Stroke Assessment + Treatment

Question 1

Scales used to measure stroke severity

Answer 1

Canadian neurological scale
4 domains:
* Level of consciousness
* Orientation (place and time)
* Aphasia (receptive and expressive)
* Motor strength (face, arm, leg)
Total max score of 11,5

Also: NIHSS - NIH scale

Question 2

What is evaluated by the FIM score or the Barthel index?

Answer 2

Level of disability

18 items(13 motor + 5 cognitive)
From complete dependence to complete independence
Total max score of 126 (7 points scale)
*administred at admission and discharge

Question 3

What is the dominant synergy in UE?

Answer 3

Flexion ; more specifically elbow flexion

Question 4

What is the dominant synergy in LE?

Answer 4

Extension; more specifically knee extension

Question 5

What is stage 1 of Chedoke? (2)

Answer 5

-Flaccidity
-No movement initiated

Question 6

What is stage 2 of Chedoke? (3)

Answer 6

-Synergies might appear in a reaction
-Minimum voluntary mvmt might be present
-Spasticity begins to develop

-Rx: through facilitation

Question 7

What is stage 3 of Chedoke? (2)

Answer 7

-Beginning of voluntary control of mvmt (in synergies)
-Spasticity at its peak

Question 8

What is stage 4 of Chedoke? (2)

Answer 8

-Spasticity decreases
-Synergy pattern can be reversed if mvmt in in the weak synergy first (can only go from weak to strong synergy)

Question 9

What is stage 5 of Chedoke? (2)

Answer 9

-Spasticity gets weaker (less strong)
-Synergy patterns can be reversed even in the strong synergy first (break strong synergy)

Question 10

What is stage 6 of Chedoke? (2)

Answer 10

-Coordination and patterns of mvmt are near normal (in rapid mvmt still affected)
-Spasticity is gone

Question 11

What is stage 7 of Chedoke ?

Answer 11

-No sign of functional impairment compared to normal side

Question 12

How many tasks per stage in Chedoke to go to the next stage?

Answer 12

2/3. Have to assess 3rd anyway.
Except Stage 6: 3/3 and 2/3 in stage 7 to be a stage 7

Question 13

What are the main goals in Rx for stage 1 Chedoke? (4)

Answer 13

-No pain arm and hand
-Normal alignment of scapula
-Adequate ms tone for mvmt
-Educate pt and family on position and handling

Ex exercises:
-avoid overstretching shoulder tissue and promote good alignment in lying/sitting
-PROM/AAROM elbow, wrist, fingers (interlocking fingers)
-glide on table (AAROM shoulder flexion)

Question 14

What are the type of Rx for stage 2 Chedoke? (3)

Answer 14

-Positioning
-Facilitation (vibrator LOL)
-Inhibition (prolonged stretching )

Question 15

What are the type of Rx for stage 3 Chedoke? (4)

Answer 15

-WB on UE +++
-EMG biofeedback
-Task in strong synergies (ex bring hand to chin)
-Funtional tasks

Question 16

What are the Rx goals for stage 5 Chedoke? (3)

Answer 16

-Full ROM
-Rapid complex mvmt –> arm and fingers
-Strength

Question 17

What are the two main mechanisms of stroke recovery? (IC)

Answer 17

1. Increase of activity of the IPSILESIONAL side (i.e., areas surrounding the lesion)
2. Increase of activity in the CONTRALESIONAL sensorimotor areas (support recovery of function, inhibits the lesioned side of brain (which is a maladaptive form of recovery) & promotes compensation)

Question 18

What are the 4 main steps in a motor relearning program (MRP)?

Answer 18

1. Analysis of task (observation, comparison, anlaysis)
2. Practice of missing components (explanation, instruction, practice & verbal and visual feedback + manual guidance)
3. Practice of task (ensuring that the pt is an ACTIVE participant)
4. Transference of training (opportunity to practice in context; consistency of practice; organization of self-monitored practice)

Question 19

What are the MAIN interventions in acute care (approx 48 hrs after stoke/pt in stable condition)

Answer 19

• Promoting independent movement
• Med mobility: Pts are prompted to change positions frequently (to prevent contracture, bed sores & DVT)
• Engage in PROM or AROM
• Sitting balance (standing when applicable)
• Transfers
• Weight-bearing exercises (UE & LE; standing? walking?)
• ADLs (bathing, eating, dressing…)
• Walking aid?

Question 20

What is the recommended dosage for INPATIENT stroke rehabilitation?

Answer 20

Three hours per day of direct task-specific therapy, five days per week (interdisciplinary team; this includes PT and OT)

Question 21

What is the recommended dosage for OUTPATIENT rehab?

Answer 21

Minimum of 45min per day per required discipline (i.e., PT & OT), 2-5 days per week.
- Ideally continues for AT LEAST 8 weeks

Question 22

When should OUTPATIENT/in-home rehab occur following discharge from an acute hospital?

Answer 22

Within 48 hours of discharge form acute hospital, and within 72 hours of discharge from inpatient rehab.

Question 23

What are the RED FLAGS (i.e., should not be included in rehab) for the upper extremity?

Answer 23

• Mental imagery & whole body vibration do NOT improve balance outcomes!

Question 24

What are the TWO red flags (no evidence of benefits) in balance training?

Answer 24

• Mental imagery & whole body vibration do NOT improve balance outcomes!

Question 25

T or F: Walking speed can be effectively manipulated with encouragement?

Answer 25

TRUE! (gait speed increased from 0.4m/s in a self-selected pace, to 1,2m/s in a motivated pace!)

Question 26

What is the cause of Stage 1 & Stage 2 shoulder pain?

Answer 26

Central pain (i.e., Complex Regional Pain Syndrome; Reflex Sympathetic Dystrophy)

Question 27

What is a RED FLAG in treating shoulder pain?

Answer 27

Aggressive ROM exercises & overhead pullies (can lead to shoulder subluxation)