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Occupational Therapy MIDTERM > Chpt.1 CVA accident (shoulder) > Flashcards

Chpt.1 CVA accident (shoulder) Flashcards

1
Q

What are 5 Progressive Neurological Conditions

A
  • MS
  • PD
  • Dementia
  • ALS
  • MD (muscular dystrophy)
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2
Q

What are 3 Non-progressive Neurological Conditions

A
  • CVA
  • TBI
  • Spina Bifida
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3
Q

What are 5 affects/deficits from Neurological conditions

A
  • Motor
  • Neglect
  • Aphasia
  • Visual deficits
  • LOC (level of consciousness)
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4
Q

What are 6 OT goals for CVA patients?

A
  1. Properly positioning
  2. Maximize AROM, PROM, strength + coordination
  3. Trying to get back Cognitive + perceptual deficits
  4. Maximize MOBILITY
  5. Develop adaptation
  6. Prevention of deformity + contracture
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5
Q

*****What are 4 deficits after having a LEFT- CVA (Right- Hemi)

A
  • depressed/quiet/cautious/
  • aphasia (language;speaking)
  • Decreased mathematical ability
  • apraxia (motor planning prob)
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6
Q

**What are 4 deficits after having a RIGHT- CVA (Left- Hemi)

A
  • impulsive behaviour
  • visual deficits
  • Anosognosia (lack of insight of impairments)
  • spacial (proprioceptive) deficits
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7
Q

TIA?

A

mini stroke

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8
Q

**Brain Stem Strokes, depending on the severity, can affect what side of your body?

A

-both sides

“Locked-state”; can’t move or speak, but are still AWARE

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9
Q

A Cerebellar stroke can damage and cause what?

A
  • cause Ataxia (lack of balance + coordination)

- cause Dysarthria (slurred speech)

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10
Q

**What are the 2 possible causes for Shoulder pain?

A
  1. IMPINGEMENT; when trauma to shoulder
    Cause: improper handling/poor positioning
  2. IMMOBILITY; by NOT doing something, can result in tissue tightness + loss of ROM
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11
Q

**What are 3 symptoms in SHOULDER-HAND SYNDROME in CVA

A
  • limited ROM in shoulder
  • swollen, shiny hand w/ limited finger ROM
  • pain in wrist extension
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12
Q

A Hemiplegic shoulder must be handled ___ to prevent development of _____

A
  • correctly

- Pain Syndrome

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13
Q

What kind of rhythm is this;

For every 60 degrees Abduction of your Humerus your Scapula moves 30 degrees

A

Scapula-Humeral Rhythm

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14
Q

What can occur because of the Scapula-Humeral Rhythm

A

Impingment

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15
Q

*****What are 6 ways to protect Hemiplegic Shoulder

A
  1. Never PULL shoulder (to change position/transfer)
  2. Dont HOLD and PULL-UP to support person
  3. Dont put your arms under their arms to re-position
  4. Dont force painful ROM
  5. Dont raise Arm ins flexion/abdution psat 90 degrees without SCAPULA GLIDING
  6. Dont raise the arm in flexion/abduction without some EXTERNAL ROTATION of humerus
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16
Q

What are 2 devices to avoid when working with a Hemiplegic Shoulder

A
  • avoid using SLINGS

- never use overhead OVERHEAD-PULLEYS

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17
Q

What are some (6) Principle Treatments in OTA

A
  1. make sure client is comfortable (proper positioning prior starting)
  2. feet flat on floor
  3. respect PAIN
  4. Proximal-> Distal (dont open hand before mobilizing shoulder first)
  5. Monitor for Fatigue and frustration
  6. On going EDUCATION
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18
Q

What percentage of people develop spasticity after a stroke

A

40%

19
Q

What is CIT and what is it?

A

-Constraint Induced Therapy; forces movement of the affected side by: restraining unaffected side to overcome using unaffected side and start using the affected side

20
Q

When is Constraint Induced Therapy most effective

A

-if there is SOME movement of shoulder/wrist and not completely spastic/ flaccid

21
Q

What is the Mirror Box Therapy?

