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Year 2: Neuromuscular > Test 1: Stroke Rehab pt 2 > Flashcards

Test 1: Stroke Rehab pt 2 Flashcards

1
Q

what is tone

A

resistance of muscles to passive stretch or elongation

amount of tension at rest

can be normal or abnormal

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2
Q

what is elasticicty

A

tone in all muscle groups must be balanced for smooth movement

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3
Q

what CNS involvement can cause disturbances in muscle tone

A

impairement of the brain, spinal cord, and other receptors/ability to work together

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4
Q

what is spasticity

A

abnormal tone

increased involuntary, velocity dependent muscle tone (faster passive movement, stronger the resistance)

UMN motor disorder

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5
Q

what is flaccidity

A

hypotonicity; often present immediately after stroke

due to effects of cerebral shock

lasts a few days/weeks

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6
Q

how does spasticity present following a stroke

A

early in stroke following falccidity (90% of cases)

pts lack ability to adjust/stabilize proximal limbs and trunk

spasticity patterns influence resting posture and limit active movements outside of synergistic patterns

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7
Q

what is posturing

A

the tightness/stiffness that is a result of spasticity in muscles (i.e. elbow remaining flexed)

can lead to spasms, degenerative changes, and fixed contracturesw

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8
Q

what are synergistic patterns

A

autonomic adjustments of postural muscles that occurs normally in prep for and during movement task

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9
Q

synergy definition

A

working together

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10
Q

characteristics of normal synergies

A

create orderly, purposeful, precise, efficient movements

movements not limited outside of biomechanical ability

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11
Q

characteristics of abnormal synergies

A

movement bound together

“massed patterns of movement”

primitive/reflexive/automatic

limited movement combos; cant be adapted to environment

attempt to activate one muscle results in activation of abnormally coupled models

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12
Q

where are flexor synergies more commonly seen

A

UE

possibly due to primitive reflex of brining hand to mouth to feed

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13
Q

where are extensor synergies more commonly seen

A

LE

possibly due to primitive reflex to stand legs extended

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14
Q

flexion synergy of shoulder girdle

A

elevation and retraction

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15
Q

flexion synergy of shoulder

A

abduction to 90 deg

ER

hyperext

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16
Q

flexion synergy of elbow

A

flexion

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17
Q

flexion synergy of forearm

A

supination

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18
Q

flexion synergy of wrist and fingers

A

flexion

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19
Q

extension synergy of hip

A

extension

abduction

internal rotation

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20
Q

extension synergy of knee

A

extension

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21
Q

extension synergy of foot/ankle

A

plantar flexion

inversion

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22
Q

which neurofacilitation model uses relflexive synergies to define the stages of motor learning and recovery following a neuro injury

A

Brunnstrom

23
Q

how to test for spasticity in PROM

A

repeat specific movements passively at different speeds to check for spasticity

quicker = higher spasticity

can use Modified Ashworth Scale

24
Q

describe clonus testing

A

quick stretch of muscle that causes sustained beating of muscle

common in plantar flexors but can occur in jaw or wrist

+ when spasmodic contraction of antagonist muscle occurs

25
Q

what is the modified ashworth scale (MAS)

A

used to measure/grade spasticity

observe position of affected limbs at rest and during voluntary movement

26
Q

describe the grades of the MAS

A

0 = no increase in tone

1 = slight increase; catch and release at end ROM

1+= slight increase; catch/release through rest ROM (1/2)

2 = more marked increase through ROM but affected part moved easily

3 = considerable increase in tone; PROM difficult

4 = affected part in rigid flexion or extension

27
Q

middle stages of brunnstrom synergies focus on what

A

moving out of synergies and into functional movements

28
Q

Words that mean that the pt is exhibiting isolated control of a movement following a synergy

A

selective capacity

individualization

fractionation

29
Q

recovery following synergies occurs in what direction

A

proximal to distal

30
Q

description and goal of Brunnstrom’s stage 1/falccid paralysis

A

marked flaccidity; no reflex/voluntary movement

Goals:
-PNF to regain motor function (reciprocal initiation)
-encourage facilitation and support against gravity

31
Q

description and goal of brunstrom’s stage 2/development of minimal movement in synergies

