Stroke Flashcards
Be able to explain why hemi-ADL strategies may foster learned non-use of hemiplegic limbs.
individual neglects to use the affected extremity
ADL strategies typically use the unaffected arm to do the majority of the tasks?
What is shaping in the context of constraint-induced therapy?
behavioral techniques that approach a desired motor outcome, in small, successive increments
shaping strategies allow subjects to experience successful gains in performance with relatively small amounts of motor improvement
The task-oriented approach to rehabilitation is important in stroke rehab. What are its four components in OT treatment?
task-oriented approach is an occupation-based approach that is client-centered and focuses on enabling the client to achieve motor recovery through occupational performance using real objects, environments, and meaningful occupations.
- Encourage weight bearing over the involved side
- Encourage trunk rotation
- Encourage trunk elongation
- Encourage scapular protraction
Dynamic systems theory, on which motor control therapy is based, is seen as an interaction among what three factors?
The interaction between client factors, the context, and the occupations that must be performed to enact the client’s roles
What does Pedretti say is the most effective factor in all forms of CIT?
Intensive practice and functional use of the affected upper extremity repeatedly across multiple contexts for many hours a day for a period of consecutive days
What UE pathologies can limit the success of CIT?
shoulder subluxation
soft tissue shortening
joint contractures/deformities
CIT research protocols assume how many hours of continuous practice a day?
6 hours
Wear the mit for 90% of daily activities?
(Not 100% sure about this)
What amount of upper extremity function would you hope to see before beginning CIT therapy?
ability to move affected arm in 45 degrees of shoulder flexion and abduction, 90 degrees of elbow flexion and extension, 20 degrees of wrist extension, and 10 degrees of extension at the MCPs and IPs
Why would you choose not to try CIT with a hemiplegic patient who has cognitive impairment?
Cognitive impairments might prevent adequate participation in the strict protocol
What is the difference between ischemic and hemorrhagic stroke? Which is more common?
Ischemic: insufficient blood flow to the brain (most common)
Hemorrhagic: bleeding; subarachnoid and intracerebral hemorrhages; has numerous causes
7 modifiable stroke risk factors
hypertension management of cardiac diseases management of diabetes cigarette smoking excessive use of alcohol use of illegal drugs lifestyle factors such as obesity, physical inactivity, diet, and emotional stress
Blockage or rupture of which brain artery is most common? Be able to list all deficits associated with this particular stroke.
- Middle cerebral artery
- Dysfunction of either hemisphere
- Contralateral hemiplegia (mostly face, arms, and tongue)
- Contralateral hemisensory loss
- Visual field impairment
- Poor contralateral conjugate gaze
- Ideational apraxia
- Lack of judgement
- Perseveration
- Field dependency
- Impaired organization of behavior
- Depression
- Lability
- Apathy
- Behavioral abnormalities - Right hemisphere dysfunction
- Left unilateral body neglect
- Left unilateral visual neglect
- Anosognosia
- Visuospatial impairment
- Left unilateral motor apraxia - Left hemisphere dysfunction
- Bilateral motor apraxia
- Broca’s aphasia
- Frustration
- Wernicke’s aphasia
Top down vs. Bottom Up assessment. What are they? When would you use each?
- A top-down approach to assessment is an assessment that focuses on the evaluation of performance areas
Principles of this approach include the following:
- inquiry into role competency and meaningfulness is the starting point for evaluation
- inquiry is focused on the roles that are important to the client who sustained a stroke, particularly those in which the client was engaged before the stroke
- any discrepancy of roles in the past, present, r future is identified to help determine a treatment plan
- the tasks that define a person are identified, as well as whether those tasks can be performed and the reasons that the task is problematic
- a connection is determined between the components of function and occupational performance
- A bottom-up approach first focuses on dysfunction of client factors
Be able to name 10 of the 15 items scored on the NIH stroke scale.
level of consciousness (1a, 1b, and 1c = 3 scores) best gaze visual fields facial palsy arm motor leg motor limb ataxia sensory best language dysarthria extinction and inattention
Be able to name and describe at least four non-motoric reasons for a person with stroke having difficulty in performing a hemi-ADL task.
Pain Edema Muscle tone Joint alignment Cognition Sensory deficit Contracture and deformity Superimposed orthopedic conditions Loss of postural control to support UE control Learned nonuse Loss of biomechanical alignment
In stroke rehab, what are five intervention principles that utilize the task-oriented approach?
help clients adjust to role and task performance limitations by exploring new roles and tasks
create an environment that includes the common challenges of everyday life
practice functional tasks or close simulations that have been identified as important by participants to find effective and efficient strategies for performance
provide opportunities for practice outside of therapy time (e.g. homework assignments)
minimize ineffective and inefficient movement patterns
What are three effects that a stroke can have on a person’s trunk?
