L10 Stroke Treatment

Question 1

NIH Stroke Scale

Answer 1

can be performed by HCP who are certified

15 item neuro exam to quantify stroke related impairments

evaluates level of consciousness, language, neglect, visual field loss, extraocular movement, motor strength, ataxia, dysarthria, sensory loss

Question 2

Predictive Validity/Meaning of NIH Stroke Scale

Answer 2

<5 = 80% will be d/c home
6-13 = require acute IPR
>14 = require LTC

Question 3

Score Range of NIH Stroke Scale

Answer 3

from 0-42, higher scores indicate greater severity of stroke

Very severe >25
Severe = 15-24
Mild to MOd = 5-14
Mild = 1-4

Question 4

Common medications prescribed to stroke victims

Answer 4

HR, BP, a-fib

anti-clotting (either to dissolve or prevent)

meds to control other comorbidities

Question 5

Contraindications for PT after stroke

Answer 5

1. elevated intracranial pressure
2. DVT or pulmonary embolism that has not been treated
3. acute changes in neuro states
4. new myocardial infarction
5. new and/or active brain bleeding that requires tx
6. unstable vital signs
7. high intensity mobility within 24 hrs of stroke

Question 6

Prognostic Factors

Answer 6

Pathoanatomical Factors
Psychosocial Factors

Question 7

Pathoanatomical prognostic factors

Answer 7

time to treatment (most important)

areas of brain affected, especially frontal lobe or ones that impact memory/language

Question 8

Psychosocial prognostic factors

Answer 8

depression due to loss of function
decreased caregiver supprot
decreased resources

Question 9

CPR to predict ability to ambulate after stroke

Answer 9

For subactue stroke

admit factors that were significant in predicting ambulation were berg balance scale and LE strength

you have to use high intensity variable gait training as the intervention for it to be valid

Question 10

Biomechanical Specificty

Answer 10

biomechanical nature of a task similar to other tasks

Question 11

Information processing

Answer 11

performing a task without distraction vs dual task performance

Question 12

Is knowledge of results or knowledge of performance better?

Answer 12

knowledge of results is a better feedback mechanism

Question 13

Active ingredients of motor learning

Answer 13

errors
feedback
practice

Question 14

Practice variables

Answer 14

intensity, distribution
specificity
manual guidance/assistance
observational learning
mental imagery
adaptive practice

Question 15

Myths for Intervention Progression

Answer 15

1. single joint movements should be mastered before multi joint
2. stability should come before mobility

Question 16

Truths for Intervention progression

Answer 16

1. Specificity of practice needs to match specificity of task
2. Tasks that require mobility and stability both should be learned concurrently
3. Part to whole task is not always appropriate
4. Different tasks types are not necessarily easier or more difficult, they are different

Question 17

Neurofacilitation Techniques

Answer 17

increase muscle tone and muscle activity by providing sensory input

quick tapping, stretch, vibration, fast brushing, quick icing, weightbearing, joint approx, overflow, eccentric/isometric activation, manual resistance

Question 18

Overflow

Answer 18

use stronger manual resistance to a stronger muscle to facilitate a muscle contraction in a weaker muscle within same synergistic movement in contralateral extremity

Question 19

NMES

Answer 19

to peripheral nerves facilitate muscle contraction, improve muscle strength, improve joint alignment and prevent disuse atrophy

helps prevent shoulder subluxation after stroke

Question 20

CPG for use of AFO and FES stimulation SHOULD

Answer 20

provide AFO and FES to improve gait speed, balance, WOL, muscle activation, endurance

Question 21

CPG for use of AFO and FES stimulation SHOULD NOT

Answer 21

provide AFO/FES to improve tone or spasticity

MAY be used to improve gait kinematics

Question 22

Synergy

Answer 22

consistent ratio of muscle co-activation necessary to coordinate body segments to perform a motor task through single neural command

stroke patients are obligated to move in muscle synergy b/c they can’t isolate joint movement

Question 23

Impact of hypertonicity on funciton

Answer 23

researchers have found decreases in strength from neuro disorders affect function more than any associated increased spasticity

important to treat the underlying strength and coordination impairments of opposing muscles and not just spasticity alone to optimize function

Question 24

Functional Strengthening for UMN Pathology

Answer 24

facilitate strengthening of weak muscles limiting the patient’s ability to move out of synergistic pattern

utilize principles of motor learning, neuroplasticity for good outcomes

adapt task, environment, person to make the task achievable

provide support as needed

Question 25

Medications for Hypertonicity and Spasticity

Answer 25

often coupled with PT meds will act systemically, which causes pt with decreased force generation of all muscles

Question 26

Positioning and Handling...

Answer 26

these techniques have not been systematically studied for effectiveness in changing functional outcome

Question 27

Examples of handling and physical inhibition

Answer 27

deep sustained pressure sustained long axis jt traction rhythmic rotation sustained stretch warm or cold icing biofeedback NMES to antagonist

Question 28

Restorative interventions

Answer 28

Encourage flexible strategies provide appropriate sensory stimulation use principles of neuroplasticity

Question 29

Adaptive/Compensatory Interventions

Answer 29

modifying the environment or task as needed to address deficits

Question 30

Strategies for unilateral spatial neglect

Answer 30

more adaptive and compensatory strategies approach from R side to decrease frustration, increase appropriate response, ensure safety

Question 31

Strategies to Maximize Communication with pts with aphasia

Answer 31

attention timing message content

Question 32

Attention strategies

Answer 32

use alerting signals avoid dual tasks speak face to face increase message saliency clarify message

Question 33

Timing strategies

Answer 33

slow rate of speech interstimulus pauses give more time narrow down context

Question 34

Message Content strategies

Answer 34

decrease syntactic complexity short message length direct wording increase redundancy

Question 35

General Intervention for pusher

Answer 35

assist the pt in realizing their misperceptions of upright vertical posture provide the pt with multiple opportunities to see if current posture is oriented to upright provide the pt with multiple opportunities to practice while performing functional tasks

Question 36

For UE pusher

Answer 36

place patient's intact arm on higher surface engage patient in reaching activity with intact arm

Question 37

For LE pusher

Answer 37

block the intact leg from migrating into abd and ext place the intact leg on stool or cross it over the hemiplegic leg to decrease pushing and increase WB on hemiplegic side

Question 38

Rescue positions for pushers

Answer 38

lie patient back in supine have pt lean onto intact arm with shoulder in abduction to decrease pushing for 30-60s