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Sub-Acute (Theory) > W9: Online Module > Flashcards

W9: Online Module Flashcards

1
Q

What are motor primary impairments (Stroke)

A

Decrease muscle strength
Decrease muscle co-ordination
Spasticity

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2
Q

What are non-motor primary impairments (Stroke)

A

Decreased vision
Decreased sensation
Decreased proprioception
Decreased speech and language
Decreased perceptual function
Decreased cognitive function
Decreased vestibular function

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3
Q

What are the secondary motor impairments (Stroke)

A

Decreased muscle length
Swelling
SH subluxation
Decreased CV fitness

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4
Q

What are the secondary non-motor impairments (Stroke)

A

Depression
Fatigue
Pain

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5
Q

What is a contracture

A

A reduction in joint range of motion caused by changes in passive mechanical properties of soft tissues, categorized as “non-reflex stiffness.”

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6
Q

What is the distinction between joint stiffness and reduced range of motion (ROM)?

A

Joint stiffness refers to the sensation of difficulty moving a joint, whereas reduced ROM is a measurable decrease in joint mobility. They are different concepts.

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7
Q

What are the two categories of stiffness?

A

Non-reflex stiffness: Increases in the stiffness of non-active muscle tissue e.g., joint capsule, ligaments, tendons, and non-active muscle tissue).

Reflex stiffness: Spasticity and dystonia

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8
Q

What is the average short-term difference in ROM with stretching interventions compared to control interventions for neurological populations?

A

2 degrees (95% CI 0 to 3 degrees)

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9
Q

What is the quality of evidence for the effect of stretch on increasing short-term ROM in neurological populations?

A

High

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10
Q

Is splinting and stretching recommended for stroke survivors at risk of developing contracture?

A

No. Strong recommendation against splinting and stretching for stroke survivors who are receiving comprehensive, active therapy.

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11
Q

What are the two-consensus based recommendations for stroke survivors at risk of developing contracture?

A

Serial casting may be trialed to reduce severe, persistent contracture when conventional therapy has failed.

Active motor training or electrical stimulation to elicit muscle activity should be provided.

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12
Q

What did Horsley et al. (2019) conclude about early active repetitive motor training for contracture prevention?

A

Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke.

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13
Q

What is Botox commonly used to treat?

A

Spasticity and dystonia

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14
Q

How does botox reduce muscle contraction?

A

By preventing the release of acetylcholine from the pre-synaptic cleft, reducing the amount available to bind at the post-synaptic cleft.

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15
Q

What are the different types of Botox, and how do they differ?

A

Types range from A to G, targeting different microstructures in the pre-synaptic cleft to reduce or eliminate acetylcholine release.

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16
Q

Why is it not possible to inject every hypertonic muscle with Botox?

A

Injecting every muscle would result in complete paralysis and no movement, so only functionally interfering muscles are selected.

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17
Q

Provide an example of a muscle commonly injected with Botox and why.

A

The tibialis posterior, often spastic or dystonic, is injected to reduce foot inversion and improve gait.

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18
Q

How often can patients receive Botox injections for spasticity?

A

Every 4-6 months

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19
Q

How long does it take for Botox to become fully effective after injection?

A

Approximately 5-7 days

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20
Q

Which of the following is TRUE?
A) Botox works within 2 hours of injection
B) Botox blocks the release of acetylcholine into the neuromuscular junction resulting in temporary partial or complete paralysis of the muscle
C) The effects of Botox last approximately 2 years
D) Botox should be administered to all muscles with spasticity/dystonia

A

B

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21
Q

Which of the following is TRUE?
A) Placebo injection is significantly better than Botox for improving upper extremity function in people with spasticity
B) Botox is significantly better than placebo injection for improving upper extremity function but the effect is not clinically worthwhile
C) Botox is significantly better than placebo injection for improving upper extremity function and the effect is clinically worthwhile
D) There is no difference between placebo and Botox injections for improving upper extremity function

A

C

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22
Q

Which of the following is FALSE
A) Botox injections of 500/1000 units resulted in an approx 1 point reduction in the Ashworth scale
B) Botox can cause muscle weakness and paralysis
C) When adverse events from botox administration occurred, these were mild to moderate
D) Botox injections result in fewer adverse events than placebo injections

A

Answer D – botox injections result in more mild to moderate adverse events than placebo injections

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23
Q

Which of the following is/are TRUE
A) Botox is recommended as a treatment for spasticity
B) All of the answers are correct
C) Stretching is recommended as a treatment for spasticity
D) Acupuncture is recommended as a treatment for spasticity

A

A

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24
Q

What percentage of stroke patients are affected by impaired vision?

