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OCCU Neuro > UE Overview > Flashcards

UE Overview Flashcards

1
Q

what is a stroke?

A

Interruption of blood flow to the brain; inadequate supply of oxygen /
nutrients.

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2
Q

where can a stroke appear?

A

Can occur in any part of the brain

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3
Q

what are the 2 main types of stroke?

A
  1. ischemic
  2. hemmhoragic
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4
Q

what is thrombosis?

A

Blockage of blood vessel

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5
Q

what is an embolism?

A

Dislodged platelets, cholesterol, or other material that travels in
bloodstream and blocks a vesse

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6
Q

what does a hemorrhagic stroke occur from?

A

Results from rupture of blood vessel

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7
Q

effects of a stroke are determined by what?

A

location and how much brain tissue is damaged

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8
Q

what are some common symptoms of a right sided stroke?

A

contralateral weakness
contralateral sensory loss
hemispatial neglect of inattention
left visual feudal neglect
impulsive or overestimation of abilities

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9
Q

what are common symptoms of a left sided stroke?

A

contralateral weakness
contralateral sensory loss
aphasia, Alexia, agraphia
slow and cautious behaviour

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10
Q

what are the bones of the shoulder?

A

scapula
clavicle
humerus

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11
Q

what are the shoulder joints?

A
  1. Sternoclavicular
  2. Acromioclavicular
  3. Glenohumeral
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12
Q

what is the “pseudo joint” of the shoulder?

A

articulation
between the scapula and
the thorax

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13
Q

what makes the glenohumeral joint?

A

Humeral head + glenoid fossa of scapula

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14
Q

what direction does the head of the humerus face?

A

faces medially, posteriorly, and superiorly

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15
Q

what direction does the glenoid fossa face at rest?

A

laterally, superiorly, and anteriorly

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16
Q

what direction does the glenoid fossa face when the arm is in the dependent position?

A

inferiorly and posteriorly

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17
Q

how much surface area of the humeral head does the glenoid fossa cover?

A

1/3 to 1/4

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18
Q

why does the glenoid fossa cover such a small surface area on the humeral head?

A

to allow mobility with little articular stability

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19
Q

what are the functions of the glenohumeral joint?

A

-spreads joint loading
-allows movement of 2 opposing surfaces

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20
Q

what structures provide static stability to the shoulder joint?

A

-labrum
-joint capsule
-joint cohesion and geometry
-ligamentous support

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21
Q

when is contact between the humeral head and glenoid fossa significantly reduced?

A

when the humerus is positioned in:

-adduction, flexion, and internal rotation
-abduction and elevation
-adducted at the side, with the scapula rotated downward

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22
Q

less contact between humeral head and glenoid fossa =

A

less stability

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23
Q

what provides dynamic stability to the shoulder?

A

supraspinatus
rotator cuff
deltoid
serrates anterior

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24
Q

what is the function of the supraspinatus?

A

maintains the humeral head in the glenoid fossa

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25
Q

what is the function of the rotator cuff?

A

keeps/steers humeral head in glenoid
externally rotates the humerus

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26
Q

what is the function of the serrates anterior?

A

moves scapula forward on ribcage (important for reach)

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27
Q

what is the function of the deltoid?

A

> 90 degree compressive:pulls humeral head into glenoid

<90 degrees superior shear: pulls humeral had superiorly

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28
Q

what does dynamic stability of the shoulder complex rely on?

A
  1. Optimal alignment of the scapula
  2. Correct Glenohumeral orientation
  3. Length-tension relationship of
    * scapula pivoters
    * rotator cuff
    * biceps & triceps
    * static restraints (the G-H ligaments
    and the joint capsule)
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29
Q

what does arm elevation require?

A
  1. Scapulothoracic motion
    * This significantly decrease the shearing effect between the humeral head and the glenoid
  2. Scapulohumeral motion
30
Q

what is scapulothoracic motion?

A

Rotation and translation about three axes of motion embedded in the scapula

31
Q

what does scapulohumeral motion allow?

A

the glenoid fossa to be positioned directly under the humeral head during the end ranges of abduction to increase joint stability

32
Q

what is the ratio of motion between the scapula and humerus during full ROM?

A
  1. early abduction (0-80 degrees) involving more humeral motion
  2. midrange (80-140 degrees) involving more scapular motion
  3. end ranges (140-170 degrees) involving motion at neighbouring joints
33
Q

what is a shoulder subluxation?

A

a partial dislocation of the shoulder joint

34
Q

what is the mechanism for a shoulder subluxation due to an ABI?

A

-muscles supporting the shoulder are not ‘working properly’

-This causes INSTABILITY in the glenohumeral joint

35
Q

what does glenohumeral stability require?

A
  • angle of glenoid fossa (forward, upward and outward)
  • scapula properly aligned on ribcage
  • seating of the humeral head in the glenoid fossa
  • function of supraspinatus and ligamentous structures
36
Q

what are the types of subluxation?

A
  • inferior subluxation
  • anterior subluxation
  • superior subluxation
37
Q

what are the key elements of upper extremity function for tool use?