A

-gives illusion of affected hand moving as normal as unaffected limb

22
Q

3 ways how to incorprate the non-functional arm:

A
  1. As a weight-bearing stabilizer
  2. Guided Movement (“hand-over-hand” to guide movement-eliminates verbal cues)
  3. Bilaterally: using both hands at the same time (ex. pick up leg to put on footrest)
23
Q

Who would achieve self-care INDEPENDENCE earlier; someone with Left or Right CVA?

A

CVA on left (R. Hemisphere)

24
Q

What is one specific POST stroke complication?

A 
Glenohumeral subluxation (GHS) 
-shoulder is hanging down
25
Q

“Learned Non-use syndrome” ; avoidance of using hand leads to to (4) deficits:

A
  • decreased STRENGTH
  • decreased ROM
  • decrease FINE MOTOR SKILL
  • Contractures/severe osteoperosis/pain
26
Q

What is the treatment used to treat LEARNED NON-USE SYNDROME to ensure hand is included at all stages

A

-Constraint Induced Therapy: client isnt allowed to use strong hand in order to build NEURAL PATHWAYS

27
Q

What are 7 stages of recovery (Signe Brunnstrom)

A
  1. Flaccidity; no movement
  2. Movement patterns emerge (synergies); spasticity begins
  3. Spasticity PEAKS
  4. Spasticity declines; movements more functional
  5. More difficult movement patterns are mastered
  6. Individual joints movements are mastered
  7. Normal motor function restored
28
Q

What are the 6 UPPER extremity CVA patterns

A
  • scapular retraction
  • shoulder depression + internal rotation
  • wrist flexion
  • flexion of fingers
29
Q

What are 4 deficits that a patient might endure when having Pain-syndrome after Hemiplegic shoulder

A
  • client avoids using arm for function
  • interferes with rehab
  • makes sleeping difficult
  • requires more medication
30
Q

What are 5 points of how you can prevent “Shoulder pain” and “Shoulder-hand syndrome”

A
  1. Bed positioning
  2. Reduce edema
  3. Encourage movement of involved shoulder
  4. Wrist in slight extension
  5. Maintain ROM of MCP/PIP/DIP joints
31
Q

What are 3 ways of how to have appropriate bed positioning for CVA patient

A
  • position on hemiplegic side
  • check to make sure scapula is in full protraction (laying on SCAPULA, not Shoulder joint)
  • in supine, affected arm at side on body, palms up (ext. rotation of humerus)
32
Q

How can you reduce edema?

A
  • ice slush
  • retrograde (go back in position) massage
  • active ROM
33
Q

How do you ensure movement of involved shoulder?

A

-make sure scapula is gliding BEFORE R.O.M. to shoulder

34
Q

How do you maintain ROM of finger joints

A

-facilitation of gross grasp

35
Q

A good exercise to break up Spastic Synergy patterns might include

A
  • trunk rotation; seperation of upp/lower body part

* dusting a table top for example

36
Q

A good exercise to reduce muscle shortness of the trunk and scapula on affected side

A

-Reaching exercises (ex. lean forward to place arm in shirt sleeve)

37
Q

Gross grasper activity:

A

holding bowl against body while mixing

38
Q

Gross manipulator activity:

A

catching a ball/fold laundry

39
Q

Fine manipulator activity:

A

tying knows

40
Q

3 functional mobility that need to be done in DIFFERENT situations under different CONDITIONS

A
  1. rolling (rolling in dark/under a blanket)
  2. sit to stand (recliner chards/car seats)
  3. standing and walking
41
Q

What are some general goals for CVA patients

A
  • Encourage WEIGHT-BEARING through involved arm
  • Increase TRUNK ROTATION
  • Encourage forward REACH to –increase scapular protraction and trunk elongation
  • Use involved hand as a STABILIZER
42
Q

How is a Glenohumeral Subluxation (GHS) assessed?

A

-by palpation between acromion and head of humerus

43
Q

**Why is it so important that you DO NOT RAISE ARM IN FLEXION OR ABDUCTION WITHOUT EXTERNAL ROTATION OF THE HUMERUS.

A

-without external rotation of humerus, the Greater Tuberosity wont be able to clear the acromion; impingment

Occupational Therapy MIDTERM (3 decks)

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