Stroke Assessment + Treatment Flashcards
Scales used to measure stroke severity
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
What is evaluated by the FIM score or the Barthel index?
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
What is the dominant synergy in UE?
Flexion ; more specifically elbow flexion
What is the dominant synergy in LE?
Extension; more specifically knee extension
What is stage 1 of Chedoke? (2)
-Flaccidity
-No movement initiated
What is stage 2 of Chedoke? (3)
-Synergies might appear in a reaction
-Minimum voluntary mvmt might be present
-Spasticity begins to develop
-Rx: through facilitation
What is stage 3 of Chedoke? (2)
-Beginning of voluntary control of mvmt (in synergies)
-Spasticity at its peak
What is stage 4 of Chedoke? (2)
-Spasticity decreases
-Synergy pattern can be reversed if mvmt in in the weak synergy first (can only go from weak to strong synergy)
What is stage 5 of Chedoke? (2)
-Spasticity gets weaker (less strong)
-Synergy patterns can be reversed even in the strong synergy first (break strong synergy)
What is stage 6 of Chedoke? (2)
-Coordination and patterns of mvmt are near normal (in rapid mvmt still affected)
-Spasticity is gone
What is stage 7 of Chedoke ?
-No sign of functional impairment compared to normal side
How many tasks per stage in Chedoke to go to the next stage?
2/3. Have to assess 3rd anyway.
Except Stage 6: 3/3 and 2/3 in stage 7 to be a stage 7
What are the main goals in Rx for stage 1 Chedoke? (4)
-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)
What are the type of Rx for stage 2 Chedoke? (3)
-Positioning
-Facilitation (vibrator LOL)
-Inhibition (prolonged stretching )
What are the type of Rx for stage 3 Chedoke? (4)
-WB on UE +++
-EMG biofeedback
-Task in strong synergies (ex bring hand to chin)
-Funtional tasks
What are the Rx goals for stage 5 Chedoke? (3)
-Full ROM
-Rapid complex mvmt –> arm and fingers
-Strength
What are the two main mechanisms of stroke recovery? (IC)
- Increase of activity of the IPSILESIONAL side (i.e., areas surrounding the lesion)
- 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)
What are the 4 main steps in a motor relearning program (MRP)?
- Analysis of task (observation, comparison, anlaysis)
- Practice of missing components (explanation, instruction, practice & verbal and visual feedback + manual guidance)
- Practice of task (ensuring that the pt is an ACTIVE participant)
- Transference of training (opportunity to practice in context; consistency of practice; organization of self-monitored practice)
What are the MAIN interventions in acute care (approx 48 hrs after stoke/pt in stable condition)
- 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?
What is the recommended dosage for INPATIENT stroke rehabilitation?
Three hours per day of direct task-specific therapy, five days per week (interdisciplinary team; this includes PT and OT)
What is the recommended dosage for OUTPATIENT rehab?
Minimum of 45min per day per required discipline (i.e., PT & OT), 2-5 days per week.
- Ideally continues for AT LEAST 8 weeks
When should OUTPATIENT/in-home rehab occur following discharge from an acute hospital?
Within 48 hours of discharge form acute hospital, and within 72 hours of discharge from inpatient rehab.
What are the RED FLAGS (i.e., should not be included in rehab) for the upper extremity?
- Mental imagery & whole body vibration do NOT improve balance outcomes!
What are the TWO red flags (no evidence of benefits) in balance training?
- Mental imagery & whole body vibration do NOT improve balance outcomes!
