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Neuromuscular (KK) > exam 2: stroke rehab interventions pt 3 > Flashcards

exam 2: stroke rehab interventions pt 3 Flashcards

1
Q

PTs select interventions based on _______
- use _____ model

A

accurate examination and evaluation
- ICF/Schenkman’s

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2
Q

what are the intervention selections (3) used based on the patient’s resources, capabilities, and affect?

A

remediation
compensation
prevention

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3
Q

things to consider when choosing to make your intervention restorative, compensatory or preventatory:

A
  • stage of recovery
  • task specific/environment specific
  • patient’s available resources
  • identify attainable goals
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4
Q

things to be mindful of when choosing interventions regarding the environment, learning variables and dose:

A
  • stage of learning
  • type of task, practice schedule, and feedback
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5
Q

Considerations for evidence based interventions:
- evidence based interventions __(are/are not)___ representative of the scope of physical therapy interventions
- focus on exercises that ______
- gaps in ______ still exist
- all strokes are _____
- ____ ____ is supported universally
- best interventions are ______

A
  • are not
  • improve movement or motor relearning/control
  • literature
  • different
  • early mobilization
  • multimodal (focus on multiple facets and deficits)
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6
Q

the choice of the intervention should take into consideration the individuals:

A

phase of poststroke recovery
severity of stroke
age
comorbidities
cognitive abilities
communication status
affective status
social and financial resources
potential discharge plan

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7
Q

what is task specific training?

A

training that involves practice of functional task where individuals attempt to reach a goal in the environment

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8
Q

task specific training follows the contemporary task-oriented model. what is that?

A

considers all theories of motor control - normal movement is also an interaction among different systems, organized around behavioral goal and constrained by environment

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9
Q

what is the rationale for the contemporary task oriented model?

A

salient goals
enhanced sensory experience
motor control is goal based
patients have varying abilities

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10
Q

what is Neuro IFRAH? (integrative functional rehabilitation and habituation)

A

a whole person approach to rehabilitation; restoring function and making that function functional to return that individual to independent living and resume life roles

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11
Q

functional mobility training uses interventions to ________.
most often used in acute care/IP/subacute facility

A

restore functional status

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12
Q

functional mobility includes:

A

bed mobility
transfers
—> supine to sit, sit to stand, bed to chair
sitting
standing

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13
Q

stroke survivors have deficits in _____, ______, _____ of muscle activity along with low balance ________

A

latency, amplitude, and timing
self-efficacy

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14
Q

why is it important to work on balance and postural control to prevent falls in stroke patients?

A

falls can lead to further morbidity and loss of self confidence

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15
Q

which ICF domain is static and dynamic postural control?
which ICF domain is performing a task with postural control?

A

body structure and function
activity domain

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16
Q

what are 2 things to be aware of with perceptual awareness postural control activities?

A

symmetry of posture
encourage vertical orientation awareness

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17
Q

WBing into LEs
- improves _____ & _____
- increases _____

A
  • limb proprioceptive awareness and strengthening
  • sensory inputs
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18
Q

enhanced feedback associated with ________, the overall sensory experience, and _________ of a purposeful activity enhanced subject performance opposed to postural control alone

A

dual task manipulation of the object
meaningfulness

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19
Q

Visual biofeedback:
- reduces _____
- improves _______ and _______
- what is the rationale behind it?

A

sway
postural symmetry and dynamic stability

movement control is organized around achieving goal of postural control and real time feedback allows for internal cueing to self correct

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20
Q

are internal or external cues better at gaining back postural control?

A

internal

21
Q

how would a patient with pusher syndrome appear?

A

sits/stands asymmetrically with most weight sifted toward weaker side

22
Q

what are two treatment options for pusher syndrome to help with midline reorientation?

A
  • use mirror to “look at posture” for awareness of midline and use of vertical structures in environment
  • pt may lean nonaffected side toward wall or therapist if they are on nonaffected side. “perform activity with shoulder touching the wall”
23
Q

what is the rationale for reorientation of midline through use of environmental prompts?

A

improves perceptual and visuospatial awareness of body

24
Q

compare/contrast aerobic training vs physical activity

A

aerobic training:
- more strenuous
- not appropriate during acute phase due to hemodynamic instability

physical activity:
- appropriate in acute phase –> early mobilization

25
Q

why would you want to incorporate aerobic training into your plan with your stroke patient?

