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Sub Acute Final Prep Sean > Stroke > Flashcards

Stroke Flashcards

1
Q

Difference in stroke between Indigenous and non-Indigenous populations

A

Indigenous Australians have a 1.7x higher stroke rate, 2x higher hospitalisation, 1.6x higher death rate

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2
Q

Types of stroke and their percentage

A

Ischemic: 87%
Haemorrhagic: 13%

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3
Q

Risk factors for both types of stroke

A

High BP
Smoking
Diabetes
Physical inactivity
Obesity
High cholesterol
Atrial Fibrillation
Excessive alcohol consumption
Age

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4
Q

Risk factors for ischemic stroke

A

Atherosclerosis
Atrial fibrillation
Prior ischemic strokes

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5
Q

Risk factors for haemorrhagic stroke

A

Bleeding disorders
Vascular malformations
Use of anticoagulants

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6
Q

Signs and symptoms of a stroke

A

FAST
Face droop
Can’t use Arms
Slurred speech
Time

Numbness, strong headache, vertigo and loss of balance, violation of speech, understanding and sight

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7
Q

Predictors of survival at 3 and 12 months post stroke

A

Age
Verbal component of the Glasgow Coma Scale
Arm power
Ability to walk
Pre-stroke dependency

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8
Q

There’s a 98% chance of walking after stroke if a patient can…

A

independently sit for 30 seconds and visibly contract muscles in the legs (with or without movement) within 72 hours

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9
Q

There’s a 98% chance of regaining upper limb function after stroke if a patient can…

A

exhibit some finger extension, some shoulder abduction within 72 hours

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10
Q

Medical treatment of stroke

A

Thrombolysis: Recombinant tpA
Aspirin
Endovascular thrombectomy
Decompressive surgery (Craniectomy)

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11
Q

Medical prevention of stroke

A

antithrombotic agents
antiplatelet agents
slow clotting
anticoagulant agents
prevent clotting
advice about risk factors - lifestyle modification

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12
Q

Patient presents <4.5hrs from symptom onset of stroke

A

tpA - Thrombolysis

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13
Q

Patient presents 6-24hrs from symptom onset of stroke

A

Endovascular thrombectomy

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14
Q

Why don’t you use tpA after 4.5hrs

A

tpA thins blood so don’t want to use it after 4.5hrs as there is a high risk of doing further damage

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15
Q

Risk of using tpA

A

risk of symptomatic Intracerebral Hemorrhage (ICH)

larger more proximal clots are more resistant to tpA

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16
Q

What is thrombectomy

A

mechanical retrieval of a clot

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17
Q

when is thrombectomy indicated

A

used for proximal large artery occlusions

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18
Q

Non-medical management of stroke

A

Doctors
Nurses
Physio’s
OT’s
Speech therapists
Social workers
Psychologists
Dieticians

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19
Q

What is neuropasticity

A

lifelong capacity of the brain to learn new ways of doing things based on new experiences and learning

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20
Q

What is adaptive plasticity

A

increased function/neural ability to perform a task

neurophysiological changes that improve the ability to perform tasks

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21
Q

What is maladaptive plasticity

A

decreased function, impaired ability to perform tasks
plasticity that is unhelpful

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22
Q

examples of unhelpful/maladaptive plasticity

A

chronic pain, allodynia

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23
Q

8 factors that influence neuroplasticity

A

use dependent and specific

repetition and intensity: reps required for lasting neural change, greater intensity induces neuroplasticity

time sensitive

task importance, motivation, feedback and attention: more neuroplasticity when training relevant + important tasks, feedback increases quality, attention and focus increase capacity to learn

environment: sensory, cognitive, motor and social stimulation facilitate increased neuroplasticity

adjuvant or adjunct therapies: priming (motor imagery, mental practice, stimulation based therapy) increases neuroplasticity

patient characteristics: younger people more neuroplasticity, stress impairs neuroplasticity

pharmacology: GABA receptor agonists used for anxiety, seizures, spasticity reduce neuroplasticity

