therapeutic consideration for individuals with hemiparesis/ hemiplegia Flashcards
what Can be used to rapidly screen an individual for some common findings associated
with a developing stroke.
BE FAST
what does BE FAST stand for
B- balance
E- eyes
F- Face
A- arm
S- speech
T- time
what are you looking for in balance for BE FAST
look for LOB or coordination loss
what are you checking for in eyes for BE FAST
check for vision changes
what are you looking for in face for BE FAST
look for asymmetries of the facial muscles by asking the person to smile
what do you ask the person to do for the arm section in BE FAST
ask the person o raise both arms simultaneously and see if they respond the same or differently
what is a general slurring and slowing of the speech pattern.
dysarthria
if the stroke is being causes by a blood clot then there is a ___ window to administer some tPA to help dissolve the clot
3 hour
what is the major sequellae of stroke
motor impairments
sensory impairments
visual/perceptual impairments
cognitive/communication impairments
how would you define hypotonia/ flaccidity
muscle tone is generally too low for normal function
how would you define hypertonia/ spasticity
muscle tone is generally too high for normal function
what will abnormal muscle tone result in
impaired joint alignment
muscles to ___ to properly stabilize joints
weak
mm to ___ to allow functional movement
stiff
what is defined as that amount of tone that is sufficient to hold us upright against gravity, but is not so strong as to inhibit selective movements
normal postural tone
These ___ reflexes serve to provide the basis for the movement patterns that progressively show more selective coordination, and less
primitive
primitive movement patterns
the righting reaction serve to provide ____ of the head to the vertical pull of gravity and ____ of the body parts to one another
orientation
alignment
what represent a critical factor in our development as upright individuals and in the development of trunk rotation.
righting reactions
what allow us 1 line of defense against
changes in our postural balance
protective extension reactions
what is protective extension reactions termed in UE and LE
UE- parachute reactions
LE- protective stepping
what acts As an extension of the protective reactions,
these motor skills allow us to maintain our balance by adjusting the location of the CoG within the BoS either by posturally fixating with strong cocontraction of musculature or by making adjustments of the trunk an
equilibrium reactions
Indicate if each statement represents an
impairment of a Righting Reaction (RR), a
Protective Reaction (PR), or an Equilibrium
Reaction (ER)
_____ Client does not extend and abduct weak arm when falling to that side.
_____ Client has difficulty lifting head off the surface in supine.
_____ Client does not move impaired leg forward quickly enough to prevent falling.
_____ Client does not lengthen weight-bearing side of trunk when shifting over to that
side.
_____ Client keeps head rotated away from weaker side.
_____ Client does not increase muscular stability around the proximal joint when
weight is shifted onto one limb.
PR
RR
PR
ER
RR
ER
the loss of selective movement patterns so that voluntary attempts at movement result in ___ ____
atypical synergies
what is predictable movement patterns occurring during volitional attempts atmovement OR as associated reactions. Thus, movements become “stereotypical” and restrictive of normal activities.
