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Neuro 1 > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What are common hemiplegic gait abnormalities that lead to asymmetrical gait patterns?

A

spatial asymmetries

  • decreased step and stride length
  • variable step width
  • decreased height in swing

temporal asymmetries

  • decreased single-limb stance time
  • increased double-limb stance time
  • increased swing time
  • decreased cadence
  • decreased weight bearing and shift in stance
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2
Q

What gait speed is needed to be independent in ADL’s and less likely to have adverse event?

A

1 - 1.4 m/s

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3
Q

What gait speed constitutes dependent in ADL’s and is more likely to be hospitalized?

A

0-0.6 m/s

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4
Q

What is the gait speed cut off for interventions to reduce falls risk?

A

< 1 m/s

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5
Q

What is a patients gait speed if they are a household ambulator?

A

0-0.4 m/s

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6
Q

What is the patients gait speed if they are a limited community ambulator?

A

0.4-0.8 m/s

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7
Q

What is the patients gait speed if they are a community ambulator?

A

0.8-1.2 m/s

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8
Q

What is normal walking speed?

A

1.2-1.4 m/s

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9
Q

What is the cutoff gait speed for a patient to be discharged to a SNF vs home?

A

< 0.1 m/s - SNF

> 0.1 m/s - d/c to home more likely

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10
Q

What are common hemiplegic gait abnormalities seen in the upper extremities?

A

decreased or absent arm swing - due to hemiplegia

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11
Q

What are common hemiplegic gait abnormalities seen in the trunk?

A
  • decreased rotation - due to asymmetrical arm swing
  • ipsilateral lateral trunk lean - glut med weakness (Trendelenburg)
  • forward trunk lean - glut max (extensors) weakness
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12
Q

What are common hemiplegic gait abnormalities seen in early stance phase (heel strike to midstance) at the pelvis/hip?

A
  • decreased pelvic rotation
  • decreased hip flexion
  • increased hip IR
  • increased hip adduction - Trendelenburg
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13
Q

What are common hemiplegic gait abnormalities seen in early stance phase (heel strike to midstance) at the knee?

A
  • increased knee flexion (particularly at initial contact)
  • peg leg - decreased knee flexion in early-stance followed by knee hyperextension in late-stance
  • excessive knee hyperextension throughout stance
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14
Q

What are common hemiplegic gait abnormalities seen in early stance phase (heel strike to midstance) at the foot/ankle?

A
  • decreased tibial progression
  • decreased ankle DF
  • lack of heel strike
  • foot flat and foot slap at initial contact
  • foot/ankle instability - inversion, supination
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15
Q

What are common hemiplegic gait abnormalities seen in late stance phase (midstance to terminal stance) at the pelvis/hip?

A
  • decreased pelvic rotation
  • decreased hip extension/terminal stance
  • hip flexion during forward progression
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16
Q

What are common hemiplegic gait abnormalities seen in late stance phase (midstance to terminal stance) at the knee?

A
  • decreased knee extension
  • knee buckling
  • delayed movement into knee flexion in preparation for swing phase
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17
Q

What are common hemiplegic gait abnormalities seen in late stance phase (midstance to terminal stance) at the foot/ankle?

A
  • decreased tibial progression - step-to pattern

- decreased heel off at terminal stance

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18
Q

What are common hemiplegic gait abnormalities seen in early swing phase (push off to mid-swing) at the pelvis/hip?

A
  • decreased hip flexion
  • hip hiking
  • circumduction
  • increased compensatory ER
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19
Q

What are common hemiplegic gait abnormalities seen in early swing phase (push off to mid-swing) at the knee?

A

decreased knee flexion

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20
Q

What are common hemiplegic gait abnormalities seen in early swing phase (push off to mid-swing) at the foot/ankle?

A
  • poor foot clearance
  • toe drag
  • decreased ankle DF
  • increased inversion
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21
Q

What are common hemiplegic gait abnormalities seen in late swing (mid-swing to heel strike) at the pelvis/hip?

A
  • decreased hip flexion
  • hip hiking
  • circumduction
  • increased compensatory ER
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22
Q

What are common hemiplegic gait abnormalities seen in late swing (mid-swing to heel strike) at the knee?