A

30-40% of stroke patients are impacted by impaired vision

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25
Q

What are the most common visual impairments in stroke patients?

A

Homonymous hemianopia (most frequent)
Diplopia (double vision)
Difficulties with ocular convergence
Oversensitivity to light
Nystagmus
Impaired saccadic movement and smooth pursuit

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26
Q

Why is it important to determine pre-existing visual deficits in stroke patients?

A

Pre-existing visual deficits should be identified as they may compound post-stroke visual impairments and functional difficulties.

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27
Q

What activities are significantly affected by visual impairments post-stroke?

A

Reading, writing, mobilising, and driving are significantly affected.

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28
Q

What common problems can arise due to vision issues post-stroke?

A

Nausea and dizziness
Balance problems
Falls due to overreliance on vision, which may be misleading or poor

29
Q

What percentage of stroke patients experience impaired sensation?

A

50-85%

30
Q

Why is sensory loss often neglected in stroke rehab?

A

There are limited training approaches for sensory discrimination.

31
Q

Name atleast three common assessments used to evaluate sensation

A

Touch detection
Texture discrimination
Proprioception (position sense: wrist, finger, ankle, knee)

32
Q

What does the SENSe therapy program aim to do?

A

Help stroke survivors regain a sense of touch and use this information in everyday activities by stimulating neurogenesis and enhancing neural connections.

33
Q

What are the seven principles of the SENSe program?

A

Select
Attentive exploration
Feedback
Calibration
Anticipate
Repeat and progress
Transfer

SAF CART

34
Q

What does the “Select” principle involve?

A

Choosing meaningful, graded, and varied training tasks to enhance transfer of skills.

35
Q

How does attentive exploration guide stroke patients

A

By focusing attention on the sensory goal of the task without vision, helping to heighten the brain’s response to sensation.

36
Q

What is the role of “Feedback” in the SENSe program?

A

Immediate, precise feedback on critical sensory features and effective hand movements for exploration.

37
Q

How does calibration improve sensation?

A

By matching impaired sensation to normal sensation through the unaffected hand or vision, realigning brain maps.

38
Q

What is the purpose of “Anticipation trials”?

A

To tune into distinctive sensory differences by predicting sensations based on prior experiences.

39
Q

Why is “Repetition and progress” important in sensory retraining?

A

Repetition consolidates learning, while progression to harder tasks strengthens neural plasticity.

40
Q

What does the transfer principle aim to achieve?

A

To apply skills to new situations by using varied stimuli and feedback during skill transfer.

41
Q

What did Carey et al. (2011) demonstrate about the SENSe program?

A

It significantly improved sensory capacity in stroke survivors, with effects maintained at 6-week and 6-month follow-ups.

42
Q

What key finding did Carey & Matyas (2005) highlight?

A

The SENSe program enabled stroke survivors to transfer sensory skills to untrained tasks effectively.

43
Q

What did Carey et al. (1993) conclude about the SENSe program?

A

It improved sensory discrimination and showed promise as a sensory rehabilitation method after stroke.

44
Q

What are three common types of perceptual-cognitive dysfunction in stroke patients?

A

Reduced concentration, impaired memory, and receptive dysphasia/aphasia.

45
Q

Tips for working with individuals with impaired cognition?

A
  • Tip 1: Task orientated, functional and meaningful practice
  • Tip 2: Clear, direct and one step instructions
  • Tip 3: Use bright/large/obvious targets for task training
  • Tip 4: Limit distractions
46
Q

Why should instructions for patients with cognitive impairment be clear, direct, and one-step?

A

To simplify communication and ensure patients can follow tasks successfully.

47
Q

How can bright or large targets assist patients with cognitive impairments during therapy?

A

They help patients focus on the task and provide clearly defined goals for movement.

48
Q

Why is it important to limit distractions during therapy for patients with cognitive impairments?

A

To reduce sensory input and keep patients focused on the task at hand.

49
Q

What is receptive aphasia/dysphasia, and what part of the brain is affected?

A

A dysfunction in comprehending language, often associated with Wernicke’s area.

50
Q

How does receptive aphasia affect speech production?

A

Patients can produce grammatically correct sentences with normal rhythm, but the content often does not make sense.

51
Q

What is expressive aphasia/dysphasia, and what part of the brain is affected?

A

A dysfunction in expressing language, associated with Broca’s area.

52
Q

How is speech affected in patients with expressive aphasia?

A

Speech may be limited to short utterances, and patients may say the wrong word but often realize their mistake.