A

minimal voluntary movement
movement in partial or whole synergy patterns
spasticity begins to develop

Goals:
-continue to progress PNF to gain motor function

32
Q

description and goal of Brunnstrom’s stage 3/voluntary movement synergy dependent

A

voluntary control of movement synergies (stuck in synergy)

movement may not be through full ROM

spasticity peaks

Goals:
-break pt out of imporper synergies to develop active, isolated movements
-recovery vs compensation: is pt using spasticity to allow for functional movility

33
Q

Brunnstrom’s stage 4/some movements out of synergy description/goal

A

development of some isolated voluntary control of movement out of synergy (can break synergy)

selective capacity; can isolate movement against gravity

spasticity declining but still present

goal:
-cont to break pt of imporper synergies to further develop active/isolated movement (i.e. knee ext with hip flexion or shoulder flexion with elbow ext)

34
Q

Description and goals of Brunnstrom’s stage 5/movements almost independent of synergy

A

can perform more difficult movements out of synergy

increased selective capacity

spasticity declining but still slightly present

goal:
-continue to break improper synergies
-develop active isolated movement and incorporated functions
-i.e. knee ext exercises with hips in flexed position while advancing limb during swing phase

35
Q

Description and goals of Brunnstrom’s stage 6/normal movement

A

ability to perform selective capacity movement

individual active/isolated joint movements out of synergy patterns

no spasticity

goals:
-continue rehab to incorporate function and return to full recovery
-avoid any learned compensatory movements (bad habits)

36
Q

Brunnstrom’s stage 7 vs 6

A

stage 7 is normal motor function restored (back to pre-stroke levels)

37
Q

reasons UE use is compromised post stroke

A

hemiplegia
spasticity
contractures
non-use
MCA involved

38
Q

common strength findings in UE limb screen

A

strength losses typically greater in distal aspect of extremity compared to proximal

39
Q

is UE or LE more commonly affected post stroke

A

UE more frequent

high incidence of MCA involvement

40
Q

residual deficits often seen in UE following stroke

A

20% of individuals with MCA strokes fail to regain functional use of affected UE

41
Q

concern of flaccidity in UE following stroke

A

can result in shoulder sublux

need to monitor position of arm/gap in glenohumeral joint

disuse/atrophy can cause further problems

42
Q

as contractures develop, what other factros can further restrict mobility

A

edema
spasticity
pain

43
Q

what is coordination

A

ability to execute smooth, accurate, controlled movement

characterized by appropriate:
-speed
-amplitude
-direction
-timing
-muscular tension
-fluidity of movement

44
Q

coordination deficits due to neuro injury

A

dyssynergia
dysmetria
dysdiadochokinesia
gait ataxia
speech dysarthria

45
Q

clinical considerations for coordination testing

A
  • screening often not performed if other deficits are present prior
    -perform 1UE and 1LE bilaterally
    -test EO and EC to determine if vision is compensating
46
Q

what to observe with coordination test

A

-movement direct/precise/easily reverse?
-reasonable time frame?
-affected by speed?
-can adjustments be made?
-does vision affect?
-greater proximally or distally?
-one side more involved?
-consistent over time?

47
Q

describe finger to nose coordination test

A

abd arm to 90

have pt bring tip of finger to nose with EO and EC

+ = jerky/wandering movement, discrepency between sides, between EO/EC, or consistently missed target

48
Q

describe finger to finger test

A

touch therapist finger then touch your nose

longer path = greater challenge for dysmetria

therapist can move finger while pt is going toward their nose

+ = jerky, missed target

49
Q

describe the rapid alternating movements test

A

tests for dysdiadochokinesia

ask pt to rapidly pronate/supinate with arms extended or on thighs

+ = uneven/jerky/slow movement/need to change amplitude

50
Q

describe finger opposition test

A

touch every fingertip with thumb

+ = uneven/jerky/sliding finger for stability

speed differences expected between dominant and non dominant hand

51
Q

describe heel to shin test

A

stroke heel of foot up and down other shin

+ = uneven/k=jerky

52
Q

describe rapid alternating movemnent test

A

rapid DF and PF feet or bend and straighten knees

ask to do unilaterally and bilaterally and compare

53
Q
A

Year 2: Neuromuscular (20 decks)

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