Test 1: Stroke Rehab pt 1 Flashcards
PT role in stroke rehab
establish POC
use whole framework
difference of evaluation from screen
eval = gathering and analysis of data from the initial exam
prioritize pt problem list
involves all parts of patient centered model
why might it be important to know a pts vocation/societal role
makes therapy salient/meaningful
where does role/vocation belong on the ICF model
participation domain
what is the SIS
stroke impact scale
self report
59 questions/8 subgroups
used in outpatient
stroke specific outcome measure
pt rates perceived recovery
important pt hx to take in for stroke pts
PMHx
functional status (plof vs clof)
comorbidities
tone/spasticity
hx of intervention
psychosocial factors to note for stroke pts
pts knowledge of condition
pt goals
coping strategies
learning style
cognition
family support
common systems involved with CVA/stroke
cognitive
cardiovascular
integumentary
musculoskeletal
neurologic
cardio screen involves
HR
RR
BP
edema
cognitive screen involves
consciousness
orientation
expected emotional/behavior responses
learning preferences
MSK screen involves
gross coordinated movement (i.e. balance, gait, locomotion, transfers, transitions)
motor function
what elements does an examination involve
identifying and defining patients IMPAIRMENTS, ACTIVITY LIMITATIONS, AND RESTRICTIONS IN PARTICIPATION.
goal of examination
determine body function/structure and activity domain limitations
uses outcome measures, standardized tests, and task analysis
purpose of examination of stroke pts
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
important considerations for STROKE examination
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
functional measures with functional mobility are used to quantify what
activity limits
inform POC
monitor progress
ascertain efficacy of stroke rehab
make recommendations for long term care
FIM scores are correlated to
successful outcomes
DC home
return to community for pts with stroke
functional mobility may be affected by what factors in body structure domain
balance sensation
vision
integumentary
impairments in force production and coordination occur in paretic limbs, thus limiting functional mobility
what is FIM
functional independence measure
18 items
examines elements of pts physical, psychosocial, and social function
7 point scale
describe the 7 point scale of FIM
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
predective values of FIM
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
transfer items involved in functional mobility
Bed > chair/WC
toilet transfer
tub/shower transfer
supine to sit consideration
use hemiplegic side for restorative benefits
use stronger side to protect limb and facilitate successful movement
key elements a therapist should observe and document with functional mobility
- pt ability to initiate movement
- strategies utilized and overall control of movement
- pt ability to terminate movement
- level and type of assist
- environmental constraints that influenced performance
aspects of normal sitting
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
common impairments in sitting
posterior pelvic tilt
anterior pelvic tilt
unequal WBing (lateral tilt/pelvic RT)
wide based posture (LEs ABD/ER and UEs used to create support)
what causes a posterior pelvic tilt
weak erector spinae
tight HS
ASIS higher than PSIS
flat L/S
sacral WBing
increased T/S flexion
FHP
key elements PT should observe and document when assessing static posture
- BOS and position/stability of COM w/i BOS
- degree of posture sway
- use of UEs to stabilize or LEs hooked around chair/mat
- level and type of assist
- environmental constraint
special considerations for posture/balance with stroke
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
what is pusher syndrome
ipsilateral pushing
active pushing iwth stronger extremity towards hemiparetic side with lateral posture imbalance
fall toward hemiparetic side
10% of pts
what are the performance based postural control and balance scales
postural assessment scale for stroke patients (PASS)
functional reach, berg balance, TUG
examples of postural stability goals
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
