CVA interventions Flashcards
stroke interventions
early intervention is optimal
use affected side (neuroplasticity - use it or lose it)
most significant recovery w/in 3-6 mths after injury
pt fully engaged & motivated
strategy to improve motor development
strategy development
consider stage of learning (cognitive, associative, autonomous)
part vs. whole task training (performance vs. learning)
appropriate speed (keep the function)
carryover/generalization (can perform in home)
bimanual tasks (dressing, pillow case on)
mental practice
have pt self assess (think about plan)
cognitive
associative
autonomous
cognitive - learning what needs to be done, lots of errors
associative - refined, some errors
autonomous - few errors, skilled performance
strategy to improve motor development
feedback
extrinsic vs. intrinsic
fading: extrinsic to intrinsic (cognitive phase may need more extrinsic then fade out feedback)
limit use of immediate feedback: concurrent vs. terminal
knowledge of performance (how/why) vs. knowledge of results (did it work/was it successful)
strategy to improve motor development
practice
organized practice
blocked-early motivation & initial learning
random better than blocked for retention of skills (promote learning as opposed to performance) (put all blocked together)
variable-helps w/adaptability of task & generalizability to other environments
interventions to improve sensory function
sensory stim for recovery to avoid learned non-use
training focuses on improved sensitivity of more affected extremities
presentation of repeated sensory stimuli for tactile, mechano- and muscle receptors (stroking, superficial & deep pressure)
interventions to improve sensory and perceptual function
flexibility and joint integrity (soft tissue/jt mob & ROM, stretching, scapula movement)
positioning, protective devices
interventions to improve strength
resistive strengthening
- sig improvement w/out increase in spasticity
- less evidence for carryover of function-specificity of training may be more important
- monitor BP for HTN
- spastic muscle doesn’t mean it’s strong
- don’t create breath hold with resistance
interventions to improve movement control
promote normal posture alignment & control; functional use of extremities
stress out synergy movement pattern (variety of patterns & contractions)
start out guiding & assisting, but shift to active ASAP (facilitate if too weak)
task specific
compensation
interventions to improve functional status -
general principles
positioning the pelvis
trunk symmetry & bilaterality
guided & AAROM as needed
stability progression: stability to controlled mob to skill
rolling and supine <>sit
other positions/transitions = floor, car, tub
postural control in sitting and standing
interventions to improve balance
address symmetry, alignment, increased WB on affected side
facilitate normal postural strategies
varied sensory conditions; dual attention tasks
Gentile’s taxonomy
Gentile’s taxonomy
difficulty increases from left to right and top to bottom
strategies for hemiplegic UE - general
- pt’s w/severe impairments are less responsive to interventions (require early mob, ROM, pos, compensatory training & enviro adaptations)
- pt’s w/better recovery benefit from repetitive & intense use of tasks (postural support, reaching, manipulation)
strategies for hemiplegic UE - constraint induced movement therapy (CIMT)
wear a splint on uninvolved hand to promote use of involved extremity
strategies for hemiplegic UE - electromyographic biofeedback (EMG-BFB)
training focuses on voluntary inhibition of spastic muscles or increasing recruitment of hypoactive muscles
strategies for hemiplegic UE - neuromuscular electrical stim (NMES)
used to reduce spasticity, improve sensory awareness and improve active movement
strategies for hemiplegic UE - GRASP
self admin graded repetitive arm supplementary program
homework based ex program
ex includes: strengthen arm/hand, ROM, gross and fine motor skills, rep goal & task for whole skill sets
significant improvements: ability to use paretic UE in ADL; ability to reach & grasp objects; increase use of UE during ADL outside therapy time
strategies for hemiplegic UE - management of shoulder pain/subluxation
flaccid arm should be supported at all times; proper positioning & handling essential in functional movements
strategies for hemiplegic UE - reducing subluxation
NMES - E-Stim reduces subluxation & pain, but not significantly
supportive devices - helps w/pain does not prevent onset
strategies for to improve LE control and function
LE training or pre-gait ex - controversial
-moving out of synergy
specific challenges: weak DF’s and hams, tight/weak PF and hip ext, lack of knee control, general extensor tone
strategies to improve locomotion - goals
increase symmetry, speed and knee control
strategies to improve locomotion - critical aspects of gait
initial weight acceptance, midstance control, propulsion, foot clearance and placement, UE posturing
strategies to improve locomotion - orthotics
AFO’s frequently used for spastic inversion and knee control; KAFO rarely indicated
NMES neuroprosthesis - bioness, walkaide
strategies to improve locomotion - locomotor training
treadmill; follow w/overground practice
BW support- provides stabilization for trunk; allow increased speed; used with treadmill or overground
