Test 2: Compensation vs Remediation Flashcards
stages of recovery
acute: 1-7 days post stroke; spontaneous recovery dominates
subacute: neuroplasticity; peaks between 7 days - 3 months and plateaus around 3-6 months
chronic: >6 months; neuroplastic changes still occur but rate begins to decline
common Acute stage care facilities and focus of therpay
ICU
most recovery due to resolution of physiologic injury
begin intervention at 24-48 hours
goals of acute stage
prevent further complications
- contracture
- seizure
- edema
- infection
- stroke reoccurance
- DVT
- postural hypotension
- skin breakdown
- depression
role of PT in acute phase
early mobilization - prevent/minimalize harmful effects of bedrest and deconditioning
monitor pt status and VS
prevent compensations and learned helplessness
PT considerations for acute phase
current trend = shorter acute stay
early discharge = higher risk of med complications
must monitor pt for complications/med emergencies
no aerobic training at this time
early mobilization encouraged
establish effective communication strategies
example acute phase interventions post stroke
functional mobility/ADL training
ROM/splinting/positioning
-move extremities 3-5x/day
-AROM promotes blood flow
family/caregiver edu
- pt handling
- prep for DC
- mobility and ROM HEP
describe subacute phase
medically stable
transition to next level of care
influenced by:
- med stability
- severity of cognitive/perceptual deficits
- behavior/effect/motivation
-pt endurance/tolerance
-prognosis
options for DC for subacute phase
subacute rehab facilities- prevent home failure
inpatient rehab
skilled nursing (SNF)
home
PT considerations for subacute phase
goal = functional independence
promote WBing through hemiparesis
can begin aerobic training
prevent learned nonuse
limit caregiver dependence
what is learned nonuse
cant use limb despite some motor funcyion
pt met with repeated failure to use limb in meaningful ways and thus learns compensatory measures to improve function and independence
interventions for PT in subacute phase
posture control/balance
progress functional mobility/ADLs
locomotor training
UE limb use
address specific impairements of body function and structure domain
describe the chronic phase
6 months post stroke
recieve care/PT in:
- outpatient PT
- home health
- community
goals fo chronic phase
continue to meet goals and progress toward independence and lowest level of care burden
sustain gains made and improve functional performance
avoid readmission
considerations for PT in chronic stage
HEP
- carry over outside of clinic
- edu family
- prevent falls/safety
transition out of pT and progress to community fitness programs
want to help pt participate in roles
example interventions for chronic stage
adderss specific functional limits at home
promote independence and aerobic capacity with locomotion training
continue to promote UE use
continue to address body structure/function limits
describe restoration interventions
reaquisitions of motor patterns that were present before CNS injury
performance of skill is identical in every way to pre-injury
what is activity induced neuroplasticity
recovery obtained through specific interventions designed to have impact on neural mechanisms
task oriented movements
bottom up approach to intervention - if pt improves mobility it is assumed they will then improve spasticity, strength, balance, etc
strategies that promote recovery/restorative function
weight bearing
visual feedback
salience
self efficacy
modeling guided movements
what are compensation interventions
substitues/alternative strategies to complete task
maladaptive neuroplasticity
- pt produces most effective and efficient movement to accomplish task
when are compensatory strategies appropriate
think about…
- discharge timing
- recovery potential
- if shorter length of stay due to insurance
- how to best decrease burden of care
- is pt depressed?
examples of compensatory approaches in acute stage
edu pt and have them turn head to affected sude ‘
place items where pt can see on less affected side
PT should sit on pts less involved side
perform mobility to less affected side
examples of remediation in acute stage
alternate to more affected sude so pt can recover perceptual or visual deficits
red tape and other compensatory strategies can be used as external cues for pt to practice scanning toward affected side
