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Neuro Rehab 2 > CVA - 4a Stroke Rehab UE > Flashcards

CVA - 4a Stroke Rehab UE Flashcards

(62 cards)

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1
Q

what are primary vs second post-stroke UE impairments (5)

A

PRIMARY
motor control/activation
altered ms tone
loss of sensation
coordination problems
unilateral neglect

SECONDARY
weakness, atrophy
ms length, ROM
edema
subluxation
pain

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2
Q

what are 4 interventions/foci of the hemiplegic UE

A

positioning
shoulder joint integ
pain management
UE functioning

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3
Q

what are the goals of positioning for a hemiplegic UE

A

protect joints
limit edema
dec pain
visualize limb
function

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4
Q

what are the goals of preserving shoulder joint integrity of hemiplegic UE

A

prevent subluxation
prevent shoulder-hand syndrome (CRPS)

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5
Q

how can pts experience pain related to the shoulder joint integrity of a hemiplegic UE

A

not having structures to hold humerus and joint capsule appropriately

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6
Q

what is a standardized outcome measure to use for a hemiplegic UE

A

Fugl Meyer

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7
Q

what is the most common sequelae secondary to a hemiplegic UE

A

inferior shoulder subluxation
- ant and superior possible, but inferior most common

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8
Q

why are inferior shoulder subluxations so common in hemiplegic UE

A

weakness, hypotonicity surrounding GH joint and gravity of limb’s wt -> downward rotation of scap and glenoid fossa -> traction of humerus -> soft tissue surrounding GH joint and joint capsule stretches and lengthens -> ms length-tension relationship changes

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9
Q

what could result from improper management of a hemiplegic UE post stroke

A

soft tissue damage causing shoulder and UE pain

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10
Q

what is pain of subluxed hemiplegic shoulder associated with

A

subluxation itself
loss of ROM
nerve impingement (GH rhythm off)
overstretching and/or rupture of ligaments, tendons, and ms of shoulder

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11
Q

how is a shoulder subluxation dx

A

radiographs (reliable, valid)
calipers or tape measure
palpation**
- 1-2 finger gap from acromion/clavicle to HOH
- also see asymmetry

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12
Q

when is it esp important to properly handle pt’s hemiplegic UE and why

A

positioning
bed mobility
transfers

dec risk of developing pain syndromes and improve functional outcomes

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13
Q

what is the goal of the collaborative care of the interdisciplinary team of a pt hemiplegic UE

A

protect from risk of secondary complications

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14
Q

what are 3 causes of hemiplegia shoulder pain

A

malalignment of joints can lead to soft tissue involvement

impingement syndrome

complex regional pain syndrome (CRPS; shoulder-hand syndrome)

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15
Q

how can malalignment of joints cause hemiplegia shoulder pain and what can it lead to

A

can lead to soft tissue involvement:
- tendon tear
- tendinitis
- bursitis

this can cause shoulder pain and dec function, adhesive capsulitis

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16
Q

how can impingement syndrome result from a hemiplegic UE

A

GH rhythm off -> humerus pulled down and not in proper alignment -> GH friction-compression if go into flex or ABD -> risk for impingement

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17
Q

how can CRPS cause hemiplegia shoulder pain

A

ANS changes -> vasomotor changes, discoloration and temp changes (pink and cool with hyperalgesia

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18
Q

how can CRPS in a hemiplegic UE be prevented

A

support and position UE

mobilize scap and UE
- esp w PROM >90deg for shoulder flex and ABD, need to ensure scap is gliding into upward rotation on thoracic wall

promote active movement and WB-ing

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19
Q

what is important education to give to caregivers to prevent CRPS in a hemiplegic UE

A

never pull on hemiplegic UE to roll pt or during transfers

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20
Q

what are 6 PT interventions for hemiplegic UE management

A

ROM
positioning to prevent progression
supportive devices
NMES
taping
promote recovery of motor function

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21
Q

how does trunk control play impact an hemiplegic UE

A

poor trunk control -> abnormal postures -> will affect how they move and scap orientation -> altered scap orientation -> change orientation of glenoid fossa

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22
Q

how does altered ms tone impact an hemiplegic UE

A

spasticity in pec major and lats downwardly rotates scap
- changes glenoid orientation

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23
Q

what does a scap that isn’t moving w ROM put the pt at risk for

A

inc risk for sublux and impingement

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24
Q

how can spasticity present in hemiplegic UE that inc risk of what secondary complication

