Reaching

Question 1

discuss UE impairments post stroke

Answer 1

somatosensory impairments - mixed exteroceptive, proprioceptive and cortical somatosensory

more time before PT = more impairments

Question 2

usual UE presentation post stroke

Answer 2

shoulder depressed/sublux and protracted

shoulder adducted and IR

elbow flexed and pronated

wrist flexed and fingers in fist

Question 3

what causes shoulder pain in stroke pt

Answer 3

altered scapular and humeral movements

dapat kasi smooth ang transition so dapat may treatment din for scapular movements

Question 4

exercise to dec shoulder pain

Answer 4

controlled lowering of UE - inc control or arm by activating anti gravity muscles that lowers spasticity

Question 5

causes of shoulder subluxation

Answer 5

flaccid deltoid and supraspin

spastic humeral depressors - subscap and infraspin

spasticity of adductors and IRs - pec major and lats

spasticity of side flexors of trunk

Question 6

contribution of visual system to reach and grasp

Answer 6

hand eye coordination
perception and object recognition
localisation

all to see targets and localize

Question 7

contribution of somatosensory system to reach and grasp

Answer 7

for fine tuning grip

tactile and pressure to determine weight, texture, density and form

Question 8

contribution of MSK system to reach and grasp

Answer 8

adequate joint ROM and strength is essential

so dapat ttrain din sila
- task and context specific

Question 9

relate postural stab to reaching and grasping

Answer 9

postural stab is no prerequisite in training reach and grasp BUT has STRONG INFLUENCE on UE function

need postural stab on more complex movement, reaching and grasping patterns

Question 10

discuss the phases of reaching

Answer 10

1. transportation phase: hand moves to target
   - hand aperture is larger
   - thumb leads direction of thumb
2. manipulation phase: fine tuning
   - aperture is fine/smaller to grab object

Question 11

goals of rehab in reaching

Answer 11

promote activity of UE for diff tasks

prevent contracture of at risk muscles - aforementioned, 1st web space and FA pronators

stimulate and preserve muscle contractility

Question 12

what is constraint induced movement therapy

Answer 12

constraint good arm to induce movement of bad arm

Question 13

criteria for CIMT

Answer 13

good sitting balance

active wrist ext - 5-10°

active wrist flexion - 5°

Question 14

parameters for MLR through CIMT

Answer 14

constraint for 6 hrs for 2 wks = exercise for 6 hrs

task specific through massed practice

video guided fback

Question 15

discuss procedures for CIMT

Answer 15

focus on shoulder activation - through tracing - mimics shoulder movement via AAROM

wrap towel for thick handle - tape marker to finger - no assistance

straight motions first to zigzag

pwede din going to X while hooked on ES
- feedback matters

Question 16

relate use of ES to post stroke pts

Answer 16

mild to severe weakness - use ES c motor training - usually supraspin and post delts

Question 17

what is mirror therapy

Answer 17

tricks the brain to think that affected arm is moving

good arm is placed in front of mirror then pt looks at reflection while doing activities

Question 18

criteria for mirror therapy

Answer 18

sufficient cognitive and verbal activities

focus at least 10 mins

follows instruction

F to G trunk control

no cardiopulmo abnormalities

unaffected limb should be pain free and N ROM