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Neuromuscular (KK) > exam 2: UE management > Flashcards

exam 2: UE management Flashcards

1
Q

UE screening falls under the ______ ICF domain
UE exam/assessment falls under _____, _______, and ______ domain

A
  1. body structure function
  2. body structure and function, activity, participation
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2
Q

what are contributing factors to shoulder subluxation with hemiplegia? (3)

A
  • weakness and weight of heavy arm
  • unlocking mechanism of capsule is lost
  • superiorly, capsule and coracohumeral ligament are taut
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3
Q

secondary adhesive capsulitis can be a result from shoulder pain due to ________

A

spasticity

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4
Q

proprioceptive loss and lack of muscle tone/strength reduce support of RTC to position humerus properly in glenoid cavity

this describes shoulder pain due to ______

A

flaccidity

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5
Q

3 causes of shoulder pain due to flaccidity:
1. prolonged periods of ________ from traction on soft tissues
2. malalignment during mobility causes ________
—> DO NOT use _______
3. poor ______ ________

A
  1. subluxation
  2. impingement ; pulleys
  3. patient handling
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6
Q

Functional Independence Measure (FIM):
- instrument used to measure ______ for _____ population
- some subtests relate to the functional use of ______ ________ —>

A
  • disability for any
  • upper extremity –> self care and transfers
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7
Q

Task specific analysis: ex- reach and grasp tasks:
- ICF domain:
- provides information on patient’s ability to _____, demonstrate ______ _____ ______, and functional UE _______

A

activity

move
anticipatory postural control
mobility

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8
Q

what are examples of task analysis?

A

stacking blocks, placing shapes in shape sorter, household tasks like folding clothes

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9
Q

Action Research Arm Test (ARAT):
- ICF domain:
- specific for:
- what are the 4 subscales?
- on a 0-3 scale, 3 means?
- ARAT has been found to be more responsive than ______ w/ increased UE function in chronic stroke

A
  • body structure and function
  • UE function in adults with neurologic dysfunction, including poststroke
  • grasp, grip, pinch, gross movement
  • 3 = performs test normally
  • FMA-UE
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10
Q

9 hole peg test:
- ICF domain:
- what is it?
- what does it measure?
- normative values are made for _______ populations

A
  • body function and structure and activity
  • speed-oriented, move pegs into 9 holes. then remove them.
  • finger dexterity
  • non neurologic pop. (general pop)
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11
Q

Box and Blocks test:
- ICF domain:
- what is it?
- what does it measure?
- normative values are made for ____ pop.

A
  • body function and structure and activity
  • box with divider contains 150 colored blocks. move as many to the other compartment in 60 sec.
  • manual dexterity
  • general pop
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12
Q

Fugl-Meyer assessment of motor performance:
- ICF domain:
- _____ specific outcome measure
- used primarily for _____
- scores range 0-2. 0 = ___ 2 = _____ so ____ score is better
- max score for FMA-UE ______
- may demonstrate ceiling effects for fine motor skills in ________

A
  • body function and structure
  • stroke
  • research
  • 0 = cannot be performed. 2 = fully performed. high score is better
  • higher functioning patients
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13
Q

Wolf Motor Function Test (WMFT):
- ICF domain:
- performance on ____ timed tasks and _____ strength measures
- tasks are arranged in order of _______
- rating scale 0-5. 0 = ? 5 = ?
- max rating of ____ points
- provides insight into _____

A
  • body function and structure
  • 15 ; 2
  • complexity
  • 0= no use of affected side ; 5= normal
  • 75
  • neural recovery mechanisms
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14
Q

Stroke impact scale (SIS):
- mainly used in ____ setting
- ICF domain:
- _____ specific outcome, ______ report
- ____ point scale. final item scale is ____ to ____
- not sensitive to _____ or _____ weakness of upper limb after stroke

A
  • outpatient
  • participation
  • stroke, self
    1. ; 0-100
  • mild or moderate
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15
Q

what are functional consequences due to maladaptive movement and multifactorial impairments? (4)

A

learned nonuse
learned bad use
forgetting to use
secondary consequences

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16
Q

learned _______:
does NOT learn to use more involved extremities due to movement ________ of less involved side

A

nonuse
substitution (compensation)

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17
Q

initially, what are 5 reasons a patient does not use the affected limb?