A

abnormal ms synergy of excessive ADD and IR
- worsens sublux pathomechanics

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25
at what ROM is ensured scapular gliding and approximation of humeral head into glenoid fossa especially important
flex and ABD >90deg
26
what ROM is contraindicated in a hemiplegic UE
overhead pulleys for self ROM - can't confirm scap is moving w arm
27
best positioning practice for hemiplegic UE while supine in bed and why
ext elbow and elevate hand, forearm supinated pts at risk for flexion contractures & inc IR tone
28
how, what, and to who should education be provided on positioning for hemiplegic UE
signage use of supports: pillows, arm troughs, trays healthcare providers, pt, fam
29
what type of stroke might a wc tray be esp good in and why
R side impulsive, poor safety awareness, reminder not to get up
30
what are pros to the use of a traditional sling
protect from overstretching supraspinatus and joint capsule free up therapist hands
31
what are cons to the use of a traditional sling (5)
1. don't dec sublux 2. don't encourage functional use of limb 3. encourage secondary adaptive shortening and contractures - IR, ADD, elbow flex, finger flex 4. encourage learned nonuse and exacerbate neglect 5. contribute to balance deficit - COM shift ant, inc postural instability
32
what is the GivMohr sling
places pt affected extremity in anatomically correct position in standing - support at hand/wrist and elbow to approximate shoulder joint
33
what are the pros of the GivMohr sling (3)
1. prevent/dec loss of ROM and contractures - UE rests at side and not flex/IR 2. prevent/dec pain 3. prevent/dec hand edema
34
what is a con of the GivMohr sling
no improvement seen in shoulder subluxation when sling removed - see benefits if sling is on - can't prevent if sling is off
35
who is NMES appropriate for
reducing subluxation & prevent further joint separation in acute and subacute stroke (<6mo)
36
what/who did NMES have no effect on
chronic stroke arm function shoulder pain
37
why is NMES ineffective in chronic stroke
ligamentous structures already overstretched, could provide temporary joint support during stim time - but no carryover once stim is off
38
what does the evidence say about the use of NMES for strengthening in post-stroke
most effective if in conjunction w active practice of task - no evidence that use alone will lead to return of ms function
39
what does evidence say about the use of taping or strapping of shoulders post-stroke
low levels of evidence may delay pain onset doesn't reduce sublux or improve function not great research available, mostly anecdotal
40
what are interventions included in task-oriented retraining (contemporary approach) - 3
CIMT bimanual therapy progressive resistance exercise
41
what is key in promoting neuromotor recovery
repetition!!!!!
42
what are tools of technology that can be used in promoting neuromotor recovery and how
EMG biofeedback - facilitate movement NMES - while doing task for strengthening robotic assist VR - w impaired UE
43
what does evidence say about PNF and neuromotor recovery
none to support use for return of function - some support for improvement in ROM
44
who is appropriate for CIMT
min cog and sensory deficits min 20deg active wrist ext min 10deg active finger ext
45
what are characteristics of CIMT
1. restraint 2. repetitive task practice 3. *shaping* - memory and motor learning for task
46
what is a modified version of CIMT and when is this used
dec duration of therapy less time using mitt more home-based therapy
47
why does bimanual therapy work
helps w crossover when intact brain is doing to mobilize to cross over to impaired side
48
what is the full name for bimanual therapy
hand-arm bimanual intensive training (HABIT)
49
who was bimanual therapy studied in
children w CP
50
what populations are and aren't appropriate for bimanual therapy and why
appropriate - children - children should practice functional tasks as most functional activities are bimanual not - adults w stroke - have already acquired bimanual skills so focus is on impaired UE
51
what are examples of augmented sensory input and feedback
WBing joint compression tapping brushing stroking air sleeves vibration visual input
52
what is the key quality of interventions to getting motion back in impaired UE
practice functional, not passive tasks
53
what are examples of simultaneous bimanual activities
UBE rolling pin weighted wand open jar dial phone typing writing
54
why should simultaneous bimanual activities be promoted
activity and proprioception in less affected UE can help improve activation and control of affected limb
55
why do we bother doing any strength training if functional activities are more effective
prevent atrophy and secondary weakness
56
what does evidence say about strength training
inc strength improve activity doesn't inc/worsen spasticity
57
how should strength training be implemented in a POC
as a complement to functional training - don't want to just do strength training w/o task oriented approach
58
what are examples of strength training interventions
grip strength - putty, foam, etc theraband hand-held wt cuff medicine balls UBE pushing, pulling, grasp/release w progressively heavier objects
59
what is PT's role with tone management
we can't directly treat tone but we can prepare limb to tolerate ROM easier and be more functional
60
what is the primary management of tone
pharmacological
61
how can PT help to manage tone in a hypotonic limb (5)
positioning protection resting splints WB-ing w good alignment tapping
62
how can PT help to manage tone in a hypertonic limb (6)
positioning - ER, ABD, ext elbow/fingers, neutral hand positioning splinting (dynamic) serial casting prolonged stretch deep pressure on tendons - esp for pts w clonus neutral warmth

Neuro Rehab 2 (48 decks)

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