A
  • cardiovascular disease and CVA go hand in hand
  • deconditioned after stroke and predisposed to sedentary lifestyle
    –> increase risk of falls
    –> decline in ambulation
    –> harming CV efficiency due to fatigue and muscle weakness
    –> inactivity leads to secondary complications
26
Q

what are 3 big challenges you may face with trying to incorporate aerobic training into a post-stroke plan?

A
  1. non-ambulatory –> limited mobility or independence
  2. poor self efficacy –> greater dependence and reduced societal interactions
  3. poor baseline of activity –> inactivity possibly led to stroke
27
Q

aerobic training leads to:

A

improved O2 consumption
improved workload tolerance
decreased fatiguability
improved VS
improved functional activities
improved self concept

28
Q

what is progressive resistive strength training?

A

application of external load in addition to force of gravity during repetitive movements to overload the muscles generating the movement

29
Q

resistance training is correlated to improved _______ in stroke survivors and counteracts _______

A

motor
hemiplegia

30
Q

true or false. strength alone is sufficient enough to overcome functional limitations

A

false
strength does NOT equal function

31
Q

for patients who are very weak (less than 3/5 strength), how can you implement resistive training?

A

gravity minimized exercises using powder boards, sling suspension, or aquatic exercise
–> can do concentric, eccentric, and isometric

32
Q

what are precautions with resistive training?
- _____ is often affected
- pts with _____ _____ are at increased risk for injury
- safely ______ pts with postural deficits
- avoid _______ for pts with unstable BP
- start with ________ protocols using _____ intensity exercises

A
  • grasp
  • impaired sensation
  • position
  • sustained max effort
  • submaximal ; low
33
Q

those with MCA CVA should do interventions if they achieve some recovery of ___________
–> training strategies should focus on _____, _______ practice

A

voluntary movement
repetitive, task-specific

34
Q

UE management treatment focuses on _____ and _______

A

restoration and prevention

35
Q

what are some evidence based upper limb interventions?

A
  1. passive positioning/WBing strategies (PROM)
  2. PNF patterns (AAROM)
  3. CIMT (forced use AROM)
  4. slings/subluxation prevention (nonuse/compensation)
36
Q

why is it important to position your patient in bed correctly?

A
  • maintains soft tissue length
  • encourages proper joint alignment
  • whole body intervention –> malalignment of LEs and trunk could influence position of UEs
37
Q

what position should the elbow be in when performing assisted stabilization WBing?

A

full extension –> avoid elbow flexors contractures due to flexor spasticity

38
Q

how should the UE be positioned to perform assisted stabilization WBing?

A

shoulder extended, abducted, and ER with elbow, wrist and fingers extended

39
Q

Rationale for UE WB:
- sustained stretching include relaxation through mechanisms of ____ ______
- slow rocking movements can be added to _______ relaxation effects from influences of slow _____ ______
- ______ proprioceptive awareness through joint compression

A
  • autogenic inhibition
  • increase ; vestibular stimulation
  • increased
40
Q

what is the rationale for using PNF techniques?
- which neuroplasticity rule?

A

hands-on treatment to facilitate active movement patterns
- use it and improve it

41
Q

what are challenges to using PNF? (3)

A
  • reliance upon therapist to perform movement
  • not related to functional task (not salient)
  • active movement needs to occur outside of synergy patterns
42
Q

what is constraint-induced movement therapy?

A

specific protocol that involves a 2 week period of timed interval training where the unaffected limb is constrained by a sling or mitt and the affected limb is challenged through therapeutic task training

43
Q

what is the rationale for using CIMT?

A
  • counteract learned nonuse
  • massed practice helps with neuroplastic changes
44
Q

why does timing matter with CIMT?

A

performance of therapy too soon after stroke may create frustration and overuse syndromes creating neuroplastic damage

45
Q

what is the purpose of using a sling for UE?

A

to protect the shoulder joint to prevent shoulder subluxation and damage to flaccid UE during movement when arm is in a dependent position

46
Q

some evidence suggests that ________ can assist with shoulder subluxation management

A

electrotherapy such as NMES

47
Q

good considerations for use of sling:
- support _____ of arm
- assist with shoulder ______ and prevent _______
- free up therapist to attend to _____

A
  • weight
  • approximation ; subluxation
  • postural/trunk control during functional activities
48
Q

bad considerations for use of sling:
- prolonged use can lead to ______
- contributes to _____ ____ disorders and body neglect
- blocks spontaneous use and contributes to ____ _____

A
  • formation of contractures and increased flexor tone
  • body scheme
  • learned nonuse

Neuromuscular (KK) (21 decks)

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