Week 2 Flashcards
Which impairment has the greatest impact on activity after stroke
- Strength
- Co-ordination
- Sensation
- Spasticity/tone
Spasticity vs Tone
Spasticity
- Velocity dependent increase in the stretch reflex
- Can include clonus
- Adaptive
Tone
- Resistance to passive movement
- Increased tone can be due to spasticity, contracture, excessive muscle activity/coordination
Ashworth vs Tardieu scale
Ashworth scale
- Measures ‘tone’: resistance to passive movement
- Grades 0-4 represent ‘no increase in tone’ to ‘limb rigid in flexion or extension’
Tardieu scale:
- Measures velocity dependent resistance to passive movement
- Grades 0-4 represent (no resistance to unfatiguable clonus)
Spasticity intervention
Weak recommendation:
- Botulinum Toxin A
- Adjunct therapies (ES, casting, taping)
Weak recommendation against:
- Acupuncture
- Routine stretching
Stronger recommendation:
-Task specific training with feedback about excessive muscle activity
Causes of loss of strength after stroke
Primary impairment
-Loss or decreased excitability of upper motor neurons as direct result of the stroke
Secondary impairment
- Decreased activity following stroke (loss of muscle mass/disuse atrophy)
- Decreased descending input (loss of lower motor neurons and motor units)
Strengthening intervention
Strong recommendation:
-Progressive resistance training
Weak recommendation
- ES
- Repetitive practice using assistive technology for arm weakness
- Constrain induced movement therapy for arm weakness
- Task specific training
- Isolated movements
- Mental practise
VERY HIGH REPS
Active exercises for very weak muscles strategies
- Decrease effect of gravity
- Eliminate friction
- Work in different parts of range (mid range is easier)
- Eccentric/isometric/concentric contractions (eccentric contractions produce higher forces with lower energy costs)
- Visual cues
- Shorten/minimise impact of the lever arm
- Reduce degrees of freedom
Strengthening interventions for grade 0/1 muscles
Active exercise
- Mid range
- Gravity eliminated
- Decrease friction
- Shorten lever arm
- Try different contraction types (eccentric/isometric/concentric)
- Reduce degrees of freedom
Devices
- EMG biofeedback
- ES
- Robotics
Mental practise
Modified task related training
Strengthening interventions for grade 2 muscles
Active exercises
- Full range
- Inner range
- Sustained contraction
- Increased speed
- Resistance to mid-range
- Positioned so that gravity provides resistance
Biofeedback (EMG biofeedback, visual targets)
Mental practice
Modified task related training
Strengthening interventions for muscles grade 3/4
- Progressive resistance exercises
- Task related training
Is co-ordination training effective after stroke guidelines
Strong recommendation for task specific training (part practice, modified whole task practice, whole task practice with increased environmental demands)
- Sitting
- Sit to stand
- Standing
- Walking
- Arm function
Lots of repetitions and feedback
Characteristics of loss of sensation after stroke
Direct result of UMN
- Loss of tactile sensation
- Loss of proprioception
Can result in:
- Slow movement
- Decreased co-ordination
- Difficulty sustaining force
- Poor spontaneous use of a limb
Somatosensory retraining programs
- Tactile localisation
- Texture discrimination
- Joint position sense
- Object recognition
SENSe Training
- Selection of tasks
- Meaningful
- Graded
- Varied for transfer of skills - Attentive exploration
- With and without vision
- Exploring response to sensation that is received
3, Feedback
- On critical features e.g. limb position
- Calibration
- Match with intact hand and vision - Anticipation
- Use prior experience - Repeat and progress
- Transfer of skills
