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NMR II > Stroke Part 2 > Flashcards

Stroke Part 2 Flashcards

1
Q

What are the prognostic indicators for shoulder pain?

A
  • Low stage of motor recovery (stage 1 & 2)
  • Scapular mal-alignment
  • Loss of shoulder movement (flex & ABD <90, ER <60)
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2
Q

T/F: It is okay to force shoulder ROM in order to see their full range

A

False

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3
Q

If scapular mobility or shoulder ER is absent what movements should not be performed by patient?

A

No abduction or flexion >90 degrees

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4
Q

What are some ways to test voluntary movements in regards to synergy dominance?

A
  • Fugl-Meyer Assessment of Physical Performance
  • Chedoke- McMaster Stroke Assessment - Impairment Inventory
  • Isolated, active movement against gravity
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5
Q

Why is MMT not valid during early stages of stroke recovery? What should be used instead? What is used when they are in late stages?

A
  • In presence of strong spasticity, reflex & synergy dominance
  • Use functional strength training instead
  • Once they are in stage 5, MMT, handheld dynamometer can be used
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6
Q

What motions of the trunk should be examined?

A
  • APT + Lumbar extension
  • PPT + Lumbar flexion
  • Lumbar lateral flexion (both directions)
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7
Q

In the early stages of recovery why may trunk motion be limited? What about late?

A
  • Early: impaired motor recruitment
  • Late: Impaired motor recruitment, ROM restriction
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8
Q

In regards to the NIH Stroke Scale is a lower score better or worse? What is severity scale?

A
  • Lower score = better
  • 25-42 very severe
  • 15-24 severe
  • 5-14 moderate
  • 1-5 mild
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9
Q

What are some facilitation model approach for intervention?

A
  • Brunnstrom’s Movement Therapy in Hemiplegia
  • Rood’s Sensory Motor approach
  • Bobath or Neuro-developmental Treatment (NDT)
  • Proprioceptive Neuromuscular Facilitation (PNF)
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10
Q

What are some task oriented model approaches for intervention?

A
  • Carr and Shepherd’s Motor Relearning Program for stroke
  • Constraint - induced movement therapy
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11
Q

What is an associated reaction?

A

An involuntary automatic movement in involved limb with active or resisted movement of another body part

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12
Q

What is a homolateral synkinesis?

A

A flexion pattern of the involved UE facilitates flexion of the involved LE

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13
Q

What is Ramiste’s Phenomenon?

A

involved LE will ABD or ADD with applied resistance to the uninvolved LE in the same direction

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14
Q

What is Souques’ phenomenon?

A

Raising involved UE above 100 degrees (flexion/ abd with ER) with elbow extension will produce extension & abudction of the fingers

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15
Q

What is the principle of Brunnstrom: Movement Therapy in Hemiplegia?

A
  • based on hierarchical model
  • Early stage reinforced synergies
  • No movement practiced that deviated from synergies until stage 4 of motor recovery
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16
Q

How is Rood Sensory Motor Approach done?

A
  • Use of sensory stimulation to facilitate & inhibit motor response
  • Believed that exercise must provide proper sensory feedback in order to be therapeutic
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17
Q

What techniques facilitate according to Rood Sensory Motor Approach?

A
  • Approximation
  • Joint compression
  • Icing
  • Light touch
  • Quick stretch
  • resistance
  • tapping
  • Traction
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18
Q

What techniques inhibit according to Rood Sensory Motor Approach?

A
  • Deep pressure
  • prolonged stretch
  • Neutral warmth
  • Prolonged cold
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19
Q

What is the order of motor control demands from least to most?

A
  • Least: Closed chain
  • Modified open chain
  • Most: Open chain
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20
Q

What is the main idea of NDT?

A
  • Individualized intervention that seeks to promote normal movement patterns
  • Proximal control in progressively challenging positions to work towards skill
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21
Q

When choosing intervention strategies for patient post stroke when may facilitation be beneficial?

A

When motor control is limited

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22
Q

When choosing intervention strategies for patient post stroke what is required for task training & CIMT to be beneficial?

A

active control

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23
Q

When choosing intervention strategies for patient post stroke when may compensation be indicated?

A

if needed to achieve functional goals

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24
Q

What are the general considerations for intervention strategies for patients post stroke?

