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MBBS 2: Head and Neck Clinical Correlations > Stroke Rehabilitation > Flashcards

Stroke Rehabilitation Flashcards

1
Q

Describe the impairments caused by stroke?

A
  1. Sensory impairment
    - Pain, touch, temperature, pressure, proprioception, two point discrimination, vibratory sensation, asteriognosis etc
  2. Motor impairment
    - weakness, altered tone/flaccidity& spasticity, abnormal synergy patterns, abnormal reflexes, altered coordination, altered motor planning
  3. Postural control and balance
    - Balance disturbance including loss of symmetry and dynamics, ipsilateral pushing/pusher syndrome
  4. Speech, Language and Swallowing
    i. Aphasia (receptive and expressive)
    ii. Dysphagia
  5. Perception and cognition
    - visual and perceptual deficits occur in 32 to 41% of the population due to lesions in the right parietal cortex thus common in left hemiplegia than right.
  6. Cognitive functions
    - are present in lesions involving the cortex. Includes, alertness, attention, memory or executive functions
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2
Q

What structures can be damaged to impair preception?

A
  1. Afferent nerves
  2. Receptors:
    - Touch
    - Proprioception (see later)
  3. Vestibula (posture and balance)
    - BPPV
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3
Q

Describe impairment of perception following stroke?

A
  1. Hemianopia - loss of vision following stroke
  2. body image
  3. neglect
  4. apraxia
  5. Pusher
  6. extinction
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4
Q

Disturbed input/perception causes?

A

• Problems interpreting and localising tactile stimulus
• Problems with proprioception
• Hand function
• Interpreting visual /auditory input

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5
Q

What conditions are causes by disturbed perception?

A

• Pusher syndrome
• Neglect
•Apraxia
•Spatial disorders
•Agnosia/anosognosia

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6
Q

What is apraxia?

A

inability to carry out purposeful movements in the presence of intact sensation, movement and coordination

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7
Q

What are the 2 types of limb apraxia?

A
  1. Ideomotor: movement occurs automatic but not on command
  2. Ideational: purposeful movements are not present either automatic or on command
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8
Q

What is neglect?

A

Hemi inattention to one side of the body
- The inability to perceive and integrate stimuli from one side of the body
Note: Neglect is similar to “extinction”
in right hemisphere damage.

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9
Q

What is extinction?

A

In extinction one only identify objects in the left if no object is placed in the right side

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10
Q

Motor cortex deficits include?

A
  1. Muscle tone
  2. Abnormal reflexes
  3. Paresis after UMNL
  4. Abnormal Movements
  5. Involuntary Movements
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11
Q

What is tone?

A

stiffness of muscle when stretching

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12
Q

Describe the 2 types of muscle tone problems casued by an impaired action system?

A
  1. hypotone
    - flaccidity, floppy
    - Usually associated with LMNL
  2. hypertone
    - UMNL or Basal Ganglia problem
    i. spastic - Velocity dependent, increase resistance to passive stretch
    ii. rigid - Increased resistance to passive stretch independent of velocity
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13
Q

Name abnormal reflexes caused by an impaired action system?

A
  1. Babinski
  2. Clonus
  3. Hyperreflexia
  4. Irradiation of reflexes
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14
Q

What is irradiation of reflexes?

A

Testing reflex of one muscle will cause reflex in other muscles

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15
Q

Name abnormal movements caused by an impaired action system?

A
  1. selective control
  2. Bradykinesia
    slow movement time (time taken to execute a task from initiation of movement
  3. Akinesia
    - Reduced ability to initiate movement
  4. Hypokinesia
    - movements that are reduced in amplitude
    Note: Impairments in coordination result in disruptions of timing, selection and scaling of movements.
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16
Q

Describe selective control in abnormal movements?

A
  • The possibility to move single joint independent of the other or without influencing other joints to move.
  • caused by lack of signals from the lateral corticospinal track
  • Abnormal synergy: stereotypical simultaneous contraction of muscles not adaptable to task or environmental demands
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17
Q

What is cognition?
What is perception?

A
  1. cognition
    - the ability to process, sort, retrieve and manipulate information
  2. Perception
    - is the integration of sensory input into psychologically meaningful information
    Note: cognitive/perception are essential for successful interaction with the environment - Impairment of which affect one’s ability to move
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18
Q

Name potential cognitive impairments?

A

Attention
Orientation
Memory
Explicit and implicit motor learning
Arousal/ Level of consciousness
planning

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19
Q

Assessment of stroke?

A

Observation
History of illness
Physical assessment: sensation, motor, function, perception, cognition
Goal setting: patient goals

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20
Q

Health condition?

A
  1. Disorder/disease
  2. The Medical Diagnosis
    - Stroke
    - RTC Tear
    - Hematoma
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21
Q

What are the impairments of body structures and functions?

A

encompasses Loss of Cognitive or Anatomical Structures or Function
1. Loss of function or movement
2. Poor force generation
3. Limited proximal stabilization
4. Decreased range of motion
5. Amputation

22
Q

Describe the activity limitations of a stroke patient?

A

refers to How the impairment affects the patient functionally
1. Unsafe transfers
2. Falls with ambulation
3. Inability to climb steps
4. Unable to dress

23
Q

Describe the participation restriction in stroke ptients?

A

Life role affected by limited function
1. Unable to hold newborn baby
2. Unable to stay at home independently
3. Unable to be a taxi driver
4. Unable to participate in church activities

24
Q

What do physiotherapists treat?