A

decreased knee extension

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23
Q

What are common hemiplegic gait abnormalities seen in late swing (mid-swing to heel strike) at the foot/ankle?

A
  • poor foot clearance
  • toe drag
  • decreased ankle DF
  • increased inversion
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24
Q

How can spasticity abnormalities impact gait?

A
  • stiff movements
  • clonus will cause jerky movements
  • UE spasticity patterns exacerbated during gait
  • secondary muscle shortening can lead to further abnormalities
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25
Q

How can hypotonia abnormalities impact gait?

A

buckling LE

floppy UE

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26
Q

How can sensory impairments impact gait?

A
  • variable foot placement
  • variable joint positioning throughout gait cycle
  • risk for ankle rolling
  • often highly visually reliant
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27
Q

How can visual deficits impact gait?

A
  • visual field cuts or loss of visual acuity - tripping, hitting walls/doors, decreased awareness of obstacles, veering while walking
  • dysconjugate gaze - visual disruption, diplopia
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28
Q

How can coordination deficits impact gait? Cerebellar/sensory vs cerebellar only

A

cerebellar or sensory originates

  • dyskinetic swing phase and arm swing
  • slower movements
  • variable foot placement
  • trunk ataxia

Cerebellar only
- extraocular incoordination can lead to visual disruption

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29
Q

How can perceptual deficits impact gait?

A
  • visuospatial neglect
  • sensory neglect
  • motor neglect
  • Pusher’s syndrome - increased UE extension and LE in stance/lateral shift of CoG outside BoS, absent reactionary strategies can lead to falls
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30
Q

What are some common indications for AFO?

A
  • weakness
  • impaired proprioception
  • spasticity
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31
Q

AFO precautions

A
  • adequate ROM in braced joints - want neutral ankle DF
  • be careful w/ sensory impairments
  • consideration for cognitive, communication, and/or perceptual deficits
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32
Q

AFO exclusion criteria

A
  • No ankle clonus
  • No LE swelling
  • No significant or poorly healing skin breakdown
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33
Q

Stirrup/Double Upright AFO indications and considerations

A

Indications

  • Concern for skin integrity
  • chronic edema

Considerations

  • permanently attached to shoe
  • heavy, clunky
  • can be unlocked to allow for DF
34
Q

Solid AFO indications and considerations

A

Indications

  • Significant LE weakness or hypotonia requiring max stability
  • alignment issues

Considerations

  • rigid
  • good support but limit mobility - non-ambulatory patients
  • good for medial/lateral stability at ankle
  • can include anterior shell for knee control
35
Q

What does the patient lose with a solid AFO? What activities may be difficult?

A
  • patient loses reciprocal gait pattern - can only do step-to gait pattern
  • descending stairs and walking up ramp are limited due to limited DF
36
Q

What is the primary brace for patients with diabetes and/or kidney issues who have edema issues?

A

stirrup/double upright AFO

37
Q

What is the primary brace recommended for PF spasticity?

38
Q

Pre-hinged AFO indications and considerations

A

Indications
- significant weakness but anticipate progressing toward hinged AFO

Considerations

  • great option to allow brace to progress w/ patient
  • can add a removable anterior plastic shell to help w/ knee buckling
39
Q

Hinged/Articulated AFO indications and considerations

A

Indications

  • need active ankle control (active DF and PF >3/5)
  • need adequate knee control (quads > 3+/5)

Considerations

  • provides adjustable ankle
  • good medial/lateral stability
  • allows for reciprocal gait pattern
40
Q

What needs to be tested prior to the use of a hinged/articulated AFO? Why?

A
  • test hamstring ROM

- if there is a knee contracture, it will be worsened with more DF ROM freedom

41
Q

Which AFO allows for reciprocal gait pattern?

A

hinged/articulated AFO and up

42
Q

What does a Ground Reactive AFO (GRAFO) do?

