Test 1: Stroke Rehab pt 1

Question 1

PT role in stroke rehab

Answer 1

establish POC

use whole framework

Question 2

difference of evaluation from screen

Answer 2

eval = gathering and analysis of data from the initial exam

prioritize pt problem list

involves all parts of patient centered model

Question 3

why might it be important to know a pts vocation/societal role

Answer 3

makes therapy salient/meaningful

Question 4

where does role/vocation belong on the ICF model

Answer 4

participation domain

Question 5

what is the SIS

Answer 5

stroke impact scale

self report

59 questions/8 subgroups

used in outpatient

stroke specific outcome measure

pt rates perceived recovery

Question 6

important pt hx to take in for stroke pts

Answer 6

PMHx

functional status (plof vs clof)

comorbidities

tone/spasticity

hx of intervention

Question 7

psychosocial factors to note for stroke pts

Answer 7

pts knowledge of condition

pt goals

coping strategies

learning style

cognition

family support

Question 8

common systems involved with CVA/stroke

Answer 8

cognitive
cardiovascular
integumentary
musculoskeletal
neurologic

Question 9

cardio screen involves

Answer 9

HR
RR
BP
edema

Question 10

cognitive screen involves

Answer 10

consciousness
orientation
expected emotional/behavior responses
learning preferences

Question 11

MSK screen involves

Answer 11

gross coordinated movement (i.e. balance, gait, locomotion, transfers, transitions)

motor function

Question 12

what elements does an examination involve

Answer 12

identifying and defining patients IMPAIRMENTS, ACTIVITY LIMITATIONS, AND RESTRICTIONS IN PARTICIPATION.

Question 13

goal of examination

Answer 13

determine body function/structure and activity domain limitations

uses outcome measures, standardized tests, and task analysis

Question 14

purpose of examination of stroke pts

Answer 14

screen for possible benefit from rehab services

develop POC w/ goals, intervention, etc

measure progress toward goals

determine if referral to other practitioner is needed

plan for DC

Question 15

important considerations for STROKE examination

Answer 15

spasticity/tone - look for synergy patterns

degree of hemiparesis (need UE use for ADLs)

postural stability w/ sitting/standing

functional mobility - look for synergy pattern

gait (if appropriate) - look for synergy pattern

Question 16

functional measures with functional mobility are used to quantify what

Answer 16

activity limits

inform POC

monitor progress

ascertain efficacy of stroke rehab

make recommendations for long term care

Question 17

FIM scores are correlated to

Answer 17

successful outcomes

DC home

return to community for pts with stroke

Question 18

functional mobility may be affected by what factors in body structure domain

Answer 18

balance sensation
vision
integumentary

impairments in force production and coordination occur in paretic limbs, thus limiting functional mobility

Question 19

what is FIM

Answer 19

functional independence measure

18 items

examines elements of pts physical, psychosocial, and social function

7 point scale

Question 20

describe the 7 point scale of FIM

Answer 20

no helper/independent = 7

no helper/modified independent = 6

helper/modified dependence = 5,4, and 3 (supervision, MinA, modA)

helper/complete dependence = 2 and 1 (max and total assist

highest score = 126, lowest = 18

Question 21

predective values of FIM

Answer 21

37-40 indicates pt will not regain independence

40-80 indicate inpatient rehab most appropriate

higher score = fewer days insurance allows for rehab; need to demonstrate medical necessity

Question 22

transfer items involved in functional mobility

Answer 22

Bed > chair/WC

toilet transfer

tub/shower transfer

Question 23

supine to sit consideration

Answer 23

use hemiplegic side for restorative benefits

use stronger side to protect limb and facilitate successful movement

Question 24

key elements a therapist should observe and document with functional mobility

Answer 24

1. pt ability to initiate movement
2. strategies utilized and overall control of movement
3. pt ability to terminate movement
4. level and type of assist
5. environmental constraints that influenced performance

Question 25

aspects of normal sitting

Answer 25

ASIS is level or slightly lower than PSIS

IT equal w/ WBing

ASIS level with each other

head in midline with chin in

trunk muscles active maintaining upright posture (co contract with core and erector spinae)

feet flat on floor

Question 26

common impairments in sitting

Answer 26

posterior pelvic tilt

anterior pelvic tilt

unequal WBing (lateral tilt/pelvic RT)

wide based posture (LEs ABD/ER and UEs used to create support)

Question 27

what causes a posterior pelvic tilt

Answer 27

weak erector spinae

tight HS

ASIS higher than PSIS

flat L/S

sacral WBing

increased T/S flexion

FHP

Question 28

key elements PT should observe and document when assessing static posture

Answer 28

1. BOS and position/stability of COM w/i BOS
2. degree of posture sway
3. use of UEs to stabilize or LEs hooked around chair/mat
4. level and type of assist
5. environmental constraint

Question 29

special considerations for posture/balance with stroke

Answer 29

control of balance can be impaired during self initiated movements or when reacting to destabilizing external force

sensorimotor disruptions cause inability to recruit effective postural strategies and adapt

uneven weight distribution can cause sway or falling

Question 30

what is pusher syndrome

Answer 30

ipsilateral pushing

active pushing iwth stronger extremity towards hemiparetic side with lateral posture imbalance

fall toward hemiparetic side

10% of pts

Question 31

what are the performance based postural control and balance scales

Answer 31

postural assessment scale for stroke patients (PASS)

functional reach, berg balance, TUG

Question 32

examples of postural stability goals

Answer 32

holds static sitting w/ increased independence

hold for so many seconds

independently self corrects orientation

weight shift w/o assist

pt attends to limb during seated mobility