A
  • Sequence of activities
  • Stage of motor control
  • Sensory & motor functions are interrelated
  • Management of muscle tone is important to maximally participate in intervention & function
  • Functional - task - oriented
  • Specificity of training
  • High intensity of practice both in and out therapy session
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25
Q

When considering intervention strategies for patients post stroke what is required for function?

A
  • active control in all 3 place of movement is essential for function
  • Function required asymmetrical, symmetrical, unilateral, bilateral & reciprocal movements
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26
Q

What are the risks of mobilizing patients too early?

A
  • Adverse events
  • Increase inflammation
  • Expansion of ischemic lesion
  • Worse functional outcome
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27
Q

What are the benefits of mobilizing patients in the acute phase?

A
  • Use it or lose it
  • Release BDNF & promote neurogenesis
  • promote neuroplasticiy & functional mobility
  • Reduce secondary complications associated with bed rest
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28
Q

What is contraindicated when deciding when to mobilize patients post stroke?

A

High - dose, very early mobilization (<24 hour) post stroke mobilization is contraindicated

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29
Q

What mobilization protocol should be implemented for the acute phase of patients post stroke?

A

Lower-dose, early mobilizations programs initiated 24-72 hours post-stroke ICH & SAH

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30
Q

What are some example of interventions that target ROM?

A
  • Positioning strategies to reduce common malalignments
  • Soft tissue/joint mobilization
  • PROM w/ terminal stretch
  • Edema & tone management
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31
Q

T/F: Overhead pulleys are contraindicated for patients post - stroke

A

True

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32
Q

When addressing ROM of the UE what is the precaution?

A

ER + distraction with mobile scapula over 90 degrees shoulder flexion

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33
Q

What are some safe self - ROM strategies that should be taught?

A
  • Arm cradling
  • Table top polishing
  • Reach to floor in sitting
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34
Q

Name some interventions for spasticity

A
  • Optimal positioning
  • Early mobilization
  • Daily stretching
  • Position in lengthened position with WB
  • Slow rocking
  • modalities
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35
Q

What are the results of progressive resistive strength training?

A
  • Improve strength
  • No increase spasticity or decrease in ROM
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36
Q

What are the principles of progressive resistive strength training?

A
  • Specificity of training
  • Combine with task specific training
  • Free weight, tubing/bands, machines
  • 3x 8-12, 2-3x/week
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37
Q

What are some precaution for strengthening interventions?

A
  • Hand function
  • Impaired sensation
  • Risk of falls
  • Comorbidities
38
Q

Name some intervention to improve sensory function

A
  • Encourage use of affected side
  • Sensory retraining programs
  • Sensory integrative treatment
  • Sensory stimulation intervention
  • Education for safety
39
Q

What are some sensory retraining programs?

A
  • mirror therapy
  • Repetitive sensory discrimination
  • Bilateral simultaneous movement
  • task practice
40
Q

What are some sensory integrative treatment?

A
  • Normalize tone
  • augment cues
  • Practice function
41
Q

What are some sensory stimulation interventions?

A
  • Compression
  • Weightbearing
  • mobilization
  • E- stim
  • Thermal stimulation
42
Q

What are some interventions for hemianopsia & unilateral neglect?

A
  • Teach visual scanning
  • Direct attention to involved side with cues
  • Encourage active movement of involved limbs
43
Q

During the acute phase what is the intervention for aerobic capacity?

A

minimize bed rest with early mobilization

44
Q

During post-acute phase what is the intervention for aerobic capacity?

A

traditional training

45
Q

What are exercise precaution when performing interventions for aerobic capacity?

A
  • Monitor HR & RPE
  • Avoid breath holding/ Valsalva
  • Medication decrease cardiac output (monitor RPE)
46
Q

What are the general considerations for managing the UE in individual post- stroke?

A
  • Maintain pain free ROM
  • Maintain/ restore normal shoulder girdle mechanics
  • Encourage active functional movements. Keep the arm & hand involved in functional activities
  • Maintain & retrain the sensory system
  • Avoid trauma
  • Educate patient & family
47
Q

What can the SAFE Model predict?

A
  • Upper limb function at 6 months within 72 hours of stroke by examining shoulder abduction & finger extension
  • Probability of regaining arm dexterity at 6 months based on SAFE score on day 2 CVA
48
Q

What are the pros of slings?

