Week 3 Flashcards
General fitness training recommendations and guidelines
Strong recommendation
- Mode: large muscle activities
- Frequency: 3-5 days/week
- Duration: 20-60min/session + 5-10mins of warm-up and cool-down activities
- Intensity: RPE 11-14
Consensus-based recommendations
- Should commence cardiorespiratory training during their inpatient stay
- Stroke survivors should be encouraged to participate in ongoing regular physical activity regardless of their level of disability
Characteristics of contracture after stroke
Muscles
- Lose sarcomeres
- Become shorter and stiffer
- Undergo changes in cross bridge connections
Connective
- Lose water
- Collagen deposition
Contracture recommendations or guidelines
Strong recommendation:
-Routine use of splints or prolonged positioning of muscles in a lengthened position (stretch)
Consensus-based recommendation:
- Serial casting may be trialled
- Active motor training
- ES aims to help take limb to EOR
Prevention of contracture
- Active practice - consider moving muscles to end of range
- Positioning (arms on lap trays) and flexibility habits
- ES to EOR
- Sustained stretch - remeasure to assess if effective
- Serial casting - for severe contracture
- Sleeping in side-lying
Swelling prevention recommendations and guidelines
Very common in affected forearm and hand
Consensus based recommendations: patients at risk of swelling
- Dynamic pressure garments
- ES (30mins, 35Hz, 10:10:10s with flex/ext.)
- Elevation of limb when resting
- Continuous passive motion with elevation
Prevention of shoulder subluxation recommendations and guidelines
Guidelines for stroke survivors at risk of shoulder subluxation:
-Weak recommendation: in first 6 months ES may be used to prevent or reduce subluxation (over supraspinatus and posterior deltoid)
-Weak recommendation against shoulder strapping is not recommended to prevent or reduce subluxation
Consensus-based recommendations:
- Firm support devices e.g. devices such as a lap tray, may be used
- A sling may be used when standing or walking
Protocol for ES for glenohumeral subluxation
Frequency:
- 30-100Hz
- Motor response
- Type 1 fibres at lower end of this range
- Pulse width: 200-400us
Duration of stimulation
- ES session progressively increased
- 4-6 hours
- Daily
Muscle contraction/relaxed ratio
-Progressively increased from 10/12 seconds to 30/2 seconds ON-OFF
Managing shoulder pain recommendations and guidelines
Weak recommendations:
- Shoulder strapping may be used to reduce pain
- Shoulder injections
- ES may be used to manage pain
- Acupuncture may be used to reduce pain
- Botulinum Toxin A may be used to reduce pain
Prevention of shoulder pain
- Education on signs
- Tailored manual handling training e.g. rolling
- Day time positioning on lap trays or arms through troughs on wheelchairs
- Night-time positioning supine or sideling on unaffected side
- Increase shoulder girdle strength
