UE Assessment and Management Flashcards
what is assessment used to determine?
- What an individual wants and needs to do
- What the individual is currently able to do
- What supports and barriers influence occupational performance and participation
what is the purpose of assessing?
- Establish baseline
- Establish goals
- Inform intervention planning process
do functional UE impairments happen in one or both upper extremities?
both!
what can perceptual impairments interfere with?
UE function
what are examples of perceptual impairments?
Visual field deficits, neglect, visual extinction, agnosia
functionally, what do we see difficulties with when someone has perceptual impairments?
- Locating target
- Identifying target (agnosia)
- Planning and executing reach and grasp (apraxia)
what are some OPC examples that are focused on motor control?
paresis
timing impairments
loss of individuation
excessive use of trunk
every plan for OT evaluation includes what?
he analysis of occupational performance. This includes:
- Identification of strengths
- Potential problems
what is activity analysis?
observation
what re methods of evaluation?
- activity analysis
- standardized vs non-standardized assessment tools
- interviews
what is a low level arm CMSA?
stages 1-2
what is a CMSA stage 1-2 arm movement and function?
incompletely selective movements (small amplitude, non-functional)
primarily used for stabilization tasks
what is an intermediate level arm CMSA?
stagers 3-5
what is a CMSA stage 3-5 arm movement and function?
biomechanical and muscle imbalances with incompletely selective movements
transitioning from stabilization to manipulation tasks
what is a high level arm?
stages 6-7
what is a CMSA stage 6-7 arm movement and function?
selective movements but lacks strength, dexterity, or coordination necessary for normal function
primarily used for manipulation tasks with emphasis on speed, accuracy, and quality of movements
what assessment do we as OTs use to assess and stroke patient?
Chedoke arm and hand activity inventory (CAHAI)
what is the benefit of the CAHAI?
Real life bilateral activity measure that clients determined as meaningful
what is the CAHAI designed specifically for?
stroke
how many tasks does the CAHAI evaluate?
7-13 functional tasks
what influences our upper extremity interventions?
- Severity of sensorimotor impairments
- Time post-stroke
- Recovery prognosis (finger extension and shoulder abduction)
- Client’s needs and goals
- Evidence of effectiveness
- Clinical resources available
how do we manage a category 1 (severally impaired) UE?
gentle, pain free weight bearing
how do we manage a category 2 (moderately impaired) UE?
transitioning from stabilization to manipulation tasks
how do we manage a category 3 (mildly impaired) UE?
Primarily used in manipulation tasks with emphasis on speed, accuracy,
quality of movement
what are some examples of interventions for a low functioning (severely impaired) UE?
- Align posture in sitting/standing, ensure limb is protected
- Develop sitting/standing tolerance for future UE function
- Gentle weight-bearing +/- facilitation
- Active-assisted ROM
- Scapular mobilizations
- Mirror therapy
- Motor imagery
how should the arm be supported while sitting?
sitting all the way at the back of the chair
hand and elbow should be well supported on a table
neutral should position (not adducted)
how should a low functioning arm be supported in standing?
using a sling
when are slings only recommended?
Slings are ONLY recommended for people with flaccid shoulders (stage 1 and 2)
Slings are ONLY recommended during transitional movements
how should the UE be handled?
supporting the arm proximally and distally
do not passively flex the shoulder past 80 degrees without performing scapular mobilizations
when is scapular rotation the greatest?
between 80-140 degrees
what movements does the scapula do?
elevates, depresses, abducts, adducts, rotates and tilts
what are interventions we can do with a moderately impaired EU pretty much anywhere?
Stabilizing activities
Task-oriented training
Facilitation in weight bearing
what are some interventions for a mildly impaired UE?
Task-oriented training
CIMT
Fine motor training
Strength training
Video gaming
what is the dose for original CIMT?
therapy for 6 hours/day, 5 days a week for 2-3 weeks
the less affective arm is constrained for 90% of waking hours
what is the dose for modified CIMT?
varies considerably
30 mins-3 hours therapy per day, 5 days per week
Less affected limb constrained for < 6 hours per da
what is the 10-10 eligibility criteria for CIMT?
10 degrees active finger and wrist extension
intact cognition and minimal spasticity
what is the recovery -intervention guidelines for stage 3 or less CMSA?
minimize pain and joint contractures
what is the recovery -intervention guidelines for stage 4 or higher CMSA?
aggressive restorative therapy
how else can stroke impairments be categorized?
6 months or less post stroke or more than 6 months post stroke
what are general UE management principles?
Training needs to be meaningful, engaging, repetitive, progressively adapted, task-specific and goal-oriented
Encourage use of affected limb during functional tasks. Training
should be designed to simulate partial or whole skills
what is Graded, Repetitive Arm Supplementary Protocol (GRASP)?
- Arm and hand exercise home program
- three different levels
how can we prevent shoulder subluxations?
positioning:
- Elevate arm when at rest
- Support arm during wheelchair use
- Risk of trauma secondary to
impaired sensation, cognition or perception - Reminder to others about careful handling of arm
what should we avoid as OTs when working with stroke survivors?
letting their arm hand
tugging up on shoulder during transfers
overhead pulleys
what are potential predictors of UE recovery?
Initial grade of UE paresis
30% show severe UE motor impairments
