening
-neuromuscular endurance/fatigue
-coordination
-balance + postural control
-task specific training
-task specific environment structure
-dosage
type of feedback used with severe weakness and used to assist in recruitment of muscles and re-education
electromyographic feedback
patients may be able to generate muscle function but do not have the ability to _______ the contraction over time
sustain
inability to coordinate muscles, joints, and limbs for smooth and accurate movement (usually due to cerebellar lesion)
ataxia
training treatment for neurological patients that is meaningful, effortful, and task specific
task specific training
4 task specific structuring of the environment
-stationary person in stationary environment
-moving person in stationary environment
-stationary person in moving environment
-moving person in moving environment
what is the proper intensity dosage to achieve neuroplastic changes?
high intensity (FITT principle)
intervention that uses the facilitation of total patterns of movement to promote motor learning
proprioceptive neuromuscular facilitation (PNF)
PNF places emphasis on _____ of function rather than compensation
recovery
PNF is based on the idea that normal movements are _____ and ________
spiral and diagonal
typically impaired following CVA due to weakness, sensory loss, impaired balance, and loss of confidence
gait
part of the body that is often overlooked during gait but very important
upper extremity
used in predicting patient’s ability to ambulate in different environments
gait speed
what 4 aspects of gait should be measured and recorded?
-time
-distance
-cadence
-velocity
what are some common gait deviations post stroke?
-slow speed
-asymmetrical or uneven step + stride lengths
-reduced stance time on affected limb
-decreased push off force on affected limb
-use of synergy patterns to advance limb
-impaired balance with UE + LE posturing
-reliance on adaptive equipment
-spasticity requiring compensatory advancement
3 classifications of walking handicap after stroke
physiological walker
limited household walker
community walker
walking classification: walks for exercise only either at home or in therapy
physiological walker
walking classification: relies on walking for home activities but requires assist for other walking activities
limited household walker
walking classification: can walk for an unlimited distance outside
community walker
primary contributor to disordered gait affecting the number, type, and frequency of motor neuron activation necessary for gait progression
paresis
primary impairment after corticospinal pathology
paresis
muscles act concentrically to generate ______ and eccentrically to ______
concentric: force
eccentric: control
spasticity is _______ dependent
velocity
what 2 ways can spasticity impact gait?
-inappropriate activation of muscle when rapidly stretched (beating)
-increased stiffness
_______ patterns are associated with reduced stability and poor locomotion
synergistic
post stroke, patients have a decreased ability to modify gait characteristics in response to terrain and slope changes such as?
-gait speed
-step length
_________ of muscles unrelated to spasticity can affect progression in gait and postural control
overactivity
overactivity is common in what muscle group?
hamstrings
inability to time and scale muscle activity during gait can lead to ______ gait
ataxic
_______ is critical to balance strategies during gait
vision
______ can have an impact on the person’s ability to perceive potential threats to stability during gait
hemianopsia
loss of ______ input in adulthood can produce gait ataxia and difficulty stabilizing the head in space
vestibular
in patients who have lost vestibular input, will they show shorter or longer double stance support?
longer
a vision problem that makes it seem like your surroundings are moving when they’re actually still because they eyes cannot stabilize (bounce with head)
+ impaired VOR
oscillopsia
what compensations occur if there is no eccentric plantarflexion control?
knee hyperextension during stance
lack of knee flexion for swing
what muscle produces more propelling force than any other muscle during the gait cycle?
gastrocs
plantarflexor spasticity primarily occurs in the early part of the _____ phase of walking secondary to stretching of the gastrocs
stance
spasticity in the plantarflexors causes inability of the _____ to generate enough force for push off
gastrocs
what 2 ways does spasticity in the plantarflexors impact foot position?
-limit dorsiflexion
-prevent heel strike at initial contact
if initial contact is made with foot flat, what will happen to the knee?
knee hyperextension
if the patient has reduced forward foot clearance, what will happen to the toe?
toe drag
weak ______ lead to difficulty controlling knee flexion during loading and midstance
quads
weak quad compensation is knee _______ during mid stance or forward trunk lean to bring ground reaction forces ________ to the knee
knee hyperextension
anterior
true or false: weak quads can also contribute to excessive knee extension
true
during initial contact, there is brief knee ______ to absorb shock, which can trigger spasticity in the quads = knee hyperextension
flexion
excessive gastroc and posterior tibialis activation can produce _______ and ________ foot positions
inversion and equinovarus
common compensatory strategies during gait
-reduced WB time on involved LE
-avoiding impact loads
-limiting joint excursions to maintain stability
hip flexor weakness primarily affects the _____ phase of gait
swing phase
if inadequate hip flexion and knee flexion for swing is lost, toe ______ is reduced
clearance (toe drag)
compensatory strategies used to achieve foot clearance without adequate hip flexion
-posterior pelvic tilt
-activation of abdominals
-circumductioon (hip hike)
-contralateral vaulting to toe
-lateral trunk lean
weakness in these muscles can result in a forward trunk learn
hip extensors
what compensation is made for hip extensor weakness to bring the center of mass behind the hips?
backward lean
what muscle is active to prevent from falling backwards?