A

has anterior shell to push ground reaction force more anterior

43
Q

Ground Reactive AFO (GRAFO) indications and considerations

A

Indications

  • drop foot
  • medial/lateral instability
  • knee buckling in stance

Considerations

  • creates knee extension to prevent buckling
  • aids in foot clearance
  • helpful w/ crouched gait pattern
44
Q

What phase does Ground Reactive AFO (GRAFO) focus on?

A

stance phase

45
Q

What does Posterior Leaf Spring (PLS) AFO help with? What phase does it assist in?

A
  • solely helps w/ foot drop (DF weakness)

- swing phase orthoses

46
Q

Posterior Leaf Spring (PLS) AFO indications and considerations

A

Indications

  • drop foot w/ minimal to no medial/lateral instability
  • absent knee buckling

Considerations

  • allow for some AROM DF and PF
  • minimal support
47
Q

What does the evidence say about the utility of BWSTT? (LEAPS, STEPS, and CPG)

A

LEAPS - significant differences found in gait speed, balance confidence

STEPS - significant difference found in gait speed, endurance

CPG - little benefit of BWSTT on walking speed and distance compared w/ overground walking

48
Q

What has BWSTT been shown to improve post-stroke?

A

improvements in gait speed, endurance, and fear of falling

49
Q

What are the major indications and considerations for BWSTT?

A
  • ambulatory patient w/ stable CV status
  • gait goals in gait speed and/or reducing fall risk
  • eliminate fall risk
  • decreased physical load on therapist
50
Q

What are some components of a BWSTT treatment protocol?

A
  • allows for more steps per session
  • be aware of CV status
  • be cautious w/ behavior or cognitive deficits
51
Q

How can BWSTT be progressed?

A
  • increase speed
  • reduce BWS
  • reduce assist and facilitation
  • add incline
  • increase duration, lessen rest breaks
52
Q

What should BWSTT look like?

A
  • benefits at higher treadmill speeds
  • BWS < 40% to remain functional
  • always be followed by over ground ambulation to promote carryover
53
Q

What type of patient is appropriate for NMES? How do treatment goals differ based on body part?

A
  • UMN injury only
  • UE - pain, subluxation, spasticity, strengthening
  • LE - spasticity, strengthening

Acute treatment - functional training
Chronic treatment - neuroprosthesis

54
Q

What are the precautions and contraindications for NMES?

A

Precautions
- impaired or absent sensory

Contraindications

  • pacemaker, defibrillator, or any electrical/metallic implant
  • open wounds, fractures, cancer near site
55
Q

What tests can be used to determine visual field cut vs neglect?

A

Visual field cut

  • Snellen
  • visual fields
  • extraocular motor - Big H

Neglect

  • double simultaneous stimulation
  • clock/house drawing test
  • cancellation test
  • line bisection test
  • KF-NAF
56
Q

What are anchors?

A
  • external facilitation
  • using target to visually seek on the neglected side
  • ex: having patient follow tape to the end or therapist arm until they see the hand
57
Q

What are guides?

A
  • internal facilitation
  • using object or finger to direct eyes toward neglect side
  • ex: moving mirror towards neglected side so patient starts to look that way
58
Q

What are the major prognostic indicators for CVA recovery?

A
  • time to medical intervention
  • type of medical intervention
  • initial NHSS score
  • age
  • education level
  • family support
  • PLOF
  • ambulatory on eval
59
Q

How does prognosis differ between hemorrhagic and ischemic strokes?

A

hemorrhagic - high mortality rates acutely, but better prognosis long-term (less cell death)

Ischemic - low mortality rate but slower recovery

60
Q

most to least disability prognosis by stroke type

A 
1 - multiple vascular territories
2 - MCA (most common)
3 - ACA
4 - PCA
5 - Brainstem
6 - small vessel stroke
7 - cerebellar
61
Q

What are the major acute prognostic indicators for UE recovery?

A

Finger extension and shoulder ABD on day 2 after CVA - most achieve some dexterity at 6 months

62
Q

What is the PREP2 algorithm? What types of assessments and considerations are involved in this prognostic decision-making algorithm?

