Treatment, clinical reasoning and evidenced based Rx for neuro Flashcards
How will you explain recovery to a person or family member post stroke?
What is believed that one of the ways people recover after a stroke is through brain plasticity or in other words re-organisation of the brain networks. This might work by some of the regions of the brain that are functioning, can help and contribute to the functioning of what is affected.
What is the guidance on how much time should be spent on UL rehab post stroke.
The NICE guidelines (2023) recommends that individuals receiver at least 1 hour of each relevant therapy five days a week.
What are the key things to take into account for stroke rehab sessions?
Making the activities align with the person’s goal
Make them functional
Take into account fatigue of the patient and psychological factors such as mood and motivation
What does the research and guidance say about Robot-assisted arm training?
NICE guidelines (2023) recommend not offering robot-assisted arm training as part of UL rehab
However, a study found that a pt who underwent robot-assisted arm training prior to conventional therapy showed improvements motor function and higher performances in movement smoothness compared to pt in just conventional therapy (Budhota et al., 2021)
What is the perspective on mirror based therapy?
NICE guidelines (2023): use if pt has weakness in upper or lower limbs post stroke as an adjunct to their rehab programme
If using it should start within 6 months post stroke and done for 30 mins a day, 5 times a week, for 4 weeks
What is the perspective of electrical stimulation for upper limb rehab post stroke?
NICE guidelines (2013) say don’t routinely offer ES but consider a trial as part of a comprehensive rehab programme for people who have evidence of muscle contraction but can’t move their arm against gravity
What are the recommended sets and reps for exercise prescription?
The American College of Sports medicine recommends 8-12 reps with 1-3 sets (70-85% 1 RM) for normal strength building.
However, a NLM (Kim et al) article says that guidance for stroke recommends 2-3 days a week of 8-15reps and 1-3 sets between 30-50% of 1RM.
What treatment would you focus on giving someone who has a sensory deficit and1/5 motor deficit
Hand facilitation and preparing the hand for rehab
What are the key elements of reach and grasp?
Target
Transport
Grasp
Manipulation
(mention these when talking about exercises)
What are the guiding principles in neuro rehab from the ICF framework, WHO (2001)?
- The ICF: The international classification of functioning, disability and health
- Team work
- Person-centred care
- Prediction
- Neural plasticity
- Motor control
- Functional movement re-education (RAMP)
- Skills acquisition
- Self management
- Health promotion
What are the perspectives on CIMT, when should it be considered and how often?
The modified CIMT used has been found to be effective for functioning in daily life, duration used ranges up to 6 hours a day, and a treatment period of 2 to 12 weeks (Kwakkel et al)
NICE guidelines (2013) say consider CIMT for people who have movement of 20 degrees of wrist extension and 10 degrees of finger extension.
What is the evidence and clinical reasoning for bilateral tasks?
NLM- (Waller and Whitall, 2024)
Says bilateral activities could have a positive effect on unilateral skills and helps with bilateral activities in daily life.
Bilateral movement- allows to activate the trunk, mirror neurons work to prepare both arms for the same movement, more natural in day to day life.
Also prevents learned non-use.
What do the NICE guidelines recommend for stroke rehab?
Task orientated
Repetitive
Involve patients in rehab plans
What are the important things to remember to ensure patient centred care in stroke rehab (research)
- Focus on recognizing the person beyond their illness
- Value individual characteristics
- Ensure the person is at the centre of care and having them as an active agent in their own care
- Respecting their expectations in the care process
(Martín-Sanz et al., 2022)
Management of shoulder pain (guidelines)
NICE guidelines : Provide info for people after stroke, as well as their families/carers about how to prevent pain and trauma to the shoulder if they are at risk of developing shoulder pain (2013)
Why are closed chain exercises good for UL stroke rehab?
Stabilising the shoulder