Inability to perceive midline as a result of spatial relationship dysfunction and leading to sitting postures that are misaligned from the vertical
Assumption of static postures that do not support engagement in functional activities
Multi directional trunk weakness
Inability to shift weight through pelvis anteriorly, posteriorly, and laterally
Spinal contracture secondary to soft-tissue shortening
Inability to move the trunk segmentally (i.e. the trunk moves as a unit)
List three ADL tasks that promote improved trunk control, and explain what the trunk does during those tasks.
Feeding: anterior weight shift occurs to bring the upper part of the body toward the table, to prevent spillage of food from utensils, and to support a hand-to-mouth pattern
Dressing: lateral weight shift to one side of the pelvis occurs so that pants and underwear can be donned over the hips
Oral Care: anterior weight shift occurs so that saliva and toothpaste may be expectorated
Transfer: the trunk extends with concurrent hip flexion to initiate a sit-to-stand transition
Meal Preparation: the trunk flexes into gravity in a controlled fashion to support a reach pattern to the lower shelf of the refrigerator
Pedretti lists 7 components that you can manage in helping a person with stroke better perform ADL in sitting. Know them.
- Establishing a neutral yet active starting alignment (i.e., a position of readiness to function)
- The client should attempt reaching activities from the above posture
- Establish the ability to maintain the trunk in midline using external cues
- Maintaining trunk range of motion (ROM) by wheelchair and armchair positioning that maintains the trunk in proper alignment
- Prescribing dynamic weight-shifting activities to allow practice of weight shifts through the pelvis
- Strengthening the trunk, best achieved by using tasks that require the client to control the trunk against gravity
- Using compensatory strategies and environmental adaptations when trunk control does not improve to a sufficient level and the client is at risk for injury
Pedretti lists 5 strategies for improving task performance in standing. Know them.
- Establishing a symmetrical base of support and proper alignment to prepare to engage in occupations.
- Establishing the ability to bear weight and shift weight through the more affected lower extremity.
- Encouraging dynamic reaching activities in multiple environments to develop task-specific weight-shifting abilities.
- Using the environment to grade task difficulty and provide external support.
- Training upright control within the context of functional tasks that are graded.
What are the benefits of sidelying on the affected side after stroke?
sensory input
become more aware of this side
become less fearful of putting weight on weak side
can help prevent painful shoulders
can reduce increased tone in flexion synergies
The shoulder can be at risk in sidelying. Why? How can you help?
increased risk of subluxation due to instability in glenohumeral joint and malalignment of positioning (i.e. scapula retracted, arm across body)
teach pt to protract scapula and support position with pillows
Why might you discourage clasped hands overhead ranging of UEs after stroke?
risk of increasing pain, prompting impingement syndrome and/or stressing carpal ligaments
List 5 contraindications for the use of a Bioness FES device.
- skin cancer
- metal pins or plates
- at risk for seizures
- pacemakers
- don’t apply on malignant tumor
- fracture/disclocation
- don’t use: simultaneously with high frequency surgical equipment; in proximity to shortwave or microwave therapy equipment
List 5 contraindications for the use of a REO Go Therapy device.
- client without supervision
- clients who can’t be active for 60 min without cardiac or respiratory problems
- persons with fixed contractures in affected limb
- persons with significant sensation/cognitive/linguistic/perceptual impairments
What electronic neurotherapy tools explored in our labs can be used in conjunction with CIT therapy? Which not?
Can be used in conjunction:
- Reo-go
- Armeo
- Bioness H200
Can not be used in conjunction:
-Functional Electrical Stimulation: RT300 by Restorative Therapies- unaffected hand could perform all of the work
Briefly describe what is meant by “computerized dynamic posturography” in the use of the SMART Balance Master.
method of assessing/isolating functional contributions of vestibular, visual, and somatosensory inputs, and the neuromuscular system in postural control and balance
pt stands on moveable platform with moving surround enclosure. Platform moves in various planes and records pt’s postural stability and motor reactions.
Why is the traditional “functional C” design hand splint a poor choice for people with hemiplegic hands (give four reasons)?
