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Neuromuscular Exam and Rehab Exam 2 > Restoration vs. Compensation & CVA Outcomes > Flashcards

Restoration vs. Compensation & CVA Outcomes Flashcards

1
Q

What is the time period for Hyper-Acute Phase?

A

0-24 hours (includes cell death)

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2
Q

What is the time period for Acute Phase?

A

1-7 days (inflammation and scarring and endogenous plasticity)

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3
Q

What is the time period for Subacute Phase?

A
  • Early ( 7 days to 3 months)
  • Late ( 3 to 6 months)
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4
Q

What is the time period of chronic phase?

A

More than 6 months post

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5
Q

What are episodes of care?

A
  • Acute care
  • Inpatient Rehabilitation
  • Subacute Rehabilitation
  • Outpatient Rehabilitation
  • Home/Community- Based Care
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6
Q

What is the setting for Acute Phase?

A

Intensive Care Unit (ICU) or specialized stroke care unit

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7
Q

What are the therapist considerations for Acute Phase?

A

Reviewing the medical record and communicating with the medical team

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8
Q

What are the goals for Acute Phase?

A
  • Monitor changes in the patient’s status and promote early mobilization
  • Early stimulation of the hemiparetic side to promote functional reorganization
  • Encourage a positive outlook towards the rehabilitation
  • Provide instruction, education and training
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9
Q

What are intervention for Acute Phase?

A

Bed mobility, Sitting, Transfers, Locomotion, ADL training, ROM, Splinting, and Positioning

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10
Q

What is the setting for Subacute Phase?

A

Intensive inpatient rehabilitation, transitional care unit (TCU) within a skilled nursing facility

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11
Q

How many disciplines are needed for a patient to qualify for Inpatient Rehab?

A

2 more more disciplines

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12
Q

How many hours of therapy a day is Inpatient Rehab?

A

3 Hours of rehab a day

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13
Q

How many days a week does a patient get PT in Inpatient Rehab?

A

6 Days

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14
Q

What are therapist considerations for Subacute Phase?

A

Tolerance to daily rehabilitation

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15
Q

What are the goals for Subacute Phase?

A

Continuation of acute phase

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16
Q

What is the setting for Chronic Phase?

A

Outpatient rehabilitation (OP), community setting, or at home

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17
Q

What are the goals for Chronic Phase?

A

Inpatient interventions plus CIMT, bilateral training, virtual reality (VR) training and electromechanical-assisted walking

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18
Q

What are the goals for Chronic Phase in Outpatient?

A

Flexibility, strength, balance, locomotion, endurance and UE function; HEP prescription

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19
Q

What are the goals for Chronic Phase in Home care?

A

Home environmental recommendations and adaptations

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20
Q

What are the goals for Chronic phase in Community Setting?

A

Recreational activities, community fitness programs and water-based activities

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21
Q

What is the recovery timeline for a stroke?

A

Generally, fastest in the first weeks and months after onset, however, improvements can continue thereafter

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22
Q

When does variability occur?

A

It occurs based on the level of language and visuospatial function and impairment involvement. It also occurs based on stroke severity

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23
Q

What is an Examination?

A

The process of obtaining a history, performing a systems review and selecting and administering tests and measures to gather data about the patient/client. The initial examination is a comprehensive screening and specific testing process that leads to a diagnostic classification. The examinations process also may identify possible problems that require consultation with or referral to another provider.

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24
Q

What is an Evaluation?

A

A dynamic process in which the physical therapist makes clinical judgements based on data gathered during the examination. This process also may identify possible problems that require consultation with or referral to another provider.

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25
Q

What is a Diagnosis?

A

Both the process and the end result of evaluation examinations data, which the PT organizes into define clusters, syndromes, or categories to help determine the prognosis (including POC) and the most appropriate intervention strategies.

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26
Q

What is Prognosis (including POC)?

A

Determination of the level of optimal improvement that may be attained through intervention and the amount of time required to reach that level. The POC specifies the interventions to be used and their timing and frequency.

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27
Q

What is an Intervention?

A

Purposeful and skilled interaction of the physical therapist with the patient/client and, if appropriate with other individuals involved in care of the patient/client, using various physical therapy methods and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis. The PT conducts a reexamination to determine changes in patient/client status and to modify or redirect intervention. The decision to reexamine may be based on new clinical findings or on lack of patient/client progress. The process of reexamination also may identify the need for consultation with or referral to another provider

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28
Q

What is an Intervention?