A

weakness or paresis
altered force production
sensory loss
spasticity
stroke-related pain (commonly shoulder pain)

18
Q

what is learned bad use?

A

when normal movement of the paretic limb is prevented, compensatory strategies are used to complete the tasks

19
Q

what two principles of neuroplasticity relate to “forgetting to use”

A

use it or lose it
repetition matters

20
Q

during which phase do therapeutic interventions focus on reducing secondary impairments?

A

chronic

21
Q

gadupe

A
22
Q

what are things to consider when choosing the interventions to use?

A
  • which impairments are contributing to the functional status
  • stage of recovery
  • learned nonuse (restorative interventions)
  • if the UE is flaccid (WB & support)
  • task-oriented approach (make it salient)
  • facilitation (but only what is needed)
  • trunk stability is a prerequisite
23
Q

why is soft tissue/joint mobilization and ROM initiated early in poststroke patients?

A

encourage AROM and prevent contracture

24
Q

in ranges of 90 deg shoulder flexion be careful not to perform _________ of ________

A

distraction of humerus

25
Q

scapula should be mobilized with emphasis of ________ and ________

A

upward rotation and protraction

25
Q

should you use shoulder pulleys with neurologic patients? why or why not?

A

no
they do not facilitate appropriate scapulohumeral rhythm

26
Q

what ICF domain do performing purposeful activities fall under?

A

activity domain

27
Q

having an intrinsic motivator falls under which two principles of neuroplasticity?

A

specificity and salience

28
Q

how do you use the upper limb as a stabilizer?
–> early or later stage intervention?

A

increase WBing and approximation of joints
–> early stroke intervention

29
Q

how do you use the upper limb as a manipulator?
–> early or later stage intervention?

A

reaching and grasping objects & performing ADLs – need finger extension
–> later stroke intervention

30
Q

what phase do you start to initiate constraint-induced movement therapy?

A

subacute –> require distal motor function

31
Q

what is the protocol for using CIMT?

A
  1. restraint unaffected arm with mitt, sling, or glove for 90% of working hours for a 2-3 week period
  2. therapy sessions are intense, repetitive task training for 6-8 hours a day
32
Q

the ideal shoulder sling:
- helps maintain _____ alignment with allowed _____
- ______ tendency of humerus to IR
- takes some weight of the arm off the ______

A
  • normal ; freedom of movement
  • decreases
  • upper trunk
33
Q

what are general rules for sling use to support UE?

A
  • minimize use during rehab
  • useful for initial transfer and gait training
  • stay away from traditional slings if you can
34
Q

what are effective alternatives to sling use?

A

taping/strapping
electrotherapy

35
Q

studies show the arm trough ______ the subluxation vs shoulder sling

A

overcorrects

36
Q

what is a WC arm trough?

A

board or lap tray attached to WC to provide support for flaccid arm

37
Q

gadupe

A
38
Q

what are pros for resting hand splint?
what is a con?

A

pros:
- limits contractures with spasticity return
- prevents extreme wrist flexion

con:
- enforces learned non-use

39
Q

in a patient using a 4WW or RW, if grip strength is an issue what can you add to assist them?

A

arm trough
or therapist facilitates hand over hand facilitation
tapping with Ace bandage

40
Q

what is a pro of using unilateral devices?
what is some cons?

A

pros:
- offers independence

cons:
- encourages compensatory gait pattern –> usually step to gait pattern is used

41
Q

what is the SAFE model?

SAFE patients by day 2 after stroke had _____ probability of achieving upper limb function

A

Some arm & finger ext.
98%

Neuromuscular (KK) (21 decks)

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