53
Q

What is mixed aphasia/dysphasia?

A

A combination of both receptive and expressive aphasia, where patients struggle with both understanding and producing language.

54
Q

What is dysarthria?

A

Impaired speech clarity due to motor dysfunction in speech muscles.

55
Q

What is dyspraxia?

A

Impaired speech clarity due to difficulty planning and sequencing movements, not caused by muscle weakness or incoordination.

56
Q

How is dysphasia different from dysarthria and dyspraxia?

A

Dysphasia involves difficulties with language comprehension or expression, while dysarthria (issue with the muscles directly involved in speech) and dyspraxia (motor coordination disorder) affect the physical production of speech.

57
Q

Who typically assesses and treats patients with speech and communication difficulties following brain injury?

A

Speech path

58
Q

What is the definition of an ankle contracture?

A

An ankle ROM of less than 90 degrees with a force of 100N (about 12Nm) is typically considered a contracture

59
Q

What are the issues with measuring ROM?

A

Quite hard to standardise eg you could push harder or softer on some days which may affect ROM.

There are more accurate options that are more costly and not clinically viable eg HUMAC

60
Q

What is torque ROM

A

What is it: The ankle is pulled by a device that wraps around the head of the 5th metatarsal
Benefits: Pulled to the exact same strain
Cons: Still clinician measured & patients with severe contracture, often have foot inversion (due to tight tib post) and that complicates measuring DF as the foot needs to be everted.

61
Q

What is the HUMAC (ROM measurement)

A

What is it: Foot is strapped in against force plate & then you can push the foot to the same force each time
Pros: ROM is also standardised because it has a goniometer embedded and you can see what ROM the ankle has been placed into. Can also measure muscle activity using electrodes
Cons: Costs over $100,000, usually not clinically viable (essentially takes up a whole room, quite big!)

62
Q

Outline strategies to communicate with patients that have aphasia?

A

Tips for working with patients with aphasia
1. Listen patiently
2. Reduce your speech rate
3. Provide more time for them to respond
4. Alternative communication strategies eg gestures, writing, etc
5. Speak slowly and clearly

63
Q

What is the recommendation for stroke survivors with sensory loss in the upper limb?

A

For stroke survivors with sensory loss of the upper limb, sensory specific training may be provided

64
Q

Spasticity: Recommendations (For people with stroke)

A
  • For the UL, Botox may be used with rehabilitation therapy to reduce spasticity, and may improve activity or motor function
  • For the LL, Botox may be used with rehabilitation therapy to reduce spasticity and may improve motor function or walking
  • Adjunct therapies to botox, such as electrical stimulation, casting and taping, may be used
65
Q

Spasticity: Recommendations against (For people with stroke)

A
  • Acupuncture should not be used: weak recommendation against (evidence investigating acupuncture is of low quality so we are unable to trust the findings) & very low quality evidence
  • Stretch: not recommended for treating spasticity
66
Q

Outline the types of patients that maybe/may not be suitable for these types of technologies (VR, etc)

A
  • Neurological conditions:
  • Stroke survivors looking to improve control & coordination
  • Parkinson’s disease to practice timing and movement precision
  • Traumatic brain injury (TBI): enhance upper limb function and reaction time
  • Rehabilitation patients
  • Orthopaedic surgery recovery to regain movement and strength
  • Individuals with multiple sclerosis (MS) for maintaining mobility and coordination
  • Developmental disorders ie ASD/developmental coordination disorder to improve motor skills
  • Elderly individuals looking to maintain mobility and prevent falls through practice of coordination and timing
67
Q

Distinguish between immersive and non-immersive VR

A

Immersive: completely block out the physical world. The user is fully surrounded by a computer-generated environment, which can include 3D visuals, sounds, and sometimes even haptic feedback (e.g., gloves or vests). Immersive VR is highly interactive and gives the feeling of being physically present in the virtual world, allowing users to move and interact with the environment in real time.

Non-immersive: user interacts with the virtual environment through a screen, often using a mouse, keyboard, or a game controller. While the virtual environment is displayed on the screen, the user’s experience is not as all-encompassing as immersive VR. The physical world is still visible to the user, and they are not fully surrounded by or immersed in the virtual environment eg WII

68
Q

Evidence for VR (immersive and non-immersive)

A

2 weeks of non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function, as measured by WMFT.

“Virtual reality improved upper limb function and activity, activities of daily living, and walking speed compared with conventional therapy. However, most comparisons were based on small sample sizes and very low- to low-quality evidence, which limits the applicability of the evidence.”

Sub-Acute (Theory) (10 decks)

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