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24
Q

Differentiate between use dependent and learning dependent plasticity

A

Use dependent: use it or lose it. Reorganisation of cortical regions as a result of motor practice

Learning dependent: reorganisation of cortical regions as a result of skill acquisition. Involves task specific training, goal setting, active problem solving, new skills

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25
Q

in Stroke patients what can we do to elicit use dependent plasticity and learning dependent plasticity

A

intensive task specific practice

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26
Q

What does intensive task specific practice involve

A

Meaningful and real world relevant training

Clear short, medium, long term SMART goals

Practice intensity: reps and time, level of supervision, level of difficult

Practice specificity: part/whole task

Practice variability: modify task, environment with relevance

Teach/communicate through demonstrations, instructions and feedback

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27
Q

Primary impairments for stroke (motor, non-motor)

A

Motor
- decreased strength
- decreased coordination
- spasticity

Non-motor
- vision
- sensation
- proprioception
- speech/language
- perceptual-cognitive function

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28
Q

Secondary impairments in stroke (motor, non-motor)

A

Motor
- decreased muscle length
- swelling
- SH subluxation
- CV fitness

Non-motor
- depression
- fatigue
- pain

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29
Q

What are the 3 practice variables that influence motor skill acquisiton

A

Practice intensity
Practice specificity
Practice variability

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30
Q

What does practice intensity involve

A

Learning motor skill requires repetitions

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31
Q

What strategies can you use to increase the amount of practice (practice intensity)

A

set up patient for independent and semi-supervised practice
use exercise booklets and wall charts
incorporate training into daily living
train carers/family/nursing staff to assist in training
pair up with training partner
group therapy

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32
Q

Considerations for practice specificity

A

Movements practiced should be similar and in the correct context while the skill is being practice.

Must consider action, task, skill and environmental context

environment specific: objects/equipment, moving or static

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33
Q

When would you use exercises with low contextual interference

A

good for beginners. non-repeated blocks of trials of each task variation

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34
Q

When would you use exercises with high contextual interference

A

good for experts. random order of trials of all task variations

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35
Q

What is practice variability

A

the variability in movement and context characteristics the learner experiences while practicing a skill

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36
Q

Types of communication

A

instructions: long and short sentences, non-verbal
demonstrations
feedback

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37
Q

How frequently would you provide instructions

A

depends on attentional capacity of patient and characteristics/interaction between task and patient

38
Q

When would you use each type of instruction

A

Long sentence: before movement
Short sentence: during movement
Non-verbal cues: during movement

39
Q

Types of demonstrations

A

Skilled demonstration by expert
Unskilled demonstration by beginners - encourages more active problem solving

40
Q

When would you use demonstrations

A

before and during practice

41
Q

feedback should be

A

timely (reinforce learning)
Descriptive (what occurred and how it could be better)

42
Q

Types of feedback

A

visual
auditory
proprioception and tactile
knowledge of results
knowledge of performance
intrinsic feedback
extrinsic feedback
qualitative
quantitative
internal attention focus
external attention focus

43
Q

Motivational strategies

A

ensure relevance of training exercises to the patients goal/motor skill

ensure goals are SMART

provide encouraging feedback

Assess outcome measure regularly to track progress

Consider reward systems and feedback

44
Q

ways to advance a task

A

resistance
more reps, frequency, duration
greater ROM
more DoF
Increased cognitive components
Distractions
variability
increased distance/amplitude, speed, direction of mvmt
part task –> whole task
decrease BoS
softer support
increase attentional demands

45
Q

How do you analyse the movement of a stroke patient

A

determine missing components and compensation strategies and then determine impairments and their causes

46
Q

Goal directed movement depends on … for the upper limb

A

object position in space
object characteristics
what you do with the object

47
Q

phases of reaching and manipulation

A

transportation phase: hand moves to target

Manipulation phase: what you do with object once you reach it

48
Q

what joints are important in the transportation phase

A

shoulder, elbow and wrist

49
Q

what joints are important in the manipulation phase

A

distal aspects of UL
hand eye coordination

50
Q

Essential components of reaching

A

Protraction and elevation of shoulder
ER, flexion, abduction, extension of shoulder
extension/flexion of elbow
pronation/supination of forearm
extension and radial deviation of wrist
extension of fingers and abduction of thumb (opening of hand)

