PRELIMS: Stroke Rehab

Question 1

What is early neurological recovery following a stroke attributable to?

Answer 1

Early recovery is attributed to the resolution of edema, allowing structurally intact but nonfunctional neurons to regain function.

Question 2

What drives functional recovery in stroke rehabilitation?

Answer 2

Functional recovery is driven by neurological recovery and rehabilitation efforts.

Question 3

What does late neurological recovery involve?

Answer 3

Late neurological recovery involves neuroplasticity, where the brain reorganizes itself to compensate for lost functions.

Question 3

Why is reperfusion of the ischemic penumbra critical?

Answer 3

Reperfusion allows nonfunctional but viable neurons to regain function and supports clinical recovery.

Question 3

Why is functional recovery important?

Answer 3

It ensures that individuals can return to their daily activities and improve their quality of life.

Question 3

What does cortical reorganization involve?

Answer 3

Cortical reorganization involves functional changes in the motor cortex due to skilled movement acquisition and injury-induced changes in remaining cortical tissue.

Question 3

What is the ischemic penumbra?

Answer 3

The ischemic penumbra is a region surrounding the core infarct area where blood flow is reduced but still salvageable.

Question 4

What is diaschisis?

Answer 4

Diaschisis is the loss or decrease in function of a brain region distant from the primary injury due to disrupted neuronal connections.

Question 4

In which Brunnstrom stage does movement begin to emerge outside of synergy?

Answer 4

Stage 4.

Question 4

What mechanisms contribute to the resolution of diaschisis?

Answer 4

Restoration of blood flow, neuronal plasticity, reestablishment of neural pathways, reduction in metabolic depression, and rehabilitation.

Question 4

What are the mechanisms of neuroplasticity?

Answer 4

Neuronal regeneration/collateral sprouting and functional reorganization/unmasking.

Question 5

What is a common lower extremity synergy pattern post-stroke?

Answer 5

Extension synergy (e.g., hip extension, knee extension).

Question 5

Extension synergy (e.g., hip extension, knee extension).

Answer 5

Stage 1 is characterized by flaccidity with no voluntary movement.

Question 5

What is a common upper extremity synergy pattern post-stroke?

Answer 5

: Flexor synergy (e.g., shoulder flexion, elbow flexion).

Question 5

Stage 1 is characterized by flaccidity with no voluntary movement.

Answer 5

Marked spasticity with movement primarily in synergy patterns.

Question 5

What is the role of tonic reflexes in Brunnstrom’s approach?

Answer 5

Tonic reflexes (TNR, TLR, tonic lumbar reflexes) help to initiate movements or inhibit undesired muscular responses by influencing muscle tone and movement patterns.

Question 6

How can cutaneous stimulation be utilized in Brunnstrom’s approach?

Answer 6

Cutaneous stimulation can reinforce flexor or extensor muscles or muscle groups locally to support motor function and recovery.

Question 6

What are associated reactions in hemiplegic patients?

Answer 6

Associated reactions are involuntary movements or reflexive increases in muscle tone observed in involved extremities when other parts of the body are moved or resisted.

Question 6

What defines Stage 6 of Brunnstrom’s stages of recovery?

Answer 6

The return of more isolated and coordinated movement patterns.

Question 7

Why are limb synergies considered necessary in stroke recovery according to Brunnstrom?

Answer 7

Limb synergies are necessary as they precede the restoration of advanced motor function and represent a stage of gross movement that must be developed before more refined movements can occur.

Question 8

What is Homolateral Limb Synkinesis?

Answer 8

It is an associated reaction where voluntary movement of the hip flexion on the affected side evokes flexion of the upper extremity on the same side.

Question 8

Describe the components of the upper extremity flexor synergy.

Answer 8

The upper extremity flexor synergy includes scapular retraction, shoulder abduction/external rotation, elbow flexion, forearm supination, wrist, and finger flexion. Elbow flexion is the strongest component and appears first.

Question 8

Explain Raimiste’s Phenomena.

Answer 8

Raimiste’s Phenomena is an associated reaction where hip adduction or abduction on one side elicits the same movement in the opposite limb.

Question 8

What are the key characteristics of Stage 2 in Brunnstrom’s recovery stages?

Answer 8

In Stage 2, spasticity begins to develop, and reflexes may start to return.

Question 9

What are the key components of the upper extremity extensor synergy?

Answer 9

The extensor synergy includes scapular protraction, shoulder adduction/internal rotation, elbow extension, forearm pronation, wrist extension, and finger flexion. Scapular adduction/internal rotation and pronation are among the strongest components.

Question 9

What are the components of the lower extremity flexor synergy?

Answer 9

The lower extremity flexor synergy involves hip flexion, hip abduction/external rotation, knee flexion, ankle dorsiflexion, and inversion. Hip flexion is the strongest component.

Question 9

What are the components of the lower extremity extensor synergy?

Answer 9

he lower extremity extensor synergy includes hip extension, hip adduction/internal rotation, knee extension, ankle plantarflexion, and inversion. Hip adduction, knee extension, and ankle plantarflexion are the strongest components.

Question 9

What defines Stage 5 in the recovery process according to Brunnstrom?

Answer 9

Stage 5 is marked by mastery of more complex movement combinations and continued decline in spasticity.

Question 10

What are the key principles for evaluating a hemiplegic patient?

Answer 10

Evaluations should be brief, easy to administer, standardized, and avoid complicated equipment. Movement patterns, rather than individual joint movements, should be tested.

Question 10

Describe the movements and changes observed in Stage 4.

Answer 10

In Stage 4, some movement combinations become possible, and spasticity begins to decline.

Question 11

Why is standard MMT not applicable for hemiplegic patients?

Answer 11

Standard MMT tests isolated muscle strength, which is not feasible in early recovery stages due to spasticity.

Question 12

What is the procedure for assessing sensory loss in a hemiplegic patient?

Answer 12

The passive motion test involves moving the affected extremity while the unaffected arm imitates movements. Sensory status is assessed through pressure sensitivity and position sense.

Question 13

What are the motor tests for the shoulder and elbow at Stage 4?

Answer 13

Tests include placing the hand behind the body, elevating the arm to a forward-horizontal position, and performing pronation-supination with the elbow at 90 degrees.

Question 14

What does Stage 5 motor testing for the arm involve?

Answer 14

It includes raising the arm to a side-horizontal position and forward and overhead, with attention to elbow extension and movement similarity to the unaffected side.

Question 15

What does Twitchell’s model predict about motor recovery?

Answer 15

It predicts recovery based on the severity of upper extremity weakness and the timing of the return of hand movement.

Question 16

What are the primary goals of rehabilitation in the acute phase of stroke recovery?

Answer 16

Goals include preventing pressure injuries, managing bladder function, preventing contractures, and preventing deep vein thrombosis (DVT).