week 5: stroke rehab & therapeutic management (pt 1)

Question 1

screen vs. eval

Answer 1

screen - used to guide eval. quick. confirm need for treatment/further exam or referral

eval - gathering & analyzing the exam and develops POC

Question 2

in the history and interview portion, you would first _____ ______ and use the _____ ______ to ask related questions

Answer 2

review chart
ICF framework

Question 3

which neuroplasticity principle relates to the question “what is the patient’s societal role or vocation?”
which ICF domain?

Answer 3

salience - making it meaningful to the pt

participation domain

Question 4

interview questions are different from MSK questions because they’re used to ________
which ICF domain does this relate to?

Answer 4

guide your systems review and screening

health conditions

Question 5

what is the purpose of systems review for stroke pt?

Answer 5

decide which system(s) are involved
— which system is causing the patient’s mobility deficits

Question 6

what is an example of a neuromuscular screen?

Answer 6

assessment of gross coordinated movements and motor function

Question 7

what three things does an examination accomplish?

Answer 7

identifying impairments, activity limitations and restrictions in participation

Question 8

a stroke examination focuses mostly on:

Answer 8

tests and outcome measures
task analysis

Question 9

what is the goal of an examination?

Answer 9

determination of underlying body function structure and activity domain limitations

Question 10

examinations can be performed by:

Answer 10

outcomes measures
task analysis

Question 11

what are important considerations for stroke exam?
*note which ones have synergy patterns present

Answer 11

spasticity/tone (synergy patterns present)
degree of hemiparesis
postural stability
functional mobility (synergy patterns present)
gait (synergy patterns present)

Question 12

FIM scores have been related to :

Answer 12

successful outcomes, discharge home, and return to the community for patients with stroke

Question 13

functional mobility is _____ domain. it can be affected by several factors in _______ domain

Answer 13

activity
body structure

Question 14

true or false. FIM is independently completed in full by PT

Answer 14

false - evaluated in parts by care team specific to scope of practice
PT does transfers and locomotion

Question 15

a FIM score of _______ indicates an individual will most likely not regain independence

Answer 15

37-40

Question 16

FIM score of ______ indicates inpatient rehab is most appropriate setting for stroke rehab

Answer 16

40-80

Question 17

the ______ the score, the fewer days insurance allows for rehab

Answer 17

higher

Question 18

what does PT test as part of the FIM?

Answer 18

functional mobility - 3 transfer items
locomotion - walking or using wheelchair
stairs - attempt 12 steps if appropriate

Question 19

what are the 7 levels of FIM scoring?

Answer 19

7 independent
6 modified independent
5 standby assist
4 contact guarding
3 mod assist
2 max assist
1 dependent

Question 20

when transferring supine to sit, use the hemiplegic side for _______
use the stronger side to ______

Answer 20

restorative benefits;
to protect limb and facilitate successful movement

Question 21

when moving your patient, what are 5 key elements to document?

Answer 21

1. ability to initiate movement
2. strategies and control
3. ability to terminate movement
4. level and type of assistance
5. environmental constraints

Question 22

normal sitting looks like:
- ASIS _____ than PSIS
- ischial tuberosities _____ WB
- ASIS are _______
- head in ______
- trunk muscles ______
- feet _______

Answer 22

• level or slightly lower
• equal
• level
• midline
• active
• flat

Question 23

posterior pelvic tilt siting position looks like:
- due to:
- ASIS ______ than PSIS
- flattening of _______
- ______ WB
- increased ______
- ______ head posture

Answer 23

• weak erector spinae or tight/spastic HS
• higher
• lumbar spine
• sacral
• kyphosis
• protracted

Question 24

recall postural systems

Answer 24

cognitive resources
MSK
muscle synergies
sensory systems
sensory organization
cognitive strategies

Question 25

to assess balance, you examine static/dynamic balance in ____

Answer 25

static & dynamic sitting
statie and dynamic standing

Question 26

control of balance may be impaired when:
- reacting to a destabilizing external force which is called ____
- during self initiated movements which is called ______

Answer 26

reactive postural control
anticipatory postural control

Question 27

patients with hemiplegia typically fall in sitting in which direction?

Answer 27

direction of weakness

Question 28

what is ipsilateral pushing (pusher syndrome)?

Answer 28

pushing with stronger extremities toward hemiparetic side with a lateral postural imbalance
–> tendency to fall toward hemiparetic side

Question 29

what are some examples of postural stability goals for a stroke pt?

Answer 29

hold static siting position w/ increased indepedence
timed goals
orientation
decreased care giver dependence
improved awareness of posture or limb