Stroke Lab I: Treatment Basics Flashcards
Stroke survivors can be generally classified as (a) low-level or (b) high-level functioning. What are the general Chedoke stages that fit into each of these categories?
(a) 1,2,3 sometimes 4 - generally significant deficits
(b) sometimes 4,5,6… important but less severe deficits.
try to name as many principles of experience-dependent neural plasticity (there are 10, try for at least 3) s possible.
(1) use it or lose it
(2) Use it and improve it
(3) specificity
(4) repetition matters
(5) intensity matters
(6) time matters
(7) salience matters
(8) age matters
(9) transference
(10) interference
What are the 6 P’s of treatment?
Hint scenario: You enter a patient’s room and notice that he is laying down strangely and apparently has been for some time. You want to sit him up, but he is confused and lists to one side in sitting when you try. You decide to use task-specific repetition and when he is able, work on sitting with no hand support.
(1) Prevention - ie ROM loss, DVTs etc from laying too long
(2) positioning - bring his shoulders back & down, symmetry etc.
(3) Postural Control - work on listing to one side, balance etc.
(4) Practice - repeated task specific training in sitting
(5) Presence of perceptual & other problems - he is confused, so use simple commands
(6) Progress - weaning off using hands to support him.
What does CMSA stand for?
Chedoke McMaster Stroke Assessment
Using the 6 p’s, provide some ideas for PREVENTION treatment of a low-level functioning stroke patient.
Prevention - mobilize as early as possible in supported sitting or standing (if possible) to prevent secondary complications like DVT, skin breakdown, or cardioresp problems.
Using the 6 p’s, provide ideas for POSITIONING of a low-level stroke patient.
Positioning - supine, side-lying on either side, make sure shoulders and pelvis are aligned, prevent ER of hip, Maintain DF of foot.
provide ideas for POSTURAL CONTROL for a low-level stroke survivor
Postural Control - use facilitation techniques like tapping, cues, or PNF to align body when in sitting, encourage weight shift, balance, reaching.
what kind of exercises should be PRACTICED in a low-level functioning patient?
Practice - protraction of scapula, ER of shoulder, elbow extension, active WB on UE, bridging, supported standing, trunk control.
How to deal with PERCEPTUAL OR OTHER PROBLEMS in low-level functioning stroke survivors?
simple commands, repetition, ensure understanding, break up tasks, etc.
What are some nice PROGRESSIONS that can be used when treating low-level functioning stroke survivors?
lying down - UE facilitation (serr ant), LE facilitation (bridge, approximate leg), progress to:
supported sitting - facilitation of trunk muscles starting with isometric to eccentric release then finally concentric lift to sitting, WB UE, balance with reaching, weight shift in sitting with arms on table (eventually with leaning and no support), lying to sit with progressively lowered bed angle, progress to:
standing - facilitated standing with knee blocked, sit-to-stands with progressively lower bed, weight shift, reaching.
For higher level patients, provide at least one example of a technique to use from each of the 6 p’s.
Positioning - maintaining good alignment in all activities including sleeping and sitting.
Prevention - avoid hip circumduction in gait, use AFOs to prevent contracture.
Postural Control - weight shift and balance work with tilt board, segmental trunk movement by sitting on ball, single leg stance.
Practice - WB in UE in different planes or from elbow, hip abd and ext for standing and gait, anti-gravity extension on mat in prone or 4pt, gait training, etc
Perceptual & other Problems -
Progression - basic to complicated grasps, closed chain to open chain like drawing alphabet with foot.
