Technology in Rehab and non-motor and secondary impairments of stroke Flashcards
How can smart devices and apps be beneficial for rehabilitation of stroke
Makes tasks interactive and fun
fun way to improve engagement and increase training frequency/repetition
encourage physical active at home
Exercise based technology examples
Immersive VR
Non immersive VR: nintendo, Wii
Training mats for step training
Robotics
are new technologies suitable for all patients?
No - consider age and function levels of patient, if set up is safe, space
Should new technologies be used as an adjunct
Yes, until more evidence demonstrating effectiveness
primary non-motor impairments of stroke
vision
sensation
proprioception
speech
cognitive function
behavioural
secondary motor and non motor impairments stroke
motor
- muscle length
- swelling
- SH sublux
- CV fitness
Non-motor
- depression
- fatigue
- pain
Is spasticity/dystonia: reflex stiffness or non-reflex stiffness
reflex stiffness: due to active muscle contraction
difference between non-reflex stiffness and reflex stiffness
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)
What is contracture
reduced joint ROM, caused by changes in passive mechanical properties of soft tissues
NOT reflex stiffness and muscle contractions
issues with ROM measurement
easy ROM measurements unlikely to measure contracture
difficult measures are costly and hard to use
can’t define true contracture
Factors that cause contracture
muscle weakness
disuse
presence of spasticity/dystonia
age
pain
injury severity
What does botox do for spasticity
paralyses muscle at NMJ which reduces amount of muscle contraction that can occur
used to treat spasticity/dystonia
What is a frequently injected muscle for spasticity
tib post - reduces inversion. Not going to interfere with gait
Spasticity recommendations
botox for UL and LL with rehab therapy and may improve activity or motor function and walking
Estim, casting and taping may be used
Recommendations against for stroke patients with spasticity
Acupuncture
Stretching
Problems from impaired visions
dizziness and nausea
balance
falls
Tips for working with people with impaired cognition
task oriented, functional and meaningful practice
clear, direct and one step instructions
use bright/large targets for task training
limit distraction
Tips for working with patients with aphasia
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
7 principles of SENSE: loss of Sense
SAFCART
Select tasks that are meaningful
Attentive exploration:
Feedback
Calibration
Anticipation
Repeat and progress
Transfer
