lab cases (liv) Flashcards
you’re working with a patient with a 2/5 MMT for trunk extension. You want to work on trunk extension stabilization. What PNF strategy would you do with a patient like this? Which side would emphasize stabilization of trunk extensors?
Reversal of isometrics/rhythmic stabilization would work on stabilization.
Pulling anteriorly at the shoulders (finger tips behind shoulder) will facilitate trunk extensors “hold, dont let me move you”
How could a therapist progress rhythmic stabilization/alternating isometrics to be a controlled mobility exercise?
progress to slow reversals with quick stretches to now work on mobility
you’re working with a patient and want to use a PNF technique for stabilization. which technique is more dynamic?
trick question! rhythmic stabilization is more complex
but it is not more dynamic that alternating isometrics
the pusher weight shift with a ball is fairly passive for a patient. how might you transition this into something more active, dynamic, or functional?
once the patient is ready to progress, some ideas could be using a walking stick and having them lean and reach away from their affected side (the side they push to)
many different way to make this functional for the patient!
you are evaluating a patient with pusher’s syndrome. when you walk into the room, they are pushing towards their left side.
which side is their weak side?
which side is their lesion on?
weak side is left
lesion is on the right
pusher patient’s push away from the side of their lesion.
you just finished laterally shifting your pusher patient on the swiss ball. what should be your next step in your treatment session?
follow this stretching/movement with a functional skill
ex: transfer towards their strong side (the side they don’t push towards)
you are working with a patient 2 weeks post stroke. you tend to stabilize just their feet during bridging but notice they are struggling and seem to be compensating with their less affected side. how might you change your hand placements if they continue to decline in therapy?
bring your hands more proximal. the more proximal your hand placements are, the more assistive you are for the patient.
stabilize at the knee. may need pelvis stabilization.
when facilitating a dynamic trunk, how might you as a therapist get a feel for the patient’s trunk mobility?
go to the end ranges of both anterior and posterior pelvic tilt
(neither of these end ranges are functional positions. patient should be somewhere in the middle to help the patient have a dynamic trunk)
in order to achieve dynamic stability the ventral and dorsal trunk activity is ____________
for movement the activity is ______________
dynamic stability = co contraction of ventral and dorsal trunk
movement= co activation of ventral and dorsal trunk
you are trying to facilitate a patient’s dynamic trunk anteriorly but it remains unsuccessful due to patient stiffness. What should be your next step in treatment?
NDT anterior mobilization of the lumbar spine
you have a patient on with a grade 3 Ashworth level of spasticity. they are weak and tight on the right side. you believe a mobilization would help them. what should you steer clear of? what might be a good treatment choice?
steer clear of bouncing, manipulations/mobilization at a high velocity due to kicking in the spasticity.
a lateral trunk mobilization- to the right in order to lengthen the right side first.
as a therapist on the pt more involved side:
for anterior facilitation our hands are ________
for anterior mobilization our hands are ______
facilitation uses fingers at the lumbar spine
mobilization uses the heel of the hand at the lumbar curve (so it is a bit lower- be careful!!!)
you are working with a patient and they need mobilization on both sides for a lateral shift. what is your order of treatment to address both sides?
as a therapist you should:
-mobilize one side
-facilitate movement on the same side (use it or lose it principle)
-mobilization of the other side
-facilitate movement of the other side now
usually a patient just has one side that is tight
you are mobilizing a patient from a lateral position. where should your hands be?
one hand will be on the lower corner of the ribs
one hand in front- thumb and middle finger on clavicle
you are ready to facilitate movement on your patient’s trunk, sitting for a bit. how would you position the patient for optimal results?
- hips higher than knees
- knees flexed around 90
- feet underneath her
- thighs parallel and hip distance apart
- feet a bit forward for more stability
your patient with a R sided stroke is not bearing weight on one side. you want to work on weight shifts. what side would you mostly likely be shifting to?
R sided stroke so L side impairments. probably not bearing weight to the left side.
want to shift towards the L.
make sure the patient maintains:
* a dynamic trunk
* relaxed shoulders
* movement is occuring at the lower trunk
* always return to midline before starting again
you’re working with a patient trying to do a functional task for rolling. you decide to work on half bridges. how might you specify the patient’s movement to be more functional for rolling?
in half bridging you would also guide the hip into adduction
hip abduction in half bridging helps with gait/standing
your patient is stiff and shortened on their right side. what bed position might be helpful for the patient?
sidelying on the affected side (R) would be helpful because they would be stretching and lengthening their R in this position.
you’re working with a patient with a strong extension synergy. you want to transfer supine to sitting, with forced use (towards strong side). what is important to have success in this transfer?
position the patient in hooklying with knees and hips flexed in order to avoid synergies.
you are working with a Mod A patient and want to work on posterior scoots. what position should you perform this exercise in?
scooting backwards from the front. (from the side is only appropriate for min A patients)
you want to do a pre gait activity using scooting on a mat. which activity would you pick for this goal?
unilateral scooting is great for pre gait due to the lateral weight shifts.
“lift off” in both anterior and posterior scoots is functional for sit <-> stand.
you are working on a patient who is fearful of falling in a stand pivot transfer. how do you address the concern while still working on transfers?
squat pivot transfer- center of gravity is lower, less chance of falling.
T or F: stand pivot transfers represent a higher level of function than a squat/scoot transfer
FALSE
it depends on what each of the limbs/trunk is doing to participate. the patient could be doing more in a squat pivot than a stand pivot.
your patient needs to go to the bathroom very soon. what is your best option for a efficient transfer?
modified stand pivot transfer
