Technology in Rehab and non-motor and secondary impairments of stroke

Question 1

How can smart devices and apps be beneficial for rehabilitation of stroke

Answer 1

Makes tasks interactive and fun
fun way to improve engagement and increase training frequency/repetition
encourage physical active at home

Question 2

Exercise based technology examples

Answer 2

Immersive VR
Non immersive VR: nintendo, Wii
Training mats for step training
Robotics

Question 3

are new technologies suitable for all patients?

Answer 3

No - consider age and function levels of patient, if set up is safe, space

Question 4

Should new technologies be used as an adjunct

Answer 4

Yes, until more evidence demonstrating effectiveness

Question 5

primary non-motor impairments of stroke

Answer 5

vision
sensation
proprioception
speech
cognitive function
behavioural

Question 6

secondary motor and non motor impairments stroke

Answer 6

motor
- muscle length
- swelling
- SH sublux
- CV fitness

Non-motor
- depression
- fatigue
- pain

Question 7

Is spasticity/dystonia: reflex stiffness or non-reflex stiffness

Answer 7

reflex stiffness: due to active muscle contraction

Question 8

difference between non-reflex stiffness and reflex stiffness

Answer 8

Non-reflex stiffness: refers to passive structures (joint capsule, ligaments, tendons and non-active muscle tissue). Non-contraction related

Reflex stiffness: refers to active muscle contraction (spasticity/dystonia)

Question 9

What is contracture

Answer 9

reduced joint ROM, caused by changes in passive mechanical properties of soft tissues

NOT reflex stiffness and muscle contractions

Question 10

issues with ROM measurement

Answer 10

easy ROM measurements unlikely to measure contracture

difficult measures are costly and hard to use

can’t define true contracture

Question 11

Factors that cause contracture

Answer 11

muscle weakness
disuse
presence of spasticity/dystonia
age
pain
injury severity

Question 12

What does botox do for spasticity

Answer 12

paralyses muscle at NMJ which reduces amount of muscle contraction that can occur

used to treat spasticity/dystonia

Question 13

What is a frequently injected muscle for spasticity

Answer 13

tib post - reduces inversion. Not going to interfere with gait

Question 14

Spasticity recommendations

Answer 14

botox for UL and LL with rehab therapy and may improve activity or motor function and walking

Estim, casting and taping may be used

Question 15

Recommendations against for stroke patients with spasticity

Answer 15

Acupuncture
Stretching

Question 16

Problems from impaired visions

Answer 16

dizziness and nausea
balance
falls

Question 17

Tips for working with people with impaired cognition

Answer 17

task oriented, functional and meaningful practice
clear, direct and one step instructions
use bright/large targets for task training
limit distraction

Question 18

Tips for working with patients with aphasia

Answer 18

speak slowly and simply
ask yes or no questions
use visuals/pictures to show what you are talking about
offer options - ‘would you like this or this’
give them to respond

DONT
speak for them
talk down to them
ignore them

Question 19

7 principles of SENSE: loss of Sense
SAFCART

Answer 19

Select tasks that are meaningful
Attentive exploration:
Feedback
Calibration
Anticipation
Repeat and progress
Transfer