A

The interaction between the PT with the patient/client and other individuals who may be involved in his/her care

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29
Q

What do intervention strategies include?

A

-Patient or client instruction
- Airway clearance techniques
- Assistive technology: prescription, application and as appropriate fabrication or modification
-Biophysical agents
-Functional training in self-care and in domestic, education, work, community, social and civic life
-Integumentary repair and protection techniques
-Manual therapy techniques
- Therapeutic exercise

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30
Q

What are the components for PT Intervention?

A
  • Environmental structure
  • Practice schedule
  • Feedback type and schedule
  • Intervention dosing
  • Program progression
    -Problem solving, reflection and self-management
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31
Q

What is the body functions/structure level for a stroke?

A

Neuronal recovery of function is restored in the tissues that were initially lost after injury

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32
Q

What is Neural Plasticity?

A

The factor that allows for the ability of the brain to modify in function and repair itself

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33
Q

What are the mechanisms for Neural Plasticity?

A
  • Neuroanatomical
  • Neurochemical
  • Neuroreceptive
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34
Q

What is Neural Regeneration?

A

Nerve Growth

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35
Q

Activation of brain area are not___?

A

Previously active

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36
Q

What are Nerve Growth Factors?

A

Trophic Factors

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37
Q

How does Trophic Factors play a role in Neural Plasticity?

A

They play a role in growth and repair processes

38
Q

What is Regenerative Synaptogenesis?

A

Sprouting of the injured axons to innervate previously innervated synapses

39
Q

What is Reactive Synaptogenesis?

A

Collateral sprouting- reclaiming of synaptic sites of the injured axon by dendritic fibers from neighboring axons

40
Q

What does Long-Term Potential (LTP) change?

A

Synaptic Strength

41
Q

What are the 10 principles of Neuroplasticity?

A
  • Use it or lose it
  • Use it or Improve it
  • Salience
  • Repetition
    -Intensity
  • Specificity
  • Age
  • Time
  • Transference
  • Interference
42
Q

What is Use it or Lose it?

A

Every thought, action, movement, and skills has a specific set of connections in your brain. When you don’t practice something for an extended period of time, the pathways for that task start to weaken and they get weaker over time

43
Q

What is Use it and Improve it?

A

However if you practice something a lot these connections can grow and become stronger. Training a thought or a behavior (and doing it regularly) can lead to improved speed and performance

44
Q

What is Slience?

A

Emotions can affect the strength of memory consolidation. If therapy is made interesting or important to you (incorporating hobbies or interests), you can more easily remember new skills or pieces of information

45
Q

What is Repetition?

A

Repetition of a learned (or re-learned) behavior is required for long-term changes in the brain. You need thousands of repetitions to master a skill. The more time you’ve spent practicing, the better you perform

46
Q

What is Intensity?

A

If you do something that doesn’t challenge you, you won’t see much of a difference. Intensity can be the number of times you do an exercise or how difficult it is. Try to find an intensity that is one step above your current level

47
Q

What is Specificity?

A

You have to train your brain in very specific ways. Learning something new or re-training an old skill (rather than going through the motions of something you already know) helps increase connections in the brain

48
Q

What is Age?

A

Our brains are the most flexible and adaptive when we are young. But brains can grow and change at any age! Effects are generally better in individuals with greater physical and mental activity

49
Q

What is Time?

A

If therapy targets changing, increasing, and strengthening the pathways in your brain (using these principles), it should work any time. However there may be windows of time where progress happens at a faster rate

50
Q

What is Transference?

A

Learning in one situation (like therapy) can generalize to other situations (like social settings). Similarly, training one specific skill can sometimes activate the pathways of nearby, untrained items and improve those skills as well

51
Q

What is Interference?

A

Neuroplasticity means the brain is always learning. But it doesn’t know the difference between good and bad. Maladaptive habits or practicing the wrong things might interfere with the changes you want to make

52
Q

What is Function Induced Recovery?

A
  • Use dependent cortical reorganization
  • The ability of the nervous system to modify itself in response to changes in activity and new experiences
53
Q

What is Task-Oriented Training?

A
  • Use of repetitive task practice
  • Example: CIMT and body weight support treadmill training (BWSTT)
54
Q

What is Critical/Sensitive Period?

A

The brain is most responsive to improvements from motor training

55
Q

What should be promoted first?

A

NEURAL PLASTICITY

56
Q

What are Procedural Interventions?

