Test 2: Compensation vs Remediation

Question 1

stages of recovery

Answer 1

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

Question 2

common Acute stage care facilities and focus of therpay

Answer 2

ICU

most recovery due to resolution of physiologic injury

begin intervention at 24-48 hours

Question 3

goals of acute stage

Answer 3

prevent further complications
- contracture
- seizure
- edema
- infection
- stroke reoccurance
- DVT
- postural hypotension
- skin breakdown
- depression

Question 4

role of PT in acute phase

Answer 4

early mobilization - prevent/minimalize harmful effects of bedrest and deconditioning

monitor pt status and VS

prevent compensations and learned helplessness

Question 5

PT considerations for acute phase

Answer 5

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

Question 6

example acute phase interventions post stroke

Answer 6

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

Question 7

describe subacute phase

Answer 7

medically stable

transition to next level of care

influenced by:
- med stability
- severity of cognitive/perceptual deficits
- behavior/effect/motivation
-pt endurance/tolerance
-prognosis

Question 8

options for DC for subacute phase

Answer 8

subacute rehab facilities- prevent home failure

inpatient rehab

skilled nursing (SNF)

home

Question 9

PT considerations for subacute phase

Answer 9

goal = functional independence

promote WBing through hemiparesis

can begin aerobic training

prevent learned nonuse

limit caregiver dependence

Question 10

what is learned nonuse

Answer 10

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

Question 11

interventions for PT in subacute phase

Answer 11

posture control/balance

progress functional mobility/ADLs

locomotor training

UE limb use

address specific impairements of body function and structure domain

Question 12

describe the chronic phase

Answer 12

6 months post stroke

recieve care/PT in:
- outpatient PT
- home health
- community

Question 13

goals fo chronic phase

Answer 13

continue to meet goals and progress toward independence and lowest level of care burden

sustain gains made and improve functional performance

avoid readmission

Question 14

considerations for PT in chronic stage

Answer 14

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

Question 15

example interventions for chronic stage

Answer 15

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

Question 16

describe restoration interventions

Answer 16

reaquisitions of motor patterns that were present before CNS injury

performance of skill is identical in every way to pre-injury

Question 17

what is activity induced neuroplasticity

Answer 17

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

Question 18

strategies that promote recovery/restorative function

Answer 18

weight bearing

visual feedback

salience

self efficacy

modeling guided movements

Question 19

what are compensation interventions

Answer 19

substitues/alternative strategies to complete task

maladaptive neuroplasticity
- pt produces most effective and efficient movement to accomplish task

Question 20

when are compensatory strategies appropriate

Answer 20

think about…
- discharge timing
- recovery potential
- if shorter length of stay due to insurance
- how to best decrease burden of care
- is pt depressed?

Question 21

examples of compensatory approaches in acute stage

Answer 21

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

Question 22

examples of remediation in acute stage

Answer 22

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