A

impairments
1. Restore Function
2. Restore Movement
Note: Therapists MUST focus treatments on identified impairments that are causing the functional limitations NOT the pathology causing the impairments

25
What is the physiotherapy treatment of stroke?
1. Exercises/tasks 2. Position 3. Ice 4. Electrical modalities
26
Importance of position treatment of stroke?
1. to develop a normal posture and movement tone 2. avoid contractures and complications. Note: The correct positioning is not the same for all patients
27
Describe the supine lying positioning?
- The bed : completely flat. The head: on a pillow; not in flexion. - Both shoulders stabilised by a pillow. - The hemiplegic arm : • lying on a pillow and slightly away from the trunk; • the elbow straight: • the wrist extended: • the fingers straight; - The hemiplegic hip : • in extension and stabilised by a pillow. The arm rests on the same pillow.
28
Describe the sitting in bed positioning?
• The bed: *the head of the bed as straight as possible; • a pillow in the lower back. . The head: unsupported, free to move. • The trunk: straight • The hip: in 90° flexion, the weight distributed over both buttocks. The arms: forwards; the elbows supported on an adjustable table (eventually with the arms on a pillow).
29
Describe the sitting in a wheelchair at a table positioning?
SITTING IN A WHEELCHAIR AT A TABLE: (fig .19 - fig. 20) - The pillow: in the lower back. The arms forward, the elbows supported on the table, paying attention to the correct position of the hand. - The feet flat on the ground or on a foot stool.
30
Describe the lying on the hemiplegic side positioning?
LYING ON THE HEMIPLEGIC SIDE (fig. 2) • The bed: completely flat. • The head: comfortably stabilised. • The trunk : slightly backwards; stabilised by a pillow in the back and the bottom. • The hemiplegic shoulder: brought forward and externally rotated. • The hemiplegic arm : • 90° of flexion; • completely supported on an arm table next to the patient's bed; • the elbow as straight as possible and the palm upwards. • The hemiplegic leg : • the hip in extension; • the knee slightly bent. • The sound arm: lying on the trunk or on a pillow. - The good leg and foot: • in stepping position on a pillow; •knee and hip slightly bent.
31
Describe the lying on the non-affected side positioning?
LYING ON THE NON-AFFECTED SIDE (fig. 4) • The bed: completely flat. • The head : comfortably stabilised and in line with the trunk. The trunk: leaning slightly forwards. • The hemiplegic shoulder: well forwards. • The hemiplegic arm and hand: • on a pillow • in about 100° forward flexion. . The hemiplegic leg: • the hip and knee slightly bent; •the leg and foot stabilised by a pillow. • The non-affected arm: in a position comfortable for the patient. • The non-affected leg: the hip and knee extended.
32
What is essential in eliciting a better postural mechanism and movement?
Facilitation = giving support or the passive introduction of correct movement. Inhibition = preventing or braking wrong movements and building up too much tension. Different techniques enable inhibition: movement, weight transfers and a good starting posture
33
Describe transfers and bed mobility in stroke patients?
Transfers and bed mobility are essential functions usually affected following a stroke Are among the leading causes of handling injuries in stroke patients Are a priority in acute stroke rehabilitation
34
What is alignment? What are its components?
Provide therapy for impairments before attempting “strengthening therapy” 1. Trunk symmetry 2. Core engagement 3. Pelvic alignment
35
Excercises?
Involves muscle activation 1. What joint actions are needed for the task? 2. What muscles are responsible for that joint action? 3. How is the muscle used? - Open v. Closed Chain - Type 1 (muscle endurance) v. Type 2 (muscle strength)
36
Bed mobility and trunk mobilization excercises?
37
Bed mobility exercise?
38
Trunk exercise for posture and balance?
39
Gait training and upper limb rehabilitartion exercise?
40
Reaching and weight bearing exercises?
41
What is orthosis?
42
AFO?
helps with weight bearing during walking by ensuring there is heal strike in a gait circle
43
Importance of repetition?
Muscular Endurance Muscular Size Muscular Strength Note: Choose a weight that causes fatigue at chosen rep range
44
Describe transfers as functional task therapy?
Transfer over the strong side if able Have patient reach out to the strong side as opposed to pushing off With strong pushers, may be beneficial to have strong hand off the table
45
Describe standing as functional task therapy?
Provide solid surface on strong side during functional activities Initiate standing early! Initiate weight shifting to midline and to weak side Limit degrees of freedom early, okay to use knee immobilizers and AFOs
46
Describe gait as function task therapy?
Break down the gait phases Initiate on a fixed surface Limit degrees of freedom
47
Treatment Strategies for Low-Level Patients?
Use a wall Place elbow on support surface in sitting (on strong side) Use wedge under weaker side to facilitate weight shift to midline Use tilt table or standing frame Can also incorporate mirror, reaching, single leg stance Seated reaching tasks Leaning/Reaching forward
48
Treatment Strategies for Mid-Level Patients?
Use table or endpoint for patient Work on transition Encourage weight shifts off table to midline and to involved side Standing reaching Single leg stance activities at the table Stepping forwards and backwards, alternating lead foot Tall kneeling, half kneeling, and quadruped Bridging variations Core stabilization
49
Treatment Strategies for High-Level Patients?
Maximize integrated strength and muscular endurance of whole body Maximize postural control Add elements of power and strength to activities
50
Describe referral issues?
Should be done early enough May depend on medical stability of patients It is a multidisciplinary team approach May continue for months or years There is a need for better communication between health workers

MBBS 2: Head and Neck Clinical Correlations (7 decks)

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