Secondary Impairments After Stroke (3) Flashcards
When is learned non-use particularly an issue after stroke?
In the upper arm. Walking - forced to use both limbs
What are the secondary impairments following a stroke?
Loss of fitness Learned non-use Contracture Swelling Shoulder subluxation Pain
What are some characteristics of loss of fitness after stroke?
Up to 75% of people with stroke have coronary artery disease
Paretic muscle
Fatigue
Environmental factors
What does the prevalence of coronary artery disease in people with stroke indicate?
That this is likely a population that already has decreased fitness
How does paretic muscle contribute to loss of fitness after stroke?
Decreased oxidative metabolism
Decreased endurance
How does fatigue contribute to loss of fitness after stroke?
Low aerobic fitness
Low muscle endurance
Is fitness training effective after stroke?
Australian stroke guidelines:
Rehab should include interventions aimed at increasing cardiorespiratory fitness once patients have sufficient strength in the large lower link muscle groups (A)
Patients should be encouraged to undertake regular, ongoing fitness training (GPP)
What can improve with cardiorespiratory training after stroke?
Speed
Tolerance
Independence during walking
Further trials need to determine optimal prescription and any long term benefits
When should fitness training be done after stroke?
Regardless of stage of recovery, significant benefit
Results generalised to those who are mildly or moderately impaired and who had relatively low risk of cardiac complications with exercise
When fitness training after stroke,what should be done to make sure they will receive benefits of training?
Put a HR monitor on to make sure they are at 50-80% max heart rate
What are the characteristics of contracture after stroke?
Muscles :
Lose sarcomeres
Become shorter and stiffer
Changes in cross bridge connections
Connective tissue:
Water loss
Collagen deposition
What is the prevalence of contracture?
Within 6 months after stroke about half of all patients develop a contracture
How to predict contracture
No one factor predicts development of contracture
Muscle strength is a significant predictor of elbow, wrist and ankle contractures
- but cannot accurately predict development of contractures in these joints
muscles are at risk of contracture?
Gastroc/soleus Shoulder internal rotators Elbow flexors Wrist flexors, long finger flexors Forearm pronators Thumb web space Hip flexors
Prevention of contracture
NO additional benefit of routine stretching
Use: routine positioning, active practice
However, monitor for the development of contracture - GPP
do not use pulleys
Positioning for prevention of contracture supine.
30 min daily of positioning at the end of range of extenrnal rotation.
Positioning daytime contracture
• Daytime
– Laptrays
– Arm troughs on wheelchairs
Positioning during Night time contrcature
– Supine or sidelying on unaffected
side
Why is swelling a problem after stroke?
Arm/ hand in dependent position
• Lack of muscle pump
Incidence shoulder subluxation
Incidence ranges from 7‐81%
– variation appears to be related to degree of
paralysis
What is shoulder subluxation associated with?
• Thought to be only one of many factors that
can cause pain, however
– associated with poor UL function
– associated with reflex sympathetic dystrophy
What are the muscles that counteract shoulder subluxation?
• To prevent subluxation
– Need supraspinatus and posterior deltoid to work
– Need to prevent downward pull of humerus
Can e stim prevent or relieve shoulder subluxation?
– ES early after stroke can prevent subluxation but ES late
after stroke cannot reduce subluxation
Protocol ES glenohumeral subluxation
30 - 100 Hz
Intensity set to obtained desired motion
ES sessions progressively increased to 4-6 hours
Increased from 10/12 secon to 30/2 seconds on-off
Which slings/supports reduce an already subluxed shoulder
– Firm support
• Laptrays, arm troughs, triangular slings
• Will temporarily reduce an already subluxed shoulder
What will not reduce an already subluxed shoulder?
Extension slings ie Bobath sling, South Sydney sling will not
reduce an already subluxed shoulder
What is shoulder pain associated with?
– Decreased ROM, sensory impairment, adhesive capulitis,
impingement, subluxation, spasticity, CRPS
longer hospitalisation and less compliance with rehav
Trauma - 50% have rotator cuff tear