TA
weakness in this muscle group can result in a contralateral pelvic drop (Trendelenburg), resulting in instability in the frontal plane
hip abductors (glute med)
what is the common compensation for a trendelenburg gait?
lateral trunk lean over stance leg
Trendelenberg gait is named according to the strong or the weak side?
weak side
spasticity in the hamstrings produces excessive knee flexion, which leads to a _____ gait pattern
crouched
in terminal swing, excessive activation of _________ prevents the knee from fully extending
hamstrings
spasticity in this muscle group can result in a scissoring gait pattern
hip adductors
knee hyperextension during initial contact = ______ weakness
quad
knee hyperextension during mid stance = ________ weakness
plantarflexors
outcome measures for gait (4-5)
-TUG
-10 meter walk
-6 minute walk
-FGA/DGI
how far does the patient walk during the TUG?
10 feet or 3 meters x2
> ___ second = fall risk for stroke population on the TUG
> 14 seconds
normal TUG time for healthy adult
< 10-12 seconds
total time to ambulate 10 meter walk test is recorded in what units?
meters/second
what gait speed in m/s is the goal to be independent in ADLs, decrease hospitalization, and be a community ambulator?
1.0 m/s
how many meters of the 10m walk test are actually timed?
6m
score < ___ on the DGI is indicative of fall risk
< 19
outcome measure that measures the patient’s ability to perform steady state walking and variations on common, strong fall risk predictor
DGI
outcome measure used to assess postural stability during walking and assesses an individual’s ability to perform multiple motor tasks while walking, strong fall risk predictor
FGA
score < ___ on FGA is indicative of fall risk
< 22
outcome measure that assesses distance walked over 6 minutes as a sub maximal test of aerobic capacity/endurance
6 minute walk test
impairment-based standardized way to test for motor recovery, organized by sequential recovery stages, and takes 30-45 minutes to administer
fugl-meyer assessment
outcome measure for finger dexterity, time is measured
9 hole peg test
outcome measure comprised of 19 UE functional tasks/movements with 4 sub scales and ordinal scoring
action research arm test
what are the 4 sub scales of the action research arm test?
grasping
gripping
pinching
gross movement
a total score of ____ indicates normal UE use on the action research arm test
57
outcome measure that evaluates disability in UE function of 13 ADLs using a quantitative and qualitative measure, reading an article is required
arm motor ability test
outcome measure that assesses unilateral gross manual dexterity and is performed in sitting, 2 square compartments with 150 wood cubes
box and blocks test
make or break test where the patient is asked to maintain an isometric contraction for 2-3 seconds, scored using force production
dynamometry
clinical syndrome that needs the most attention to the UE
MCA stroke
attention should be paid to external rotation and humeral distraction with mobilizations, especially in ranges of 90 degrees flexion or more, to avoid _________
impingement
what scapular motion should be prioritized with mobilizations to prevent impingement with overhead movements?
upward rotation
contraindicated secondary to impairments in scapulohumeral movement
pulleys
prioritize elbow extension to avoid ________
contractures
what mobilization grades for the carpal bones should be considered before stretching?
grades I and II
additional priority should be placed on maintaining the length of wrist and finger _________
extensors
once full ROM is achieved, the limbs should be placed in the lengthened position and maintained. this is called?
sustained stretching
modality that slows nerve conduction and decreases muscle spindle activity to reduce spasticity
cold modalities
modality used to target the antagonist muscles for the goal of reciprocal inhibition
functional electrical stimulation (FES)
encourage utilization of the ______ side to promote increased awareness and sensory function
affected
most common shoulder subluxation
inferior
occurs secondary to muscular and biomechanics factors of glenohumeral joint stability, often FOOSH mechanism
shoulder subluxation
when the shoulder is _______ post stroke, there is reduced support and action of the rotator cuff
-proprioceptive loss
-lack of muscle tone
-muscle paralysis
flaccid
when the shoulder is _______ post stroke, there is abnormal muscle tone that can contribute to poor scapular motion
-subluxation and restricted movement could occur (adhesive capsulitis)
spastic
application of imagery techniques for improving motor performance and learning, practice can be visual or kinesthetic
mental imagery (MI)
assesses a patient’s ability to imagine
quick mental chronometry screen
type of therapeutic intervention that focuses on moving the less impaired limb while watching its mirror reflection
mirror therapy (MT)
what type of feedback does mirror therapy use to improve motor function?
visual feedback
inability to activate which muscle is a common cause of impaired heel strike?
tibialis anterior
corrects supination to improve ankle stability, common impairments in neurologic gait
aircast
gait intervention that has proper intensity, repetition, and specificity?
high intensity gait training (HIGT)
score < ____ on the BERG is indicative of a fall risk for older adults and people with a stroke
< 45
14 item scale for measuring balance in sitting and standing in adults
BERG balance scale
test for reactive balance, pull backwards and observe response
retropulsive test
12 items performance based scape used for assessing and monitoring postural control following a stroke, max score is 36
postural assessment scale for stroke patients (PASS)
36 item test that assesses balance across 6 domains of postural control, total score of 108 and scored as a percentage
balance evaluations systems test (BEST)
< __% on the BEST Is indicative of a fall risk
< 82%
16 item self reported measure of balance confidence in performing various activities, rating is 0-100% with 0 being no confidence and 100 being the most confident
activities specific balance confidence scale
test that assesses how well an older adult is using sensory inputs when one of more sensory systems are compromised, 4 conditions for testing
modified clinical test for sensory interaction in balance (mCTSIB)
