Restoration vs. Compensation & CVA Outcomes Flashcards
What is the time period for Hyper-Acute Phase?
0-24 hours (includes cell death)
What is the time period for Acute Phase?
1-7 days (inflammation and scarring and endogenous plasticity)
What is the time period for Subacute Phase?
- Early ( 7 days to 3 months)
- Late ( 3 to 6 months)
What is the time period of chronic phase?
More than 6 months post
What are episodes of care?
- Acute care
- Inpatient Rehabilitation
- Subacute Rehabilitation
- Outpatient Rehabilitation
- Home/Community- Based Care
What is the setting for Acute Phase?
Intensive Care Unit (ICU) or specialized stroke care unit
What are the therapist considerations for Acute Phase?
Reviewing the medical record and communicating with the medical team
What are the goals for Acute Phase?
- 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
What are intervention for Acute Phase?
Bed mobility, Sitting, Transfers, Locomotion, ADL training, ROM, Splinting, and Positioning
What is the setting for Subacute Phase?
Intensive inpatient rehabilitation, transitional care unit (TCU) within a skilled nursing facility
How many disciplines are needed for a patient to qualify for Inpatient Rehab?
2 more more disciplines
How many hours of therapy a day is Inpatient Rehab?
3 Hours of rehab a day
How many days a week does a patient get PT in Inpatient Rehab?
6 Days
What are therapist considerations for Subacute Phase?
Tolerance to daily rehabilitation
What are the goals for Subacute Phase?
Continuation of acute phase
What is the setting for Chronic Phase?
Outpatient rehabilitation (OP), community setting, or at home
What are the goals for Chronic Phase?
Inpatient interventions plus CIMT, bilateral training, virtual reality (VR) training and electromechanical-assisted walking
What are the goals for Chronic Phase in Outpatient?
Flexibility, strength, balance, locomotion, endurance and UE function; HEP prescription
What are the goals for Chronic Phase in Home care?
Home environmental recommendations and adaptations
What are the goals for Chronic phase in Community Setting?
Recreational activities, community fitness programs and water-based activities
What is the recovery timeline for a stroke?
Generally, fastest in the first weeks and months after onset, however, improvements can continue thereafter
When does variability occur?
It occurs based on the level of language and visuospatial function and impairment involvement. It also occurs based on stroke severity
What is an Examination?
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.
What is an Evaluation?
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.
What is a Diagnosis?
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.
What is Prognosis (including POC)?
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.
What is an Intervention?
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
What is an Intervention?
The interaction between the PT with the patient/client and other individuals who may be involved in his/her care
What do intervention strategies include?
-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
What are the components for PT Intervention?
- Environmental structure
- Practice schedule
- Feedback type and schedule
- Intervention dosing
- Program progression
-Problem solving, reflection and self-management
What is the body functions/structure level for a stroke?
Neuronal recovery of function is restored in the tissues that were initially lost after injury
What is Neural Plasticity?
The factor that allows for the ability of the brain to modify in function and repair itself
What are the mechanisms for Neural Plasticity?
- Neuroanatomical
- Neurochemical
- Neuroreceptive
What is Neural Regeneration?
Nerve Growth
Activation of brain area are not___?
Previously active
What are Nerve Growth Factors?
Trophic Factors
How does Trophic Factors play a role in Neural Plasticity?
They play a role in growth and repair processes
What is Regenerative Synaptogenesis?
Sprouting of the injured axons to innervate previously innervated synapses
What is Reactive Synaptogenesis?
Collateral sprouting- reclaiming of synaptic sites of the injured axon by dendritic fibers from neighboring axons
What does Long-Term Potential (LTP) change?
Synaptic Strength
What are the 10 principles of Neuroplasticity?
- Use it or lose it
- Use it or Improve it
- Salience
- Repetition
-Intensity - Specificity
- Age
- Time
- Transference
- Interference
What is Use it or Lose it?
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
What is Use it and Improve it?
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
What is Slience?
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
What is Repetition?
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
What is Intensity?
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
What is Specificity?
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
What is Age?