A
  1. Locate target (coordination of eye-head movements)
  2. Volitional motor control
    * Reach
    * Grasp
    * In-hand manipulation
38
Q

what is the role of the trunk while reaching for an object within arm’s length?

A

trunk acts as a stabilizer for postural control

39
Q

what is the trunks role while reaching for an object outside of arms length?

A

Trunk becomes part of the kinematic chain to extend reaching distance

40
Q

what are the in hand. manipulation skills?

A
  1. Shift
  2. Simple rotation
  3. Complex rotation
  4. Shift + rotation
41
Q

what are the key elements of upper extremity function for tool use?

A
  1. Locate target (coordination of eye-head movements)
  2. Volitional motor control
    * Reach
    * Grasp
    * In-hand manipulation
42
Q

what is one of the most common and challenging sequelae post-stroke?

A

impaired upper extremity function

43
Q

what is of primary importance for regaining independence?

A

recovery of arm and hand function

44
Q

What post-stroke impairments directly impact the upper extremity?

A
  1. Impaired motor control
  2. Impaired sensory perception
  3. Shoulder pain
45
Q

what is typical posture post-stroke?

A

Head: lateral flexed toward involved side, rotation away from involved side

Upper extremity: scapular depression and retraction, shoulder adduction and internal rotation, elbow
flexion, forearm pronation, wrist flexion, ulnar deviation, finger flexion

Trunk:posterior pelvic tilt, possible rotation, lateral flexion toward involved side

46
Q

what happens to the scapula post stroke?

A

downwardly rotates

47
Q

what happens to the glenoid fossa post stroke?

A

loses forward, upward and outward
orientation

48
Q

what happens to the head of the humerus post stroke?

A

loses alignment with the glenoid fossa

49
Q

why is it common to have upper extremity subluxations post stroke?

A
  • Motor impairments cause trunk/postural changes which pre-dispose the shoulder joint to malalignment and disadvantageous glenohumeral orientation
  • Motor impairments cause weakness in muscles responsible for static and dynamic stability
50
Q

what are some movement pattern compensation strategies?

A
  • lateral trunk flexion
  • trunk rotation
  • scapula adduction and elevation
  • elbow flexion
51
Q

where to movement pattern compensation patterns stem from?

A

1) Spasticity
2) Inability to recruit appropriate muscles
3) Weakness
4) Soft tissue tightness

52
Q

what is muscle tone?

A

resistance to passive movement of a joint

53
Q

what is the continuum of tone?

A

Flacidity- hypotonia- normal-spasticity-rigidity

54
Q

what are some examples of increased tone in an intact
nervous system?

A
  • Acquiring a new motor skill (riding a bike)
  • Fear of falling
  • Pain/expectation of pain
  • Trying to do something in a hurry
55
Q

define spasticity

A

A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes

56
Q

define rigidity

A

Heightened resistance to passive movement of the limb,
independent of the velocity of stretch (non velocity dependent)

57
Q

is rigidity unidirectional or bidirectional?

A

bidirectional

58
Q

what is the triangle of impact of tone?

A

increased spasticity- immobilization and disuse- contracture

59
Q

what is the impact of tone post stroke?

A
  • Ranges from minor effects on the quality of movement to
    significant difficulties for caregiving and ADL
  • Spasticity, contracture and weakness all contribute to loss of
    function
60
Q

what is the greatest contributor to tone 0-4 months?

A

spasticity

61
Q

what is the greatest contributor to tone more than 4 months?

A

weakness

62
Q

how many tone present?

A

synergy patterns

63
Q

what is a synergy pattern?

A
  • Mass movement patterns
  • Not selective or isolated movement
  • Can be elicited voluntarily or as a reflex response
64
Q

what is an upper extremity flexor synergy?

A
  • Retraction/elevation of the shoulder
  • Abduction of the shoulder
  • Flexion of the elbow
  • Supination of the forearm
  • Flexed wrist and fingers
65
Q

what does impaired sensation post stroke impact?

A
  1. Sensory feedback
    (resulting in dysthymic/uncoordinated
    movement)
  2. Response or urge to move
  3. Functional use even with intact motor function
66
Q

what is shoulder pain post stroke correlated with?

A
  • loss of external rotation
  • lack of biomechanical alignment
  • impingement syndromes
  • tendonitis (overuse or traumatic)
  • supraspinatus
  • subacromial bursitis
  • spasticity
67
Q

what is the definition of hemiplegic shoulder pain?

A

Shoulder pain present at rest, or
during passive or active movement on the hemiparetic side after stroke with no history of trauma or injury

68
Q

is hemiplegic shoulder pain a symptom of diagnosis?

A

symptom

69
Q

whaat are contributing factors to hemiplegic shoulder pain post stroke?

A
  1. impaired motor control
  2. soft tissue lesions
  3. altered peripheral and CNS activity
70
Q

initially, what percentage of stroke survivors have severe UE motor impairments?

A

30%

OCCU Neuro (12 decks)

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