Stroke Rehabilitation Flashcards
Twitchell’s pattern of motor recovery following a stroke
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
what muscle groups of UE and LE of the involved side exhibits increase in tone first in the pattern of recovery?
UE = flexors and adductors LE = Extensors and adductors
How long after stroke do you start getting clonus?
1-38 days post-onset of hemiplegia
When do you get the first intentional movement after stroke?
6-33 days post-onset of hemiplegia
What is usually the first intentional movement after stroke
shoulder flexion
Synergy patterns of UE and LE
UE = Flexor synergy pattern of shoulder, elbow, wrist, and finger flexion LE = Flexors synergy pattern of Proximal hip
What comes first? Flexor synergy pattern or extensor synergy patter
flexor
Diaschisis
functional deactivation of undamaged areas of the CNS that are separate from the lesioned area
When do you see an increase in DTR?
48 hours after stroke
Neuroplasticity
Ability of CNS to reorganize and remodel after CNS injury
What part of the body recovers first? Arm or Leg
Leg occurs earlier and is more complete than arm
Timeframe for recovery after stroke
Majority within first 3 months. Minor additional recovery after 6 months
Which bone has the most decrease in BMD after stroke
Humerus
timing of return of hand movement and prognosis
motor recovery in hand by 4 weeks, up to 70% chance of making full or good recovery
timing of flaccidity and prognosis
flaccidity greater than 48 hours is poor prognosis
proprioception and prognosis
return of proprioception > 9 days is poor prognosis
7 stages of brunnstrom
- flaccidity
- spasticity
- voluntary control over synergies with increase spasticity
- patterns out of synergy with decrease in spasticity
- complex movement combinations learned with decrease in spasticity
- disappearance of spasticity with movement of individual joints
- normal function
strongest predictor of functional outcome at discharge
functional status at admission
Repetitive practice mixed with continuous modification of the program to keep training tasks challenging to the patient
Task-oriented therapy
Using spiral and diagonal components of movement to facilitate movement patterns
Proprioceptive neuromuscular facilitation
Rehab method based on inhibiting primitive patterns of movement and facilitating automatic, voluntary reactions.
Bobath approach/neurodevelopmental technique
Most commonly used rehab method for motor deficits
Bobath approach/neurodevelopmental technique
Rehab method based on the concept that pathologic movement patterns must not be used for training
Bobath approach/neurodevelopmental technique
What are “pathologic movement patterns” after a stroke?
limb synergy patterns and primitive reflexes
What is the theory behind the Bobath approach
Using pathologic muscle patterns makes it too readily available to use at the expense of normal muscle patterns
Rehab method based on using primitive synergistic patterns during training to improve motor control through central facilitation
Brunnstrom approach/movement therapy
What is the theory behind the Brunnstrom approach?
After CNS injury, movement patterns regresses to older patterns. So, synergies and primitive reflexes are considered normal process of recovery before normal patters return.
Rehab method based on using motor patterns available to them during their recovery process
Brunnstrom approach/movement therapy
Rehab method that uses Twitchell’s recovery process
Brunnstrom approach/movement therapy
Rehab method based on modifying muscle tone and motor activity through the use of cutaneous sensorimotor stimulation to promote contraction of proximal muscles
Rood approach/sensorimotor approach
Rehab method based on cognitive motor relearning theory
Carr and Shepherd approach/motor relearning program
Rehab method where patient relearns how to move functionally and solving motor problems while attempting new tasks
Carr and Shepherd approach/motor relearning program
CIMT requires patients to have at least what motion?
10 degrees active wrist extension
10 degrees thumb abduction/extension
10 degrees extension in at least 2 additional digits
Most common cause of dysphagia in stroke
Delayed pharyngeal swallowing
Gold standard for evaluation and treatment of dysphagia
Videofluorographic Swallowing Evaluation (VFSS) aka MBS
What is used to evaluate the pharyngeal phase of swallowing?
Fiberoptic endoscopic evaluation of swallowing (FEES)
What phase of swallowing does FEES evaluate
pharyngeal phase
Predictors of aspiration on VFSS
Decreased pharyngeal peristalsis and delayed swallow reflex