51
Q

Essential component of manipulation

A

flexion/extension of wrist and fingers
flexion and abduction (conjoint rotation) of thumb and fingers
closure of thumb and fingers (MCP joint flexion and IPJ in some extension)
Cupping of hand
independent finger movements

52
Q

some patterns of compensation in UL impairment

A

inactivity of shoulder abductors + flaccid RC: patients can’t set scapula and elevate shoulder as result (hike)

distal muscles often affected

general resting posture in hemiparetic arm: IR, adduction, elbow flexion, forearm pronation, thumb adduction, finger and wrist flexion

coactivation of muscles and poor control of synergistic muscles: lack of coordination between segments

53
Q

Potential compensatory strategies for reaching

A

hip flexion, excessive elevation, abduction and IR of shoulder when reaching forward

lateral flexion of trunk to intact side

excessive elbow flexion, pronation of forearm and wrist flexion

increased trunk contribution to movement

slower, less accurate and more segmented

use of intact arm for all reaching tasks

54
Q

potential compensatory strategies for manipulation

A

excessive wrist flexion when grasping and manipulating objects

excessive aperture for grasp and release

excessive force when grasping

extension of CMC joint of thumb and pronation of forearm for grasp and release

use of intact hand

55
Q

underlying impairment for lack of shoulder elevation (missing essential component)

A

weak RC muscles
lack of scapulohumeral rhythm so inability to stabilise scapula

56
Q

underlying impairment for lack of supination (missing essential component)

A

pronator tightness
supinator weakness

57
Q

underlying impairment for lack of wrist extension (missing essential component)

A

extensor weakness
flexor tightness

58
Q

underlying impairment for lack of shoulder flexion/protraction (missing essential component)

A

Protractor/shoulder flexor weakness

IR Tightness

59
Q

underlying impairment for lack of elbow extension (missing essential component)

A

elbow flexor tightness
elbow extensor weakness

60
Q

Devices/programs used to increase repetitions and independence and improve neuroplasticity

A

CIMT
Robotics
Assistive devices

61
Q

Inclusion criteria for CIMT in UL Stroke

A

10 degs of active wrist extension
10 degs thumb abduction
10 degs finger extension
minimal cognitive/perceptual deficits

62
Q

When is mirror therapy suitable for UL stroke patients

A

patients with flaccid hand as it provides a visual illusion of movement to promote motor recovery

provides feedback that the hand is actually functioning

63
Q

other treatments for stroke rehab in the UL

A

VR
Robotics
Video games and mental practice

64
Q

Essential components of bridging to shifting

A

flexion of hips
flexion of knees
dorsiflexion of ankles
hip extension
hip abduction or adduction
triceps / upper extremity muscles

65
Q

Essential components of rolling over in bed

A

rotation and flexion of the neck
hip and knee flexion
flexion and protraction of the shoulder
rotation with the trunk

66
Q

common adaptive strategies of rolling over in bed

A

wriggling instead of turning
pulling with intact arm

67
Q

Essential components of SOEOB

A

Lateral flexion of neck
lateral flexion of trunk and SH abduction + elbow extension of lower arm
legs lifted and lowered over side of bed

68
Q

common adaptive strategies of SOEOB

A

flexion and rotation of the neck forward
excessive pushing up on intact arm
hooking intact leg under affected leg
falls backwards

69
Q

Essential components of sitting

A

ankles plantargrade
Feet and knees close together
weight evenly distributed
flexion of knees/hips with extension of trunk (i.e. shoulders over hips)
head balanced on level shoulders

70
Q

common adaptive strategies of sitting

A

widening of BOS i.e. feet and/or knees too far apart or one or both hips ER, using arms for support
shifts weight to intact foot/buttock
flexes forward when the task requires the body weight to be shifted sideways
shuffles feet
uses arms for balance
avoids balance threat by decreasing movement speed and amplitude and/or holding stiffly and/or holding breath

