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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
in Stroke patients what can we do to elicit use dependent plasticity and learning dependent plasticity
intensive task specific practice
26
What does intensive task specific practice involve
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
27
Primary impairments for stroke (motor, non-motor)
Motor - decreased strength - decreased coordination - spasticity Non-motor - vision - sensation - proprioception - speech/language - perceptual-cognitive function
28
Secondary impairments in stroke (motor, non-motor)
Motor - decreased muscle length - swelling - SH subluxation - CV fitness Non-motor - depression - fatigue - pain
29
What are the 3 practice variables that influence motor skill acquisiton
Practice intensity Practice specificity Practice variability
30
What does practice intensity involve
Learning motor skill requires repetitions
31
What strategies can you use to increase the amount of practice (practice intensity)
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
32
Considerations for practice specificity
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
33
When would you use exercises with low contextual interference
good for beginners. non-repeated blocks of trials of each task variation
34
When would you use exercises with high contextual interference
good for experts. random order of trials of all task variations
35
What is practice variability
the variability in movement and context characteristics the learner experiences while practicing a skill
36
Types of communication
instructions: long and short sentences, non-verbal demonstrations feedback
37
How frequently would you provide instructions
depends on attentional capacity of patient and characteristics/interaction between task and patient
38
When would you use each type of instruction
Long sentence: before movement Short sentence: during movement Non-verbal cues: during movement
39
Types of demonstrations
Skilled demonstration by expert Unskilled demonstration by beginners - encourages more active problem solving
40
When would you use demonstrations
before and during practice
41
feedback should be
timely (reinforce learning) Descriptive (what occurred and how it could be better)
42
Types of feedback
visual auditory proprioception and tactile knowledge of results knowledge of performance intrinsic feedback extrinsic feedback qualitative quantitative internal attention focus external attention focus
43
Motivational strategies
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
ways to advance a task
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
How do you analyse the movement of a stroke patient
determine missing components and compensation strategies and then determine impairments and their causes
46
Goal directed movement depends on ... for the upper limb
object position in space object characteristics what you do with the object
47
phases of reaching and manipulation
transportation phase: hand moves to target Manipulation phase: what you do with object once you reach it
48
what joints are important in the transportation phase
shoulder, elbow and wrist
49
what joints are important in the manipulation phase
distal aspects of UL hand eye coordination
50
Essential components of reaching
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
Essential component of manipulation
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
some patterns of compensation in UL impairment
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
Potential compensatory strategies for reaching
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
potential compensatory strategies for manipulation
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
underlying impairment for lack of shoulder elevation (missing essential component)
weak RC muscles lack of scapulohumeral rhythm so inability to stabilise scapula
56
underlying impairment for lack of supination (missing essential component)
pronator tightness supinator weakness
57
underlying impairment for lack of wrist extension (missing essential component)
extensor weakness flexor tightness
58
underlying impairment for lack of shoulder flexion/protraction (missing essential component)
Protractor/shoulder flexor weakness IR Tightness
59
underlying impairment for lack of elbow extension (missing essential component)
elbow flexor tightness elbow extensor weakness
60
Devices/programs used to increase repetitions and independence and improve neuroplasticity
CIMT Robotics Assistive devices
61
Inclusion criteria for CIMT in UL Stroke
10 degs of active wrist extension 10 degs thumb abduction 10 degs finger extension minimal cognitive/perceptual deficits
62
When is mirror therapy suitable for UL stroke patients
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
other treatments for stroke rehab in the UL
VR Robotics Video games and mental practice
64
Essential components of bridging to shifting
flexion of hips flexion of knees dorsiflexion of ankles hip extension hip abduction or adduction triceps / upper extremity muscles
65
Essential components of rolling over in bed
rotation and flexion of the neck hip and knee flexion flexion and protraction of the shoulder rotation with the trunk
66
common adaptive strategies of rolling over in bed
wriggling instead of turning pulling with intact arm
67
Essential components of SOEOB
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
common adaptive strategies of SOEOB
flexion and rotation of the neck forward excessive pushing up on intact arm hooking intact leg under affected leg falls backwards
69
Essential components of sitting
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
common adaptive strategies of sitting
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
Essential components of STS
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
Common adaptive strategies in STS
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
common impairments for STS
Weak LL muscles - quads, hammies, iliopsoas Weak trunk limited ROM - ankle and knee
74
Part task training for STS
strengthen knee/hip flexion and knee/hip extension Practice moving bottom forward train increase in knee flexion train increase in hip flexion
75
Whole task training for STS
train on hard chair train on high chair train with assist train in a quiet room add speed, cognitive task, physical task
76
Equipment used to assist with bed mobility
bed rails leg lifters slide sheets transfer boards
77
Essential requirements of walking
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
Stance : Swing ratio
60% stance 40% swing
79
Stance phases
initial contact loading response mid stance terminal stance pre-swing
80
Swing phases
initial swing mid swing terminal swing
81
Initial contact
coming from swing so need to decelerate and prepare for extension Hip extensors, knee flexors and ankle dorsiflexors work eccentrically to decelerate leg
82
Loading response
shifting weight to landing leg. Phase of shock absorption Hip extensors, knee extensors and tib ant work eccentrically to help with shock absorption
83
Mid stance
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
Terminal stance
Stretch flexors in preparation for swing to generate energy Plantarflexors working eccentrically, quads and hamstring generate energy to maintain knee and hip extension,
85
Pre-Swing
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
Mid-Swing
leg acts as pendulum hip flexors, dorsiflexors and hamstrings activated
87
Terminal Swing
Deceleration of swinging limb Hip extensors contract Knee flexors contract eccentrically to slow knee extension Dorsiflexors contract to prepare for heel contact
88
Walking Essential Components
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
Common compensatory movements in walking
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
Compensation from weak propulsion in terminal stance
excessive hip or knee flexing circumducting the leg lifting opposite leg by going into plantarflexion
91
Equipment and technology used to increase reps and intensity and efficiency of walking
BWS robotics AFOs VR Circuit class

Sub Acute Final Prep Sean (10 decks)

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