OTA week four

Question 1

stages of recovery after a stroke - the brunnstorm approach

Answer 1

1. flaccidity
2. spasticity appears
3. spasticity increases
4. spasticity decreases
5. complex movements appear
6. spasticity disappears
7. normal function returns

Question 2

how to make it meaningful

Answer 2

• base it on their interests
• educate patient during the tasks
• pace sessions and ensure some success

Question 3

common treatments and their effectiveness

Answer 3

1. Functional activities
2. Mirror therapy
3. Virtual reality
4. Strength training
5. Mental imagery
6. Supplementary Training, including GRASP
7. Splinting and orthotics
8. Range of motion

Question 4

functional activities

Answer 4

evidence level: early level A; late level A

• pt engages in training that is meaningful, engaging, repetitive

Question 5

ADL

Answer 5

early level A; late level A

• most effective means to improve UE function
• remediation is the optimal approach

Question 6

ADL : compensatory techniques

Answer 6

evidence level B

• pt who can’t produce any voluntary muscle activity in the affected upper limb, pt should be taught compensatory techniques and be provided with adl equi[

Question 7

specific compensatory treatment modalities for the UE

Answer 7

evidence level b and c

• adaptive devices designed to improve safety and function should be given to pt if other methods don’t work with them
• need for special equip should be evaluated on individual basis

-functional dynamic orthoses are an emerging therapy tool that may be offered to pt to facilitate repetitive task specific training

Question 8

mirror therapy

Answer 8

• level of early level a ; late level a
• considered as an adjunct to motor therapy for pt with severe paresis.
  helps to improve UE and motor function and adls

Question 9

traditional or modified constraint induced movement therapy (cimt)

Answer 9

evidence level early level a ; late level a

• pt with 20 degrees of active wrist ext and 10 degrees of active finger ext with minimal sensory or cognitive deficits
• 2 types of version of cimt: complete restraint and partial

Question 10

strength training

Answer 10

evidence level : level a

• strength training should be considered for persons with mild to moderate UE impairment

Question 11

supplementary training - GRASP

Answer 11

early evidence level B ; late evidence level c

• aimed at increasing active movement and functional use of the affected arm between therapy sessions

Question 12

mental imagery

Answer 12

early evidence level b ; late evidence c

• rehearsal of a physical activity in the absence of any physical movement
• can mentally rehearse adl or exercise tasks

Question 13

mental imagery scripts

Answer 13

1. Physical
2. Environmental
3. Task
4. Timing
5. Learning
6. Emotion
7. Perspective

Question 14

splinting post stroke

Answer 14

• spasticity and contractures can be prevented by antispastic pattern positioning, rom exercises, or stretching (evidence Levels: Early- Level C; Late-Level
  C)
• splints is not recommended, but optimal protocols for using splints for improvement of tissue length and spasticity management have not yet been determined
• for some patients, using splints could be useful and should be considered on an individual basis

Question 15

what is the purpose of orthoses and splints

Answer 15

provides structure to:

• support joint in an optimal position for function and to reduce inflammation
• correct posture or deformity
• provide assistance
• protect or support an area

Question 16

what are types of braces?

Answer 16

• cervical neck collar
  -tlso
  -afo
  -kafo

Question 17

splinting post stroke

Answer 17

• promote function and increase rom, manage spasticity, prevent contracture, positioning assistance of edema management
  -provide an adjunct to movement retraining and task practice
  -pain management

Question 18

splinting; pros, cons, and red flags

Answer 18

• tone is a dynamic thing; splinting one area leads to unexpected changes
  -splints must allow for as much function as possible
  -splints must be monitored for fit and functions
  -common goals for splinting:
  stage 1 supporting for flaccid or painful hand
  stage 2-3 maintaining rom for hygiene and skin integrity

Question 19

rom ; do not

Answer 19

-overhead pulleys should not be used (evidence level a)
-don’t move it beyond 90 degrees of shoulder flex or abd, unless scapula is upwardly rotated and the humerus is laterally rotated (evidence level a)
-avoid pulling on affected arm (evidence level c)
- DONT PULL ON THE ARM OR SHOULDER EVERRRR

Question 20

ROM ; dos

Answer 20

• hcp, pt, family should be educated to correctly handle the involved evidence level a
• pt with flaccid arm, ems can be considered (evidence level: early level b; late level b)
  -joint protection strategies minimizes shoulder pain which includes:
  positioning and supporting the arm during rest (evidence level b). protecting and supporting the arm during functional mobility (Evidence
  Level C).
  Protecting and supporting the arm
  during wheelchair use by using a
  hemi-tray or arm trough (Evidence
  Level C).

Question 21

managing hand edema: do

Answer 21

• active, active assisted, or prom, in conjunction with arm elevation - level c
• retrograde massage - level c
• gentle grade 1-2 mobilizations for accessory movements of hand and fingers - level c

Question 22

management of crps - complex regional pain syndrome

Answer 22

prevention: active, active assisted, prom, can be used to prevent crps - level c

Question 23

what are 5 things to remember to monitor when using a splint?

Answer 23

• swelling
• redness
  -blisters/skin integrity
  -irritation
  -numbness

Question 24

after having a stroke, at which stage does spasticity start to appear based on the brunnstrom approach?

Answer 24

• stage 2

Question 25

name one example of a remediation treatment modality for the UE, after a stroke, that is evidence based level A

Answer 25

• mirror therapy is a great remediation for the UE as it improves UE motor function and ADLs