A

Combines Shoulder ABD MMT and Finger EXT MMT (total out of 10) and look at them 72 hours

  • Considers age, MEPS (electrical diagnostic way for us to measure motor activity in extremities)
  • MEPS – function that looks a brain activity during motor function
63
Q

PREP2 excellent and treatment focus

A

potential to make complete recovery of UE function within 3 months

Treatment - promote normal function and minimise compensation

64
Q

PREP2 good and treatment focus

A

potential to use affected hand and arm for most ADL’s within 3 months. May have some weakness, slowness, or clumsiness

Treatment - promote normal function and minimise compensation w/ affected limb

65
Q

PREP2 limited and treatment focus

A

potential to regain movement in affected UE within 3 months, but daily activities are likely to require significant modification

Treatment - promote movement and reduce impairment by improving strength and ROM. Promote adaptation for ADL using affected limb

66
Q

PREP2 poor and treatment focus

A

unlikely to regain useful movement of UE within 3 months

Treatment - prevent secondary complications such as pain, spasticity, and shoulder instability. teach compensation w/ other arm

67
Q

What are available prognostic indicators for UE recovery in the subacute setting?

A
  • early AROM finger EXT, grasp release, shoulder shrug, and shoulder ABD
  • absence of somatosensory loss, visual field loss and/or neglect
  • presence of grip strength or AROM shoulder FLEX
68
Q

What are available prognostic indicators for return to ambulation post stroke?

A
  • ambulation on eval
  • balance scores on eval
  • minimal loss of LE strength
  • minimal perceptual visual or cognitive deficits
  • healthy BMI
  • younger age (<65)
69
Q

How much recovery is seen at the chronic stage of CVA recovery?

A
  • majority can walk short distances on flat surfaces w/ about 1/2 limited community ambulatory (0.4-0.8 gait speed)
  • very few are unlimited ambulation (>1.2)
  • majority have partially or completely dependent ADLs and most will regain functional independence
70
Q

For the Stroke Impact Scale, describe the major function of the test and basic areas of examination and what it has been shown to correlate with.

A
  • subjective questionnaire evaluating disability and health-related QoL after CVA

8 domains

  • strength
  • hand function
  • ADL/IADL
  • mobility
  • communication
  • emotion
  • memory and thinking
  • participation/role function
71
Q

What does the Orpington Prognostic Scale evaluate? What are its cut-off scores?

A

measures

  • motor deficits
  • proprioception
  • balance
  • cognition

< 3.2 = likely return home
3.2-5.2 = respond better to rehab
> 5.2 = dependent w/ increased risk of instituionalism

want a low score

72
Q

What type of patient is PASS test used for? What does it measure?

A

stroke specifc balance assessment

  • sitting, standing, and dynamic balance
73
Q

What type of patient is the TIS used for? What does it measure?

A

CVA, Parkinson’s, MS

  • static and dynamic sitting and upper/lower trunk coordination
74
Q

What type of patient is the FIST used for? What does it measure?

A

CVA and vestibular

  • evaluates sensory, motor, anticipatory, reactive, and steady-state balance factor in SITTING
75
Q

TUG-motor vs TUG-cog

A

motor - TUG w/ cup of water

cog - TUG and count backwards by 3 from 100 from randomly selected starting number

76
Q

Why might you choose to utilize a TUG vs. TUG-Motor vs. TUG-Cog?

A

tug-motor and tug-cog are dual-task skills

77
Q

What are some basic strategies to utilize when your patient demonstrates cognitive impairments that limit their participation in activities?

A
  • simple directions
  • establish a routine
  • carry out activities in a consistent manner
  • employ repetition as much as possible
  • minimize distractions
  • recognize when it is time to take a break
78
Q

What are some basic strategies to utilize when your patient has aphasia?

A
  • simple, short phrases
  • give additional time
  • be mindful of the volume of your voice
  • simple yes/no questions
  • gestures to facilitate understanding
79
Q

What is berg balance cut off for community-level ambulation?

80
Q

What is berg balance cutoff for unassisted ambulation?

81
Q

_________________ is a strong overall predictor of both stroke severity and community ambulation status

A

self-selected walking speed

Neuro 1 (11 decks)

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