A
  • Protect from traction injury to soft tissue, nerves & vasculature
  • Therapist hands are free to help with mobility
49
Q

What are the cons of slings?

A
  • Little reduction of subluxation
  • Position of arm in ADD/IR + elbow flexion increase flexor tone & contracture which increase neglect & learned non-use
50
Q

What are the guidelines for using slings?

A
  • Minimize use
  • Select appropriate sling for the individual
  • Consider alternatives
51
Q

What is a flaccid presentation of shoulder pain?

A
  • Lack of tone, proprioception & muscle activation
  • Subluxation, traction, chronic pain
52
Q

How does shoulder impingement syndrome occur?

A

With flexion/ abduction without normal glenohumeral rhythm

53
Q

How can adhesive capsulitis occur post stroke?

A
  • Hypertonia restricts movement
  • Secondary tightness of ligaments, tendons & join capsule
  • Intracapsular inflammation can occur
54
Q

If a patient has a painful shoulder what activities should they avoid?

A
  • PROM without adequate scapular mobility
  • Traction & pulling on UE during transfers
  • No overhead pulleys
55
Q

When treating a painful shoulder what activities should be selected?

A
  • Mobilize scapula in side lying
  • Work towards approximation of the head of the humorous in glenoid fossa in good alignment
  • Maintain/establish normal scapulohumeral rhythm
  • Consider intervention to reduce sublimation
56
Q

Describe stage 1 of Complex Regional Pain Syndrome (CRPS) and is it reversible in this stage?

A
  • Discoloration (pink)
  • Cool
  • Hypersensitive
  • Guarded movement
  • Highly reversible
57
Q

Describe stage 2 of CRPS and what is the prognosis?

A
  • Pain subsides
  • Dystrophic changes
  • Early osteoporosis
  • Variable prognosis
58
Q

Describe stage 3 of CRPS and is it reversible in this stage?

A
  • Atrophic phase (skin, muscle, bone)
  • Largely irreversible
59
Q

How should CRPS be treated?

A
  • proper positioning & handling
  • PROM, grade 1 & 2 mobilizations
  • shoulder PROM only with scapular mobilizations, limit to 90 degrees flexion or abduction or point of pain
  • AROM (therapy ball on table in standing)
  • Edema management
60
Q

name some residual deformities you may see while a patient recovers from CRPS

A
  • Wrist flexion
  • Ulnar deviation
  • Flattened palm, decreased definition of the arches
  • Decreased web space
  • Decreased MCP flexion
  • Decreased finger adduction
61
Q

When selecting interventions to enhance postural control & force production what postures should be selected?

A
  • That put patients into more extended postures
  • High sitting (hip above knees)
  • Standing
  • Squatting
62
Q

name some transitions to bias involved trunk, limb extensors & abductors

A
  • Lateral weight shift in high sit
  • Lift off
  • Scooting
  • Sit to stand
  • Stand
  • Stand & step less involved limb
63
Q

What is the order for progression of interventions to enhance postural control & force production?

A
  • Closed Kinetic chain (static stability, body on stable limb)
  • Modified open kinetic chain (body & limb move together, limb moves on stable body)
  • Open kinetic chain
64
Q

What is pusher’s syndrome?

A
  • Lateral postural imbalance caused by pushing with the stronger extremities toward the involved side
  • Resist correction to midline
  • Altered perception of body’s orientation (misperception of vertical 20 degrees)
65
Q

Pusher’s syndrome is common in strokes involving what?

A
  • posterolateral thalamus
  • insula
  • operculum
66
Q

T/F: Pusher’s syndrome can not be corrected

A

False
- Can be corrected with proper identification and intervention training

67
Q

What tasks do patients with pusher syndrome have difficulty with?

A
  • Standing
  • Walking
  • Transfers
  • ADLs
68
Q

What are the treatment objectives when treating pusher’s syndrome?

A
  • Assist patient to learn their perception of vertical is incorrect
  • DIrect patient to visually explore surroundings and look for visual verticals
  • Encourage patient to reach, weight shift, & transfer to the less involved side
  • Practice to make more automatic (dual task)
  • Do not forget to treat the more involved side too
69
Q

In treatment of pusher syndrome emphasize (passive or active) weight shifts toward (stronger or weaker side)

A

Emphasize active weight shifts towards the stronger side

70
Q

Name some intervention strategies for pusher syndrome

A
  • Visual stimuli
  • Can help to position therapist/ wall on stronger side/ stand pt In corner
  • Focus on unilateral support with weaker UE
  • Disadvantage less involved limbs to discourage pushing
  • Shorten cane or change support
  • Motor learning strategies very effective
  • Body weight support treadmill training
71
Q

What are intervention principles to treat ataxia?