71
Q

Essential components of STS

A

Pre-extension phase (flexion momentum + momentum transfer)
- rapid trunk flexion by flexion at the hips and an extended trunk
- posterior feet movement (ankle DF)

Extension phase
- movement of the knees forward (relative DF)
- hip extension (gluteal complex)
- knee extension (quads)

Stabilisation phase
- reactive postural movements + knee/hip/ankle control

72
Q

Common adaptive strategies in STS

A

pre extension phase
- weight borne through intact side
- wide BOS

extension phase
- falls backwards
- pushes through arms
- weight borne through intact side
- final alignment flexed

73
Q

common impairments for STS

A

Weak LL muscles - quads, hammies, iliopsoas

Weak trunk

limited ROM - ankle and knee

74
Q

Part task training for STS

A

strengthen knee/hip flexion and knee/hip extension
Practice moving bottom forward
train increase in knee flexion
train increase in hip flexion

75
Q

Whole task training for STS

A

train on hard chair
train on high chair
train with assist
train in a quiet room
add speed, cognitive task, physical task

76
Q

Equipment used to assist with bed mobility

A

bed rails
leg lifters
slide sheets
transfer boards

77
Q

Essential requirements of walking

A

Progression: progress COM over new BOS each time we step

Postural control: need to control body against gravity to move COM forward

Adaptation: adjust movement to demands of environment

78
Q

Stance : Swing ratio

A

60% stance
40% swing

79
Q

Stance phases

A

initial contact
loading response
mid stance
terminal stance
pre-swing

80
Q

Swing phases

A

initial swing
mid swing
terminal swing

81
Q

Initial contact

A

coming from swing so need to decelerate and prepare for extension

Hip extensors, knee flexors and ankle dorsiflexors work eccentrically to decelerate leg

82
Q

Loading response

A

shifting weight to landing leg. Phase of shock absorption

Hip extensors, knee extensors and tib ant work eccentrically to help with shock absorption

83
Q

Mid stance

A

Drive COM forwards. In SL stance so need to control pelvic alignment (glute med)

Glute med and plantarflexors are main drivers inthis phase

Knee and hip extension (reduced activity due to GRF in middle of joint)

84
Q

Terminal stance

A

Stretch flexors in preparation for swing to generate energy

Plantarflexors working eccentrically, quads and hamstring generate energy to maintain knee and hip extension,

85
Q

Pre-Swing

A

everything stretched from terminal phase generates energy in this stage. Convert to strong concentric contractions

Hip flexors drive leg forwards
hamstrings maintain knee flexion
activation of tib ant to counter strong PF generated during push off

86
Q

Mid-Swing

A

leg acts as pendulum

hip flexors, dorsiflexors and hamstrings activated

87
Q

Terminal Swing

A

Deceleration of swinging limb

Hip extensors contract
Knee flexors contract eccentrically to slow knee extension
Dorsiflexors contract to prepare for heel contact

88
Q

Walking Essential Components

A

Initial alignment
- ankles dorsiflexed
- hips neutral
- feet shoulder/hip width apart

Stance
- extension of hip throughout
- flexion of knee on heel strike. Extension in midstance, flexion prior to toe off
- DF until end of stance. Fast PF (push off)

Swing
- flexion of knee. Knee extends to heel strike
- flexion of hip
- DF of ankle

89
Q

Common compensatory movements in walking

A

Walking slowly and increased time in double support

Short step lengths

Trunk inclined forwards during stance

Wide BoS

Toes not clearing the ground during swing

Trunk inclined backwards at the end of swing

90
Q

Compensation from weak propulsion in terminal stance

A

excessive hip or knee flexing
circumducting the leg
lifting opposite leg by going into plantarflexion

91
Q

Equipment and technology used to increase reps and intensity and efficiency of walking

A

BWS
robotics
AFOs
VR
Circuit class

Sub Acute Final Prep Sean (10 decks)

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