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Year 2: Neuromuscular > Test 2: Stroke rehab pt. 3 > Flashcards

Test 2: Stroke rehab pt. 3 Flashcards

1
Q

types of intervention selection for PT in stroke rehab

A

Remediation: when there is potential for structure and behavior plasticity

compensation

prevention

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2
Q

what factors affect whether the intervention is geared towards restoration, compensation, or prevention

A

stage of recovery

task/environment specific factors

pt resources- family, PLOF vs CLOF

attainable goals/DC plan

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3
Q

important PT considerations for evidence based practice

A

evidence based interventions dont define the scope of PT

focus on exercise that improves movement/motor learning/control

gaps in literature still exist- much of what we do is not in researches extensively yet

All strokes are different- not 1 optimal intervention

early mobilization is supported universally

best interventions are multimodal

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4
Q

factors to take into account when choosing stroke intervention

A

phase of recovery
severity
pt age
comorbidities
cognitive abilities
communication status
affective status
social and financial resources
potential DC planb

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5
Q

difference between rote exercise vs task specific

A

task specific = functional task where pt reaches goal in environment

rote = doesn’t have function directly tied to exercise

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6
Q

rationale for task specific training

A

salient goals

enhanced sensory experience

motor control is goal based

pts have varying abilities - more freedom in achieving task

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7
Q

what is neuro IFRAH

A

IFRAH = integrative functional rehabilitation and habitation

whole person approach

RESTORE FUNCTION not movement lost

habitation = process of helping those with disabilities attain, keep, or improve skills and functioning for daily living

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8
Q

functional mobility includes

A

bed mobility
transfers
sitting
standing

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9
Q

why have stroke pts “find midline”

A

pts with acute neuro disorders often haev misalignment of midline (“inattention”)

use verbal and tactile cues as well as mirror visual feedback

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10
Q

importance of dual task posture activities

A

better outcomes with dual tasks

enhanced feedback with dual task manipulation of object, overall sensory experience, and meaningfulness of a purposeful activity enhances subject performance

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11
Q

types of visual biofeedback

A

force platform with screen visual feedback

VR/video games

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12
Q

benefits of visual feedback for postural control and why

A

reduced sway
improved posture symmetry
improved dynamic stability

movement control is organized around achieving posture control and real time feedback allows for internal cuing to self correct

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13
Q

what is pusher syndrome and possible interventions

A

pt sits/stands asymmetrically with most weight shifted toward weaker side

have pt look at posture in mirror

pt can lean non affected side toward wall/therapist and keep it there while performing exercise

uses environmental prompts to improve perceptual and visuospatial awareness of body

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14
Q

when to use physical activity vs aerobic training

A

aerobic = more strenuous; not appropriate in acute stage

physical activity = appropriate in acute; early mobilization

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15
Q

rationale for aerobic training in stroke rehab

A

CVD and CVA go hand in hand

post stroke deconditioning/pts predisposed to a sedentary lifestyle

  • increase fall risk
  • decline in ambulation ability
  • low level CV exercise is difficult, thus further harming CV system
  • inactivity = secondary complications
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16
Q

challenges of aerobic training with stroke patients

A

many are nonambulatory

poor self efficacy

poor baseline of activity

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17
Q

aerobic training for subacute phase

A

walking
treadmill
cycle ergometry
seated stepper

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18
Q

non ambulatory aerobic training

A

UBE
recumbent bike
nu step
aquatic therapy

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19
Q

ambulatory treatment options with support

A

BWSTT
robotic assisted treatment training
aquatic therapy

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20
Q

aerobic training leads to

A

improved O2 consumption
improved workload tolerance
decreased fatiguability
improved VS at submax workloads
improved self concept
improved functional activities

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21
Q

what is progressive resistive strength training and its benefits

A

application of external load in addition to gravity during repetitive movements to overload the muscles generating the movement

improves strength

no evidence for increase in spascticity or decrease in ROM

increases function in the presence of significant weakness

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22
Q

rationale for resistive training

A

increased strength is correlated with improved motor function in stroke survivors (i.e. standind, posture control, gait, etc)

strength training counteracts hemiplegia

23
Q

concerns/limits with resistive training

A

strength does not equal function

strength alone cant overcome functional limits

inconsistent findings of benefits in research

24
Q

precautions with resistive training

A

hemiplegia affects grasp

impaired sensation = increase injury

place pts with posture deficits should be positioned to prevent falls

avoid valsalva for pts with unstable BP

start with submax protocols

25
Q

what types of UE treatments are best for stroke pts

A

focus on restoration and prevention of further MSK complication

close collaboration with OT

PT should focus on posture and mobility aspects

OTs should focuse on ADL aspects

26
Q

recovery of skilled upper limb use includes

A

managing MSK impairments

sensory and perceptual retraining

motor strengthening

improvement of selective capacity/fractionation

27
Q

evidence for upper limb interventions

A

passive positioning/WBing strategies (PROM)