- the traditional functional “C” positions the long finger flexors in a shortened position
- the bent up sides cause bridging of the straps that allow the fingers to pull back and out
- the thumb is usually positioned in too much opposition-they usually have one strap for all four fingers
- the neurologically involved hand is a dynamic component that is constantly changing
- it changes with postural movements and associated reactions (e.g., sneezing, laughting, or standing up from chair) resulting in increased tone
- as the fingers move into flexion, something has to give
- unfortunately, it’s the patient’s IP joints that give under the pressure
- pain and joint damage are often the end result - “chronic imbalances of the force about a joint or series of joints can lead to deformities”
Why is a Saebo-Stretch splint considered a better choice than a static splint for a hemiplegic hand (four reasons)?
as tone increases, the SaeboStretch protects the joints by allowing the fingers to move into flexion
provides a low-load, long duration stretch to return fingers to extension
improve positioning by utilizing new strapping design with non-slip material
maintain and/or improve range of motion
to prevent contractures or minimize soft tissue shortening
overcomes issues which can result from traditional splints including deformity, joint damage, hypermobility, and contracture
Describe the Saebo-Stretch
also known as a resting hand splint or a night-time splint
stroke, TBI, SCI, CP
to prevent contractures or minimize soft tissue shortening
dynamic hand piece
allows the fingers to move through flexion caused by associated reactions (laugh, sneeze, stands up out of chair) and tone
utilizes a low-load, long-duration stretch to return the fingers to the desired position
overcomes issues which can result from traditional splints including deformity, joint damage, hypermobility, and contractures
Describe the SaeboFlex
allows individuals suffering from neurological impairments such as stroke the ability to incorporate their hand
functionally into therapy and at home by supporting the weakened wrist, hand, and fingers
a custom fabricated orthosis that is non-electrically based and is purely mechanical
positions the wrist and fingers into extension in preparation for functional activities
the user is able to grasp an object by voluntarily flexing his or her fingers
the extension spring system assists in re-opening the hand to release the object
treatment principles are based on the latest advances in neurorehabilitation research documenting the brain’s ability to “re-program” itself through mass practice, task oriented arm training
takes advantage of the most recent research by allowing patients to immediately begin using their hand for functional grasp and release activities
the ability to use the hand in therapy and at home has been reported as extremely motivating during the recovery process
goal: decrease learned non-use, increase learned use, reduce spasticity, improve ROM/strength/control, and improve quality of life
extraordinary ability of the brain to modify its own structure and function following changes within the body or in the external environment
Brain plasticity
stroke; the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain
Cerebral vascular accident
obstruction in a blood vessel due to blood clot or air bubble
Embolism
a brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain or the eye, sometimes as a precursor to a stroke; comes on suddenly, last few minutes to several hours but no longer than 24hrs
Transient ischemic attack (TIA)
inability to perform particular purposive actions, as a result of brain damage
Apraxia
lack of knowledge or denial about deficits or disease process and the implications of the deficit
Anosagnosia
slow, labored speech with frequent misarticulations; good auditory comprehension except when speech is rapid, grammatically complex, or lengthy
Reading comprehension and writing may be severely affected, and a client wiht Broca’s aphasia usually has deficits in monetary concepts and the ability to perform calculations
Broca’s aphasia
impaired auditory comprehension and feedback, along with fluent, well-articulated paraphasic speech. (so clearly spoken words, but the person doesn’t use them in a way that makes sense)
speech may occur at an excessive rate and may be hyperfluent
reading and writing comprehension is often limited, and mathematic skills may be impaired
Wernicke’s aphasia
decreased/impaired vision in half (or more) of the visual field in one or both eyes
Hemianopsia
total or partial loss of vision in a normal-appearing eye caused by damage to the brain’s occipital cortex; can be acquired or congenital, and may also be transient in certain instances.
Cortical blindness
a form of aphasia in which the patient is unable to recall the names of everyday objects
Anomia
inability to write
Agraphia
acquired neurological disorder causing a loss in the ability to communicate through writing, either due to some form of motor dysfunction or an inability to spell (acquired dyslexia)
Alexia
involuntary rapid eye movements, either vertical, horizontal or rotary
Nystagmus
double vision (simultaneous perception of two images of a single object
Diplopia
lack of voluntary coordination of muscle movements; the loss of full control of bodily movements
Ataxia
blood clot that typically forms in large veins of lower leg or thigh; could become embolism; bad
DVT: (deep venous thrombosis)
temporary/partial dislocation of glenohumeral joint; typically due to shoulder instability
Shoulder subluxation