A

Restorative, Compensatory, Preventative

57
Q

What is Restorative Interventions?

A

Directed toward remediating or improving the patient’s status in terms of impairments, activity limitations, participation restrictions and recovery of function

58
Q

What are the targeted areas for Restorative Interventions?

A

The involved extremities or trunk

59
Q

Should there be assumed existing potential for change?

A

YES (EXAMPLE: A PATIENT POST-ACUTE CVA)

60
Q

What is Compensatory Interventions?

A

Directed toward promoting optimal function using new motor patterns

61
Q

What are the two considerations made for Compensatory Interventions?

A

Adaptation and Substitution

62
Q

What is the target for Substitution?

A

Less involved or uninvolved extremities

62
Q

What is Adaptation?

A

Using the involved segments and adapting with remaining motor elements

63
Q

What is Substitution?

A

Functions are replaced or taken over by different body segments using different motor patterns

64
Q

What other Adaptations can be considered?

A

Task, Activity, or Environment

65
Q

What are some Compensation Intervention Examples?

A
  • Use of the intact limbs to compensate for those with weakness
  • Use of sensory conservation and joint preservation techniques
  • Use of environmental adaptations to optimize performance
66
Q

What can be used together to maximize function?

A

Restorative, Compensation/Substitution

67
Q

What can be used when restorative interventions fail?

A

Restorative, Compensation/Substitution

68
Q

What are preventative interventions?

A

Directed towards minimizing potential problems and maintaining health

69
Q

What can a therapist do to help prevent things with physical therapy?

A
  • Decreased vital capacity and cardiovascular endurance
  • Disuse atrophy and weakness
  • Contractures
  • Decubitus Ulcers
  • Deep Vein Thrombosis (DVT)
  • Renal Calculi
  • Urinary Tract Infections
  • Pneumonia
  • Depression
70
Q

What are some Intervention Selection Considerations?

A
  • Examination and Evaluation of the patient
  • Physical Therapy Diagnosis
  • Prognosis
  • Goals and expected outcomes
71
Q

What is restoration?

A

The reappearance of motor patterns that were present before CNS injury

72
Q

What is Compensation?

A

The appearance of new motor patterns results from adaptation of remaining motor elements or substitution of alternative motor strategies and body segments

73
Q

What is Substitution Training?

A

The patient is made aware of movements deficiencies and the changes required to complete the functional task

74
Q

What happens to alternate ways during substitution training?

A

Alternate ways are proposed, broken down and adopted

75
Q

What are the requirements for substitution training?

A

It requires patient practice to relearn the task. The practice then needs to occur in the environment it is expected to occur

76
Q

What is performed in a new way with substitution training?

A

Prior movement

77
Q

What are examples of Substitution Training for Post CVA with Hemiparesis?

A

Using the less affected UE to dress

78
Q

What are examples of Substitution Training for Post CVA with Unilateral Neglect?

A
  • Color coding shoes to dress
  • Extending and color coding the w/c brake toggle to ease identification
79
Q

What are the concerns when utilizing substitution training?

A

Focusing on the less involved segments may suppress recovery and contribute to learned nonuse of impaired segments

80
Q

What can concerns utilizing substitution training lead to?

A

Development of splinter skills

81
Q

What is Splinter Skills?

A

Acquired in a manner inconsistent with skills the individual already processes

82
Q

What can Splinter Skills not do?

A

These skills cannot be generalized to task variations or other environments

83
Q

What should you NOT DO during Substitution Training?

A

Place a point of focus to see if there is potential for recovery

84
Q

What should you DO during Substitution Training?

A

Perform when recovery potential is limited

85
Q

What else should you DO during Substitution Training?

A

Perform when the patients presents with significant comorbidities, impairments, and functional limitations with little or no expectation for additional recovery

86
Q

What should a PT consider when designing a POC and selecting interventions?

A

-Patient variability
- Timeframe of injury/impairment onset
- Nature of the impairments

87
Q

What has the GREATEST impact on functional performance?

A

Motor and Perceptual Deficits

88
Q

What has a negative affect on recovery?

A

Sensory loss, disorientation, communication disorders and decreased cardiorespiratory endurance

89
Q

What are some positive factors that can affect recovery?

A
  • High Motivation
  • Stable and Supportive family
  • Financial resources
  • Intensive training with repetitive practice

Neuromuscular Exam and Rehab Exam 2 (8 decks)

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