PPC AT1 MID SEM EXAM Flashcards
STROKE: Primary motor impairments
- Muscle weakness
- Loss of coordination
STROKE: Primary non-motor impairments
- Altered sensation
- Altered proprioception
- Altered perception
- Altered cognition
- Altered communication
- Altered behaviour
STROKE: Secondary motor impairments
- Loss of CV fitness
- Reduced muscle length
- Spasticity
STROKE: Secondary non-motor impairments
- Fatigue
STROKE: Early motor activity limitations
Decreased walking, standing, standing up, sitting, bed mobility, reaching and manipulation, speaking and swallowing
STROKE: Early non-motor activity limitations
Decreased speech and cognition
STROKE: Late motor activity limitations
- 80% can walk by end of rehab
- 65% non-walkers achieve walking by 6 months
STROKE: Late non-motor activity limitations
50% with aphasia have recovered by 6 months
STROKE: Early participation restrictions
Decreased domestic tasks, self care, work, study and sport
STROKE: Late participation restrictions
40-80% dead or dependent on others at 6 months
TBI: Primary motor impairments
- Muscle weakness
- Ataxia
TBI: Primary non-motor impairments
- Altered perception
- Altered cognition
- Altered behaviour
- Altered proprioception
- Altered sensation
TBI: Secondary motor impairments
- Loss of CV fitness
- Reduced muscle length
- Spasticity
TBI: Secondary non-motor impairments
- Fatigue
- Depression
TBI: Early motor activity limitations
Decreased walking, standing, standing up, sitting, bed mobility, reaching and manipulation, and swallowing
TBI: Early non-motor activity limitations
Decreased speech and cognitive ability
TBI: Late motor and non-motor activity limitations
70% with severe TBI will have ongoing limitations
TBI: Early participation restrictions
Decreased domestic tasks, self care, work, study and sport
TBI: Late participation restrictions
- 63% socially isolated
- 60% higher support needs
- Approx. 40% will return to work after TBI
PD: Primary motor impairments
- Tremor
- Bradykinesia
- Hypokinesia
- Freezing
- Rigidity
PD: Primary non-motor impairments
- Altered cognition
PD: Secondary motor impairments
- Dyskinesia
- Dystonia
- Muscle weakness
- Loss of CV fitness
PD: Secondary non-motor impairments
- Depression
- Anxiety
- Apathy
- Psychosis
PD: Early motor activity limitations
Decreased walking, standing, standing up, bed mobility, reaching and manipulation
PD: Early non-motor activity limitations
Decreased cognitive ability in 40% of cases
PD: Late motor activity limitations
Degenerative condition where performance will deteriorate over time
PD: Late non-motor activity limitations
Decreased language and cognition
PD: Early participation restrictions
Mild upon diagnosis, increasing over time
PD: Late participation restrictions
Normal life expectancy in most cases, with decreasing domestic tasks, self care, work, study and sport, with increased need for support over time
STANDING: Main important components
- Feet few inches apart and pointing forwards
- Hips in front of ankles
- Shoulders over hips
- Head balanced on level shoulders
- Erect trunk
STANDING: Adaptive strategies
- Wide base of support (feet far apart or legs externally rotated)
- Shifts weight to intact foot
- Flexes at hips/protracts at shoulder instead of dorsiflexing at ankles, moves trunk instead of hips/ankles (for reaching)
- Takes premature step
- Shuffles feet
- Uses arms for balance
- Avoids balance threats by hypo/bradykinesia, holding breath or stiffly
SIT TO STAND: Main important components
- Initial alignment reduces thigh support and increases ankle DF
- Feet placement (knee flexion, ankles back into dorsiflexion)
- Inclination of trunk forward by flexion at hips with extended trunk
- Movement of knees forward
- Extension of hips and knees for final standing alignment
SIT TO STAND: Adaptive strategies
PRE-EXTENSION PHASE:
- Weight borne through intact side
- Wide base of support
EXTENSION PHASE:
- Falls backwards
- Pushes through arms
- Weight borne through intact side
- Final alignment flexed
REACHING AND MANIPULATION: Main important components of REACHING
- Protraction and elevation of shoulder girdle
- Shoulder flexion (fwd), abduction (side), and extension (bwd)
- Shoulder external rotation
- Elbow flex/ext
- Wrist extension w/ radial deviation
- Opening of hand aperture btw fingers and thumb
- Pronation/supination appropriate to object
REACHING AND MANIPULATION: Main important components of GRASPING
- Extension of wrist/fingers
- Conjunct rotation (flex+abd) of CMCJ thumb
- Conjunct rotation of MCPJ of ulna fingers
- Closure of thumb/fingers around object w/ MCPJ flex while some IPJ in some ext
REACHING AND MANIPULATION: Main important components of HOLDING
- Flex/ext of wrist holding object
- Lifting, placing and rotating objects of different sizes and weights
REACHING AND MANIPULATION: Main important components of MANIPULATING
- Flex/ext of fingers
- Cupping of the hand
- Independent finger flex/ext (e.g. tapping)
REACHING AND MANIPULATION: Adaptive strategies
- Uses intact arm only
