Stroke Lab Flashcards
Stage 1 Shoulder Hand Syndrome
- Lasts several weeks
- Limited ROM
- Swelling of dorsum of hand
- Shiny skin
- Limited ROM in finger flexion
- Hypersensitive to touch, pressure or variation in movement
- Pain in wrist extension
Stage 2 Shoulder hand syndrome
- Harder to reverse, several weeks to months
- Shoulder pain subsides, ROM increases
- Less painful limitations
- Decreased edema in hand but fingers are stiffer
- Coarse hair and nails
- Decreased sensitivity
- Can see osteoporosis on x-ray
Stage 3 Shoulder hand syndrome
- irreversible
- progressive atrophy of bones, skin, muscles
- limitation of hands, wrists, fingers increases, leaving hands painless but useless and atrophied in clawed position
Treatment of Shoulder hand Syndrome
- Reduce edema
- Maintain or increase ROM of MCP, PIP, and DIP
- Maintain wrist in slight extension
- Encourage movement of involved shoulder
- Bed position on hemiplegic side for sensory input
- positive mental imagery is not recommended
Neglect
- Dense L hemiplegia
- Flaccidity (L)
- Poor trunk control –> flexion and posterior pelvic tilt
- L Homonymous Hemianopsia
- L absent sensation
- Perceptual deficit- lack of acknowledgement of L side of world
Pusher
- Mild to moderate hemiparesis
- Normal to mild/mod hypertonicity
- Inaccurate perception of midline
- Impaired to intact sensation on involved side
- Impaired judgement/safety awareness
Apraxia Presentaiton
- Varying levels of sensory and motor loss
- Varying levels of tone dysfunction
- Functional Activities are not consistent with motor evaluation
Apraxia Definition
” a disorder of voluntary learned movement that is characterized by an inability
to perform purposeful movements, which cannot be accounted for by inadequate strength, loss of coordination, impaired sensation, attentional difficulties, abnormal tone, movement disorders, intellectual deterioration, poor comprehension, or uncooperativeness. The patient is unable to accomplish the task even though the instructions are understood.”
Supine Positioning Recommendations For Hemiplegic Patient
- Pillow under involved shoulder; arm slightly abducted, ER, and extended on a pillow
- Thin roll under involved pelvis and small roll under knee
- Lateral roll to prevent ER/Flexion
Sidelying on uninvolved side
- Involved shoulder forward and supported on a pillow
- Involved hip forward with knee and ankle supported on a pillow (or hip neutral with knee flexed)
Sidelying on invovled side
- Involved shoulder forward, out to the side, ER, with elbow extended (palm up)
- WB on scapula and NOT the head of humerus
Acute Care Stroke Management: Safety
- Acute distress: Stop treatment, return to sitting or lying down, observe and assess; monitor vital signs; determine whether it is appropriate to proceed with planned of adjusted intervention. If you decide not to proceed, notify nurse and/or physician
- Sternal, fall, aspiration precautions
- IV infiltration (fluid goes into tissue instead of vein)
Stroke Intervention planning
Determined by:
- Medical condition
- Tolerance to activity
- Length of treatment session
- Address impairments as well as functional activities
Qualities of Intervention Activities for Stroke
- Use simple, common objects
- Use repetition
- Require problem solving as appropriate
- Determine how much precision you wish to require
- Select tasks that are meaningful to you and pt