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
What is Time?
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
What is Transference?
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
What is Interference?
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
What is Function Induced Recovery?
- Use dependent cortical reorganization
- The ability of the nervous system to modify itself in response to changes in activity and new experiences
What is Task-Oriented Training?
- Use of repetitive task practice
- Example: CIMT and body weight support treadmill training (BWSTT)
What is Critical/Sensitive Period?
The brain is most responsive to improvements from motor training
What should be promoted first?
NEURAL PLASTICITY
What are Procedural Interventions?
Restorative, Compensatory, Preventative
What is Restorative Interventions?
Directed toward remediating or improving the patient’s status in terms of impairments, activity limitations, participation restrictions and recovery of function
What are the targeted areas for Restorative Interventions?
The involved extremities or trunk
Should there be assumed existing potential for change?
YES (EXAMPLE: A PATIENT POST-ACUTE CVA)
What is Compensatory Interventions?
Directed toward promoting optimal function using new motor patterns
What are the two considerations made for Compensatory Interventions?
Adaptation and Substitution
What is the target for Substitution?
Less involved or uninvolved extremities
What is Adaptation?
Using the involved segments and adapting with remaining motor elements
What is Substitution?
Functions are replaced or taken over by different body segments using different motor patterns
What other Adaptations can be considered?
Task, Activity, or Environment
What are some Compensation Intervention Examples?
- 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
What can be used together to maximize function?
Restorative, Compensation/Substitution
What can be used when restorative interventions fail?
Restorative, Compensation/Substitution
What are preventative interventions?
Directed towards minimizing potential problems and maintaining health
What can a therapist do to help prevent things with physical therapy?
- Decreased vital capacity and cardiovascular endurance
- Disuse atrophy and weakness
- Contractures
- Decubitus Ulcers
- Deep Vein Thrombosis (DVT)
- Renal Calculi
- Urinary Tract Infections
- Pneumonia
- Depression
What are some Intervention Selection Considerations?
- Examination and Evaluation of the patient
- Physical Therapy Diagnosis
- Prognosis
- Goals and expected outcomes
What is restoration?
The reappearance of motor patterns that were present before CNS injury
What is Compensation?
The appearance of new motor patterns results from adaptation of remaining motor elements or substitution of alternative motor strategies and body segments
What is Substitution Training?
The patient is made aware of movements deficiencies and the changes required to complete the functional task
What happens to alternate ways during substitution training?
Alternate ways are proposed, broken down and adopted
What are the requirements for substitution training?
It requires patient practice to relearn the task. The practice then needs to occur in the environment it is expected to occur
What is performed in a new way with substitution training?
Prior movement
What are examples of Substitution Training for Post CVA with Hemiparesis?
Using the less affected UE to dress
What are examples of Substitution Training for Post CVA with Unilateral Neglect?
- Color coding shoes to dress
- Extending and color coding the w/c brake toggle to ease identification
What are the concerns when utilizing substitution training?
Focusing on the less involved segments may suppress recovery and contribute to learned nonuse of impaired segments
What can concerns utilizing substitution training lead to?
Development of splinter skills
What is Splinter Skills?
Acquired in a manner inconsistent with skills the individual already processes
What can Splinter Skills not do?
These skills cannot be generalized to task variations or other environments
What should you NOT DO during Substitution Training?
Place a point of focus to see if there is potential for recovery
What should you DO during Substitution Training?
Perform when recovery potential is limited
What else should you DO during Substitution Training?
Perform when the patients presents with significant comorbidities, impairments, and functional limitations with little or no expectation for additional recovery
What should a PT consider when designing a POC and selecting interventions?
-Patient variability
- Timeframe of injury/impairment onset
- Nature of the impairments
What has the GREATEST impact on functional performance?
Motor and Perceptual Deficits
What has a negative affect on recovery?
Sensory loss, disorientation, communication disorders and decreased cardiorespiratory endurance
What are some positive factors that can affect recovery?
- High Motivation
- Stable and Supportive family
- Financial resources
- Intensive training with repetitive practice