- Excessive hip flexion, shoulder elevation, abd+IR at GHJ, trunk side flexion to intact side
- Excessive elbow flex + forearm pronation
- Grasps/releases objects w/ wrist in excessive flexion
- Excessive aperture btw thumb & fingers for grasp/release
- Extension of CMCJ thumb & pronation of forearm for grasp/release
- Flat hand/lack of cupping
- Inability to move objects within hand
WALKING STANCE: Main important components for HIP
- Extension of hip throughout
- Lateral horizontal shift of pelvis and trunk
WALKING STANCE: Main important components for KNEE
- Flexion of knee (10 degree knee yield) on heel strike
- Knee extension through midstance
- Knee flexion prior to toe-off
WALKING STANCE: Main important components for ANKLE
- Dorsiflexion of ankle at heel strike and throughout stance
- Fast concentric plantarflexion
WALKING SWING: Main important components for HIP
- Hip extension at toe-off
- Hip flexion throughout mid-swing and at end swing
- Pelvic rotation forward
- Slight lateral pelvic tilt downwards
WALKING SWING: Main important components for KNEE
- Flexion of knee at toe-off
- Continued knee flexion through mid swing
- Knee extension prior to heel strike
WALKING SWING: Main important components for ANKLE
- Initial plantarflexion at toe-off, dorsiflexion throughout swing
- Eccentric dorsiflexion at heel strike
WALKING: Adaptive strategies
- Slow speed/cadence
- Increased time in double support
- Short step length
- Trunk inclined forward in stance
- Wide base of support
- Elevation of pelvis and abduction of leg
- Toes not clearing ground during swing (or circumduction)
- Trunk inclined backwards at end of swing
COMMUNICATION: What is needed in an introduction for an exercise?
My name and what I do
COMMUNICATION: What is needed in an explanation of an exercise?
The exercise needs to be meaningfully related to patient’s context (e.g. we are doing this to work on your coordination so you don’t fall as often, as this is something you are concerned about)
COMMUNICATION: What is needed in instructions for an exercise?
- Simple and specific verbal instructions
- Demonstration of exercise
- Consideration of cognitive impairments to understanding instructions
COMMUNICATION: What is needed for feedback for an exercise?
Knowledge of performance: given during exercise (unless cognitively slow) to indicate they are completing exercise correctly or not
Knowledge of results: given at end of training to indicate how many times they were successful in completing the exercise
DEFINITIONS: Weakness
Reduction in peak torque and ability to generate force rapidly
DEFINITIONS: Spasticity
A velocity-dependent increase in tonic stretch reflexes w/ exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex
DEFINITIONS: Muscle tone
Resistance of normal, relaxed limb to passive stretch
DEFINITIONS: Hypertonia
Increased resistance of relaxed limb to passive stretch
DEFINITIONS: Hypotonia
Decreased resistance of relaxed limb to passive stretch
DEFINITIONS: Contracture
Decreased compliance to passive stretch due to change in mechanical properties of a muscle
DEFINITIONS: Balance
The ability to control the centre of mass relative to the base of support
DEFINITIONS: Coordination
The ability to solve any motor task precisely, quickly, rationally and deftly w/ flexibility with respect to the changing environment
DEFINITIONS: Dysphagia
Difficulty swallowing
DEFINITIONS: Aphasia
Loss of ability to produce and/or comprehend language
DEFINITIONS: Neglect
Spatial inattention, meaning a decreased ability to attend to information on both sides of the body and/or environment
DEFINITIONS: Short-term memory loss
Decreased ability to recall recent events
DEFINITIONS: Post traumatic amnesia (PTA)
Disorientation to time and place, inability to lay down memories. Common after TBI
DEFINITIONS: Apathy
Reduced goal-directed behaviour
DEFINITIONS: Emotional lability
Outbursts of uncontrolled and inappropriate emotion (e.g. crying or laughing)
DEFINITIONS: Disinhibition
Failure to control drives (e.g. anger, sexual, hunger)
DEFINITIONS: Dysarthria
A motor speech coordination problem resulting in difficult or unclear articulation of speech
DEFINITIONS: Tremor
A more or less rhythmic, involuntary movement. Tremor in PD is a resting tremor (disappears w/ action and sleep) more prominent in distal areas
DEFINITIONS: Postural tremor
Tremor present while maintaining a position against gravity
DEFINITIONS: Kinetic tremor
Tremor present during voluntary movement
DEFINITIONS: Rigidity
Increased stiffness throughout joint PROM, present during bidirectional movements
DEFINITIONS: Bradykinesia
Slowness of movement
DEFINITIONS: Akinesia
Reduced spontaneous movement (freezing)
DEFINITIONS: Hypokinesia
Reduced amplitude of movement
DEFINITIONS: Freezing
Difficulty commencing or continuing a rhythmic repetitive movement
DEFINITIONS: Dyskinesia
Involuntary, purposeless movements (common side effect of PD medications wear off)
DEFINITIONS: Dystonia
Prolonged muscle spasms and persistent postures of the body (occur in PD when medication is not effective)
