Online Module: Secondary and Non-motor Impairments

Question 1

Briefly discuss how contracture could affect/alter your approach to treatment for a patient.

Answer 1

Permanent muscle shortening can limit joint range, leading to stiffness and restricted mobility. Treatment should include stretching, joint mobilization, and positioning techniques. Assistive devices and orthotics may be incorporated to maintain range and prevent further contracture.

Question 2

Briefly discuss how spasticity/dystonia could affect/alter your approach to treatment for a patient.

Answer 2

Increased muscle tone or involuntary movements require an approach focused on reducing spasticity and promoting functional movement. Techniques such as slow, prolonged stretching, weight-bearing activities, and the use of inhibitory patterns or modalities (e.g., cold therapy, electrical stimulation) can help. Pharmacological treatments like Botox can temporarily reduce spasticity, allowing for focused rehabilitation efforts.

Question 3

Briefly discuss how impaired vision could affect/alter your approach to treatment for a patient.

Answer 3

Vision issues can affect balance and coordination. Treatment should incorporate compensatory strategies, such as auditory cues, contrasting colors for exercises, and tactile feedback. Safety modifications to the environment and tasks focusing on spatial awareness and orientation are essential.

Question 4

Briefly discuss how impaired cognition could affect/alter your approach to treatment for a patient.

Answer 4

Cognitive deficits can hinder a patient’s ability to follow instructions and engage actively in rehabilitation. Treatment must be simplified and structured, often with step-by-step guidance and visual cues. Repetition and consistency can help reinforce learning and adherence.

Question 5

Briefly discuss how impaired sensation aphasia could affect/alter your approach to treatment for a patient.

Answer 5

Reduced sensation affects proprioception and protective reactions, posing a risk for injury. Treatment focuses on enhancing sensory input, such as weight-bearing activities and sensory retraining techniques. Adaptive strategies and increased use of visual feedback help mitigate these challenges.

Question 6

Briefly discuss how aphasia could affect/alter your approach to treatment for a patient.

Answer 6

Difficulty with language can impede communication and understanding of treatment. Strategies include using simple, clear instructions, non-verbal communication (gestures, pictures), and ensuring adequate time for response. Family or caregiver involvement can enhance communication

Question 7

Outline some of the potential issues when measuring joint range of motion and how these issues could be mitigated.

Answer 7

Issues:
- Patient Positioning: Improper positioning can affect accuracy. Ensure standard positions for each joint measurement.
- Measurement Consistency: Variability between sessions or examiners can lead to inconsistent results. Standardized methods and training can reduce inter-rater variability.
- Spasticity and Muscle Tone: High muscle tone may impact ROM assessment. Use techniques to temporarily reduce tone before measurement (e.g., slow stretching).
- Pain and Discomfort: Patients with pain may restrict movement. Address pain management strategies prior to measurement.
- Patient Cooperation: Cognitive or communication impairments can affect cooperation. Simplify instructions and use visual demonstrations.

Mitigation Strategies:
- Use standardized tools (goniometers, inclinometers) and techniques.
- Train staff to improve inter-rater reliability.
- Incorporate objective measures where possible (e.g., video analysis).
- Repeat measurements and average results for better reliability.

Question 8

Briefly outline the recommendations and discuss the evidence (for and against) treatment of contracture, spasticity/dystonia (i.e. Botox) and impaired sensation

Answer 8

Botox blocks the release of acetylcholine into the neuromuscular junction resulting in a temporary partial or complete paralysis of the muscle

Recommendations (for people with stroke)
For the UL, Botox may be used with rehabilitation therapy reduce spasticity, and may improve activity or motor function
For the lower limb, Botox may be used with rehabilitation therapy reduce spasticity, and may improve motor function or walking
Adjunct therapies to Botox, such as electrical stimulation, casting and taping, may be used

Recommendations against (for people with stroke)
Acupuncture should not be used Weak recommendation against Very low quality evidence
Stretch Routine use of stretch is not recommended

Question 9

Outline strategies to communicate with patients that have aphasia

Answer 9

• Use of hand signals (thumbs up or thumbs down), drawings, typing on a tablet

5 Do’s
- Ask Yes/no questions
- Use text and pictures
- Keep speech simple, slow and natural
- Offer options this, or this
- Give time to respond

3 Don’ts
Speak for them
Talk down to them Ignore them
Be condescending
Speaking louder
NO Speaking in a high pitch child-like tone is frustrating and condescending

Question 10

Outline the differences between dysarthria, dyspraxia and dysphasia

Answer 10

Dysarthria: Impaired ability to produce clear speech due to impaired motor function of the speech muscles

Dyspraxia: Impaired ability to produce clear speech due to impaired planning and sequencing of movement in speech muscles that is not due to reduced muscle strength, coordination or sensation.

Dysphasia is either receptive or expressive. Receptive - the dysfunction of comprehending /receiving language (like youre speaking to them in a foreign language), and expressive is where understanding is good, but finding the words is difficult