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OCCU Neuro > UE Assessment and Management > Flashcards

UE Assessment and Management Flashcards

1
Q

what is assessment used to determine?

A
  1. What an individual wants and needs to do
  2. What the individual is currently able to do
  3. What supports and barriers influence occupational performance and participation
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2
Q

what is the purpose of assessing?

A
  1. Establish baseline
  2. Establish goals
  3. Inform intervention planning process
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3
Q

do functional UE impairments happen in one or both upper extremities?

A

both!

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4
Q

what can perceptual impairments interfere with?

A

UE function

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5
Q

what are examples of perceptual impairments?

A

Visual field deficits, neglect, visual extinction, agnosia

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6
Q

functionally, what do we see difficulties with when someone has perceptual impairments?

A
  • Locating target
  • Identifying target (agnosia)
  • Planning and executing reach and grasp (apraxia)
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7
Q

what are some OPC examples that are focused on motor control?

A

paresis
timing impairments
loss of individuation
excessive use of trunk

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8
Q

every plan for OT evaluation includes what?

A

he analysis of occupational performance. This includes:

  • Identification of strengths
  • Potential problems
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9
Q

what is activity analysis?

A

observation

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10
Q

what re methods of evaluation?

A
  1. activity analysis
  2. standardized vs non-standardized assessment tools
  3. interviews
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11
Q

what is a low level arm CMSA?

A

stages 1-2

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12
Q

what is a CMSA stage 1-2 arm movement and function?

A

incompletely selective movements (small amplitude, non-functional)

primarily used for stabilization tasks

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13
Q

what is an intermediate level arm CMSA?

A

stagers 3-5

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14
Q

what is a CMSA stage 3-5 arm movement and function?

A

biomechanical and muscle imbalances with incompletely selective movements

transitioning from stabilization to manipulation tasks

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15
Q

what is a high level arm?

A

stages 6-7

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16
Q

what is a CMSA stage 6-7 arm movement and function?

A

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

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17
Q

what assessment do we as OTs use to assess and stroke patient?

A

Chedoke arm and hand activity inventory (CAHAI)

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18
Q

what is the benefit of the CAHAI?

A

Real life bilateral activity measure that clients determined as meaningful

19
Q

what is the CAHAI designed specifically for?

A

stroke

20
Q

how many tasks does the CAHAI evaluate?

A

7-13 functional tasks

21
Q

what influences our upper extremity interventions?

A
  1. Severity of sensorimotor impairments
  2. Time post-stroke
  3. Recovery prognosis (finger extension and shoulder abduction)
  4. Client’s needs and goals
  5. Evidence of effectiveness
  6. Clinical resources available
22
Q

how do we manage a category 1 (severally impaired) UE?

A

gentle, pain free weight bearing

23
Q

how do we manage a category 2 (moderately impaired) UE?

A

transitioning from stabilization to manipulation tasks

24
Q

how do we manage a category 3 (mildly impaired) UE?

A

Primarily used in manipulation tasks with emphasis on speed, accuracy,
quality of movement

25
Q

what are some examples of interventions for a low functioning (severely impaired) UE?

A
  • 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
26
Q

how should the arm be supported while sitting?

A

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)

27
Q

how should a low functioning arm be supported in standing?

A

using a sling

28
Q

when are slings only recommended?

A

Slings are ONLY recommended for people with flaccid shoulders (stage 1 and 2)

Slings are ONLY recommended during transitional movements

29
Q

how should the UE be handled?

A

supporting the arm proximally and distally

do not passively flex the shoulder past 80 degrees without performing scapular mobilizations

30
Q

when is scapular rotation the greatest?

A

between 80-140 degrees

31
Q

what movements does the scapula do?

A

elevates, depresses, abducts, adducts, rotates and tilts

32
Q

what are interventions we can do with a moderately impaired EU pretty much anywhere?

A

Stabilizing activities
Task-oriented training
Facilitation in weight bearing

33
Q

what are some interventions for a mildly impaired UE?

A

Task-oriented training
CIMT
Fine motor training
Strength training
Video gaming

34
Q

what is the dose for original CIMT?

A

therapy for 6 hours/day, 5 days a week for 2-3 weeks

the less affective arm is constrained for 90% of waking hours

35
Q

what is the dose for modified CIMT?

A

varies considerably

30 mins-3 hours therapy per day, 5 days per week

Less affected limb constrained for < 6 hours per da

36
Q

what is the 10-10 eligibility criteria for CIMT?

A

10 degrees active finger and wrist extension

intact cognition and minimal spasticity

37
Q

what is the recovery -intervention guidelines for stage 3 or less CMSA?

A

minimize pain and joint contractures

38
Q

what is the recovery -intervention guidelines for stage 4 or higher CMSA?

A

aggressive restorative therapy

39
Q

how else can stroke impairments be categorized?

A

6 months or less post stroke or more than 6 months post stroke

40
Q

what are general UE management principles?

A

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

41
Q

what is Graded, Repetitive Arm Supplementary Protocol (GRASP)?

A
  • Arm and hand exercise home program
  • three different levels
42
Q

how can we prevent shoulder subluxations?

A

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
43
Q

what should we avoid as OTs when working with stroke survivors?

A

letting their arm hand

tugging up on shoulder during transfers

overhead pulleys

44
Q

what are potential predictors of UE recovery?

A

Initial grade of UE paresis

30% show severe UE motor impairments

OCCU Neuro (12 decks)

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