Stroke Rehabilitation

Question 1

Twitchell’s pattern of motor recovery following a stroke

Answer 1

Flaccid –> increased DTRs after 48 hours –> increase in muscle tone –> spasticity –> clonus 1-38 days post-hemiplegia –> first intentional movements appear 6-33 days after hemiplegia –> flexor synergy pattern –> extensor synergy pattern

Question 2

what muscle groups of UE and LE of the involved side exhibits increase in tone first in the pattern of recovery?

Answer 2

UE = flexors and adductors
LE = Extensors and adductors

Question 3

How long after stroke do you start getting clonus?

Answer 3

1-38 days post-onset of hemiplegia

Question 4

When do you get the first intentional movement after stroke?

Answer 4

6-33 days post-onset of hemiplegia

Question 5

What is usually the first intentional movement after stroke

Answer 5

shoulder flexion

Question 6

Synergy patterns of UE and LE

Answer 6

UE = Flexor synergy pattern of shoulder, elbow, wrist, and finger flexion
LE = Flexors synergy pattern of Proximal hip

Question 7

What comes first? Flexor synergy pattern or extensor synergy patter

Answer 7

flexor

Question 8

Diaschisis

Answer 8

functional deactivation of undamaged areas of the CNS that are separate from the lesioned area

Question 9

When do you see an increase in DTR?

Answer 9

48 hours after stroke

Question 10

Neuroplasticity

Answer 10

Ability of CNS to reorganize and remodel after CNS injury

Question 11

What part of the body recovers first? Arm or Leg

Answer 11

Leg occurs earlier and is more complete than arm

Question 12

Timeframe for recovery after stroke

Answer 12

Majority within first 3 months. Minor additional recovery after 6 months

Question 13

Which bone has the most decrease in BMD after stroke

Answer 13

Humerus

Question 14

timing of return of hand movement and prognosis

Answer 14

motor recovery in hand by 4 weeks, up to 70% chance of making full or good recovery

Question 15

timing of flaccidity and prognosis

Answer 15

flaccidity greater than 48 hours is poor prognosis

Question 16

proprioception and prognosis

Answer 16

return of proprioception > 9 days is poor prognosis

Question 17

7 stages of brunnstrom

Answer 17

1. flaccidity
2. spasticity
3. voluntary control over synergies with increase spasticity
4. patterns out of synergy with decrease in spasticity
5. complex movement combinations learned with decrease in spasticity
6. disappearance of spasticity with movement of individual joints
7. normal function

Question 18

strongest predictor of functional outcome at discharge

Answer 18

functional status at admission

Question 19

Repetitive practice mixed with continuous modification of the program to keep training tasks challenging to the patient

Answer 19

Task-oriented therapy

Question 20

Using spiral and diagonal components of movement to facilitate movement patterns

Answer 20

Proprioceptive neuromuscular facilitation

Question 21

Rehab method based on inhibiting primitive patterns of movement and facilitating automatic, voluntary reactions.

Answer 21

Bobath approach/neurodevelopmental technique

Question 22

Most commonly used rehab method for motor deficits

Answer 22

Bobath approach/neurodevelopmental technique

Question 23

Rehab method based on the concept that pathologic movement patterns must not be used for training

Answer 23

Bobath approach/neurodevelopmental technique

Question 24

What are “pathologic movement patterns” after a stroke?

Answer 24

limb synergy patterns and primitive reflexes

Question 25

What is the theory behind the Bobath approach

Answer 25

Using pathologic muscle patterns makes it too readily available to use at the expense of normal muscle patterns

Question 26

Rehab method based on using primitive synergistic patterns during training to improve motor control through central facilitation

Answer 26

Brunnstrom approach/movement therapy

Question 27

What is the theory behind the Brunnstrom approach?

Answer 27

After CNS injury, movement patterns regresses to older patterns. So, synergies and primitive reflexes are considered normal process of recovery before normal patters return.

Question 28

Rehab method based on using motor patterns available to them during their recovery process

Answer 28

Brunnstrom approach/movement therapy

Question 29

Rehab method that uses Twitchell’s recovery process

Answer 29

Brunnstrom approach/movement therapy

Question 30

Rehab method based on modifying muscle tone and motor activity through the use of cutaneous sensorimotor stimulation to promote contraction of proximal muscles

Answer 30

Rood approach/sensorimotor approach

Question 31

Rehab method based on cognitive motor relearning theory

Answer 31

Carr and Shepherd approach/motor relearning program

Question 32

Rehab method where patient relearns how to move functionally and solving motor problems while attempting new tasks

Answer 32

Carr and Shepherd approach/motor relearning program

Question 33

CIMT requires patients to have at least what motion?

Answer 33

10 degrees active wrist extension
10 degrees thumb abduction/extension
10 degrees extension in at least 2 additional digits

Question 34

Most common cause of dysphagia in stroke

Answer 34

Delayed pharyngeal swallowing

Question 35

Gold standard for evaluation and treatment of dysphagia

Answer 35

Videofluorographic Swallowing Evaluation (VFSS) aka MBS

Question 36

What is used to evaluate the pharyngeal phase of swallowing?

Answer 36

Fiberoptic endoscopic evaluation of swallowing (FEES)

Question 37

What phase of swallowing does FEES evaluate

Answer 37

pharyngeal phase

Question 38

Predictors of aspiration on VFSS

Answer 38

Decreased pharyngeal peristalsis and delayed swallow reflex