PNF patterns (AAROM)

CIMT (forced use AROM) - evidence based

slings/sublux prevention (nonuse/compensation)

28
Q

what is assisted stabilization WBing

A

pt performs WBing through affected extremity with assisted stabilization and positioning from therapist and performs weight shifting

full elbow ext important

29
Q

intervention protocol for UE WBing

A

hand WBing at pt side

shoulder extended, abducted, and ER with elbow, wrist, and fingers extended

maintain position performing weight shifting loading for several minutes

30
Q

rationale for UE WBing

A

sustained stretching include relaxation through mechanisms of autogenic inhibition

slow rocking movements can be added to increase relaxation effects from influences of slow vestibualr stimulation

increased proprioceptove awareness through approximation of joints

31
Q

what is PNF

A

uses facilitation of total patterns of movement to promote motor learninf in synergistic patterns

emphasis on patterns to promote recovery of function

32
Q

rationale for PNF

A

active assisted hands on treatment to facilitate active movement patterns

33
Q

challenge of PNF

A

reliance on therapist to perform movement

not related to functional task

active movements needs to occur outside of synergy pattern

34
Q

what is CIMT

A

specific protocol that involves 2 week period of timed interval training where the unaffected limb is constrained by sling or mitt and affected limb is challenged through therapeutic task training

35
Q

rationale for CIMT

A

counteract learned nonuse

massed practive thought to induce cortical reorganization (neuroplastic changes)

research = maintained use of UE with 2 year follow up retention studies

36
Q

challenge of CIMT

A

concerns regarding performance of therapy too soon after stroke may create frustration and overuse syndromes creating neuroplastic changes

(timing matters)

37
Q

prevalence of shoulder sublux with stroke

A

malalignment of glenohumeral joint where humeral head displaces downward

56-82% occurance with stroke hemiplegia

67% of pts report incidence of shoulder hand pain syndrome post stroke

38
Q

intervention for shoulder sublux

A

slings = controversial

no evidence that slings can prevent sublux

some evidence for electrotherapy like NMES

39
Q

positives of sling use post stroke

A

support weight of arm and protect pt

can assist with shoulder approximation and prevent sublux (Giv Mohr Sling)

frees up therapist to attend to postural/trunk control during activitie s

40
Q

negatives of sling use post stroke

A

can cause contracture with prolonged use

contributes to body scheme disorders and body neglect

use blocks spontaneous use of UE and contribute to learned non use

affects postural stability and use of UE to weight shift with LOB

41
Q

what is EMGBF

A

uses surface electrodes to record muscle actuion potentials and present information in a visual and auditory manner

42
Q

what is NMES

A

neuromuscular electrical stimulation shourt term intervention for regaining muscle force, motor control, and reduce spasticity

43
Q

what is FES

A

functional electrical stimulation

motor level ES used to substitute for voluntary activation when the peripheral nerve supply to the muscle remains intact during functional activity

44
Q

rationale for EMGBF

A

timely and proportional info about muscle activation provided to pt

allows them to increase control over muscel force and activation

45
Q

main 2 functions of NMES/FES

A

improve force generation - more motor units firing

reduce spasticity - stimulation of antagonist muscle results in reciprocal inhibition of agonist and relaxes its tone

46
Q

what areas of the body is NMES/FES most supported

A

ankle
knee
wrist

47
Q

what is overground locomotor (gait) training

A

PT facilitateds gait training in reciprocal stepping pattern while advancing toward end goal

most common for stroke pts

48
Q

considerations for PT with gait training

A

must meet pre-gait dynamic posture stability first

need proximal stability in standing and good posture awareness

keep physical assistance to minimum and fade as quickly as possible

49
Q

what are some overground gait training progressions

A

functional movements (different directions, surfaces, steps, etc)

task specific skills (walking in home or community environment)

activities that involve coincident timing

dual task

50
Q

what does research say about the type of gait training and the phase of stroke recovery

A

chronic - can improve walking distance and ability but not balance

subacute- can improve balance and walking ability but not distance

acute - no improvement in walking, too many degrees of freedom

51
Q

PT considerations for body weight supported TT (BWSTT)

A

PT can provide manual assist

closed loop training

can introduce gait earlier and safer

harness provides safety, lowered weight, no need for AD

can transition away from harness to reduce BW incrementally

52
Q

BWSTT has been shown to specifically improve

A

walking velocity and walking distance

53
Q

what is robotic assisted gait training

A

electromechanical

uses exoskeleton or auto ambulator systems

no difference in outcomes compared to conventional training

54
Q
A

Year 2: Neuromuscular (20 decks)

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