atypical synergies
what is the UE flexion synergy that is associated with hemiparestic synergies
scapular
shoulder
elbow
forearm
wrist
-scapular elevation and retraction*
- shoulder abduction and ER
- elbow flexion*
-forearm supination
- wrist and finger flexion *
what is the UE extension synergy that is associated with hemiparestic synergies (9)
scapular 2
shoulder 3
elbow
forearm
wrist
finger
scapular depression
- scapular protraction
- shoulder extension *
- shoulder adduction *
- shoulder IR*
-elbow extension
-forearm pronation*
- writs extension
-finer flexion*
where is the strongest motion components for synergies associated with hemiparetic synergies
UE
what is UE resting synergy
combination of the strongest components from both movement synergies
what are the most common UE synergies for these
Scapula:
Shoulder:
Elbow:
Forearm: ]
Wrist/Hand:
Scapula: Scapular depression & retraction
Shoulder: Extension, adduction, & internal rotation
Elbow: Flexion
Forearm: Pronation
Wrist/Hand: Wrist & finger flexion
what are the LE flexion synergy associated with hemiparetic syngeries (6)
pelvic
hip 3
knee
ankle
-pelvic elevation and retraction*
- hip flexion *
- hip abduction
- hip ER
-knee flexion
-ankle DR with foot inversion*
what are the LE extension synergy associated with hemiparetic syngeries
pelvic
hip 3
knee
ankle
-pelvic depression and protraction
- hip extension
-hip adduction*
- hip IR *
- knee extension *
-ankle PF won’t foot inversion*
what is the LE resting synergy associated with hemiparetic synergies
pelvis:
Hip:
knee:
ankle/foot:
pelvis: elevation and retraction
Hip: flexion , adduction , IR
knee: extension
ankle/foot: PF with inversion
what is dysphasia
eating/swallowing activity limitation
disorders of tactile function can be what 3 things
hypo , hyper or dysesthesia
what is disorders of proprioception and knesthesia
lacks awareness of limb position/movement
interactions of what 3 things will be disturbed for disorders of complex multimodal sensory mechanisms
vestibular , visual and proprioception for balance
lack of somatosenation anf proprioception can causes ultimate breakdown in ___ _____ since motor planning becomes more chaotic
movement patterns
although pre-programmed movements can be initiated without sensory stimulus, what is required for motor learned or refinement
feedback
what are disorders of body imagine
R and L sides of the body are no longer mirror images of each other
disorders of body imagine makes what hard for the pateitns to do
pre plan movements bc actions are no longer bilateral symmetrical
what is the main visual disorder
homonymous hemianopsia
the double letter cancellation test is. a ___ test
times
what is the fugl meyer test assessing
UE and LE sensorimotor function
what is the line bisection test
bisect the middle of the line
what is the modified ashworth scale for
muscle tone (spasticity )
what scale determines the severity of the stroke
national institutes of health stroke scale
what score is used for the prognosis of the stroke
orpington prognostic score
which scale test gait , stance , sitting and speech
scale for the assessment and rating of ataxia (SARA)
what does the stroke rehabilitation assessment of movement (STREAM) measure
impairments and activity levels
what scores can you use for the stroke rehabilitation assessment of movement
total score , voluntary movement limb score and/or basic mobility score
what position is the angle of muscle reaction measured at
0°
what does R1 mean for the angle of muscle reaction
PROM till catch point (where it catches during ROM)
what does R2 mean for the angle of muscle reaction
full PROM (the ROM the PT can go after the catch happens)
what scale is used for spasticity
tardieu scale
Action Reach Arm Test
Functional Independence Measure/Functional Assessment Measure
(FIM/FAM)
Postural Assessment Scale Stroke (PASS)
STREAM (also impairment based)
Stroke Impact Scale (SIS)
these are all examples of what
outcome measures
what are the 3 things that the action reach arm test assesses
grip
grasp
pinch
Functional Independence Measure/Functional Assessment Measure (FIM/FAM) is used for what
rehabilitation
what outcome measrue test for posture in sitting and standing
postural assessment scale for stroke patients (PASS)
what kind of questions does the stroke impact scale ask
about physical problems
Dementia
Global aphasia
Previous stroke
Older age
Prolonged urinary and bowel incontinence
Severe visuospatial deficits
Persistent sensory deficits
these are all examples of what
predictors of poor rehab outcome in stroke
what is functional independence define as
ability to handle ones needs without the assistance of a caregiver
what are the general goals of rehabilitation
maximize functional independence
return to the most optimal living environment
improve quality of life
what are some identifiable “neurophysiolgical approaches”
PNF = Proprioception Neuromuscular Facilitation
Brunnstrom = Movement Therapy in Hemiplegia
NDT = Neurodevelopmental Techniques (Bobath)
Neuro-IFRAH = Neuro-Integrative Rehabilitation and Habilitation
Rood = Sensorimotor Retraining
what are some identifiable “neurophysiolgical approaches”
PNF = Proprioception Neuromuscular Facilitation
Brunnstrom = Movement Therapy in Hemiplegia
NDT = Neurodevelopmental Techniques (Bobath)
Neuro-IFRAH = Neuro-Integrative Rehabilitation and Habilitation
Rood = Sensorimotor Retraining