A
  • Address active trunk control & stability
  • Use task specific, functional practice
  • Progress challenge by: reducing BOS & decreasing reliance on UE
72
Q

Patients with ataxia initially have a challenge in stability with limbs in closed kinetic chain. How should this be addressed?

A
  • Joints mid range to avoid passive propping
  • Work on graded recruitment
  • Gradually increase the range of movement
  • Gradually decrease the amount of support through UE
73
Q

In treating patients with ataxia, after they master closed kinetic chain activities where should they progress? How is this done?

A
  • Modified open chain activities
  • Sensory feedback
  • Grade recruitment
  • Limit degrees of freedom
74
Q

In treating patients with ataxia, after they master modified open kinetic chain activities where should they progress?

A
  • Open kinetic chain
  • Initially use object in hand to provide feedback
  • Select object or task with consequence
75
Q

What do positioning strategies reduce?

A

Malalignments

76
Q

How often should PROM (or AROM) with terminal stretch be implemented? How often if contracture is developing?

A
  • Daily
  • Twice daily
77
Q

What are some modalities that can be used to decrease spasticity?

A
  • Cold
  • Massage
  • E-stim to antagonist (reciprocal)
  • Botox
78
Q

What should be avoided when strengthening patients with comorbidities post- stroke?

A
  • Acute: High intensity sustained max
  • Avoid isometric & Valsalva
79
Q

What protocol should be used when strengthening patients post-stroke?

A

Submaximal protocol 30-50% MVC w/ gradual progression

80
Q

Name some interventions for those without voluntary movement according to algorithm for selecting Upper Limb Interventions

A
  • Maintain PROM
  • Prevent/manage edem
  • Sensory retraining
  • Manage spasticity
  • Positioning
  • Patient education
  • Motor Imagery
  • Mirror therapy
  • E Stim
  • Supportive device
  • Avoid splinting
  • Compensatory techniques
81
Q

Name some interventions for those with some voluntary movement according to algorithm for selecting Upper Limb Interventions

A
  • Sensory retraining
  • Manage spasticity
  • Positioning
  • Patient education
  • Motor Imagery
  • Mirror therapy
  • E Stim
  • Supportive device
  • Maintain PROM/ AAROM
  • Robot assisted therapy*
  • Bilateral arm training *
  • Trunk restraint*
82
Q

Name some interventions for those with shoulder abduction against gravity according to algorithm for selecting Upper Limb Interventions

A
  • Motor Imagery
  • Sensory retraining
  • Mirror therapy
  • E Stim, EMG triggered E-stim
  • Robot assisted therapy
  • Bilateral arm training
  • Trunk restraint
  • TST*
  • Video gaming *
83
Q

Name some interventions for those with finger extension according to algorithm for selecting Upper Limb Interventions

A
  • Motor Imagery
  • Sensory retraining
  • Mirror therapy
  • Trunk restraint
  • TST
  • Video gaming
  • Strength training*
  • Mod- CIMT or CIMT*
84
Q

Name some interventions for those with/at risk for shoulder pain according to algorithm for selecting Upper Limb Intervention

A
  • Education
  • Gentle mobilization
  • E-stim for subluxation
  • Analgesia
  • Team prevention
  • Avoid strapping
  • Botulinum toxin for spasticity
85
Q

What are some strategies to reduce subluxation?

A
  • Supportive positions
  • NMES
  • Biofeedback
  • Taping
86
Q

T/F: Recovery from CRPS is a fast process

A

False - Slow

87
Q

What does CRPS stand for?

A

Complex regional pain syndrome

88
Q

What are some treatment options for gait?

A
  • Treadmill training (w or w/o harness)
  • Robotic- assisted locomotor training
  • Functional electrical stimulation (FES)
  • Virtual reality
  • Motor imagery
  • Rhythmic Auditory Cueing
  • Orthotics & devices
89
Q

When is recovery for stroke the fastest?

A

First weeks to months

90
Q

How long can functional gains be made?

A

months to years

NMR II (14 decks)

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