week 5: stroke rehab & therapeutic management (pt 1) Flashcards
screen vs. eval
screen - used to guide eval. quick. confirm need for treatment/further exam or referral
eval - gathering & analyzing the exam and develops POC
in the history and interview portion, you would first _____ ______ and use the _____ ______ to ask related questions
review chart
ICF framework
which neuroplasticity principle relates to the question “what is the patient’s societal role or vocation?”
which ICF domain?
salience - making it meaningful to the pt
participation domain
interview questions are different from MSK questions because they’re used to ________
which ICF domain does this relate to?
guide your systems review and screening
health conditions
what is the purpose of systems review for stroke pt?
decide which system(s) are involved
— which system is causing the patient’s mobility deficits
what is an example of a neuromuscular screen?
assessment of gross coordinated movements and motor function
what three things does an examination accomplish?
identifying impairments, activity limitations and restrictions in participation
a stroke examination focuses mostly on:
tests and outcome measures
task analysis
what is the goal of an examination?
determination of underlying body function structure and activity domain limitations
examinations can be performed by:
outcomes measures
task analysis
what are important considerations for stroke exam?
*note which ones have synergy patterns present
spasticity/tone (synergy patterns present)
degree of hemiparesis
postural stability
functional mobility (synergy patterns present)
gait (synergy patterns present)
FIM scores have been related to :
successful outcomes, discharge home, and return to the community for patients with stroke
functional mobility is _____ domain. it can be affected by several factors in _______ domain
activity
body structure
true or false. FIM is independently completed in full by PT
false - evaluated in parts by care team specific to scope of practice
PT does transfers and locomotion
a FIM score of _______ indicates an individual will most likely not regain independence
37-40
FIM score of ______ indicates inpatient rehab is most appropriate setting for stroke rehab
40-80
the ______ the score, the fewer days insurance allows for rehab
higher
what does PT test as part of the FIM?
functional mobility - 3 transfer items
locomotion - walking or using wheelchair
stairs - attempt 12 steps if appropriate
what are the 7 levels of FIM scoring?
7 independent
6 modified independent
5 standby assist
4 contact guarding
3 mod assist
2 max assist
1 dependent
when transferring supine to sit, use the hemiplegic side for _______
use the stronger side to ______
restorative benefits;
to protect limb and facilitate successful movement
when moving your patient, what are 5 key elements to document?
- ability to initiate movement
- strategies and control
- ability to terminate movement
- level and type of assistance
- environmental constraints
normal sitting looks like:
- ASIS _____ than PSIS
- ischial tuberosities _____ WB
- ASIS are _______
- head in ______
- trunk muscles ______
- feet _______
- level or slightly lower
- equal
- level
- midline
- active
- flat
posterior pelvic tilt siting position looks like:
- due to:
- ASIS ______ than PSIS
- flattening of _______
- ______ WB
- increased ______
- ______ head posture
- weak erector spinae or tight/spastic HS
- higher
- lumbar spine
- sacral
- kyphosis
- protracted
recall postural systems
cognitive resources
MSK
muscle synergies
sensory systems
sensory organization
cognitive strategies
to assess balance, you examine static/dynamic balance in ____
static & dynamic sitting
statie and dynamic standing
control of balance may be impaired when:
- reacting to a destabilizing external force which is called ____
- during self initiated movements which is called ______
reactive postural control
anticipatory postural control
patients with hemiplegia typically fall in sitting in which direction?
direction of weakness
what is ipsilateral pushing (pusher syndrome)?
pushing with stronger extremities toward hemiparetic side with a lateral postural imbalance
–> tendency to fall toward hemiparetic side
what are some examples of postural stability goals for a stroke pt?
hold static siting position w/ increased indepedence
timed goals
orientation
decreased care giver dependence
improved awareness of posture or limb
