MOTOR RECOVERY AND FUNCTION

Question 1

What synergy dominants in UE?

Answer 1

Flexion

Question 2

What synergy dominates in LE

Answer 2

Etension

Question 3

Stage 1 of Brunnstrom

Answer 3

Flacid paralysis

Question 4

Stage 2 of Brunnstrom

Answer 4

Increase in ton, no voluntary movement

Question 5

Stage 3 Of Brunnstorm

Answer 5

Increase in tone
Obligatory patterns of movment within limited range
Spastic movement within lmited range

Question 6

How many stages are on the Chedoke?

Answer 6

7

Question 7

Is there voluntary movement at stage 2 of chedoke?

Answer 7

no

Question 8

Stage 3 Chedoke

Answer 8

Spasticity quite marked

Synnergistic movements can be elicited voluntarily but are obigatory

Question 9

Stage 4 Chedoke

Answer 9

Spasticity decreased
Can move from weaker to stronger synergy and back and forth
Way more functional

Question 10

Stage 5 Chedoke

Answer 10

Spasticity waning
In rapid movements still some spasticity
Less interference with function

Question 11

Stage 6 Chedoke

Answer 11

Coordination and patterns of movement are near normal

Question 12

Stage 7 Chedoke

Answer 12

Normal

Question 13

Stage 7 Chedoke

Answer 13

Normal

Question 14

Motor recovery stage 1 UE

Answer 14

flaccid paralysis is present
Hyporeflexic
No active movement elicited by reflex or voluntary movement

Question 15

Motor recovery stage 2 UE

Answer 15

Spasticity is present, flet as a resistance to passive movement
Reflex response to facilitate
No voluntary movement

Question 16

Motor recovery stage 3 UE

Answer 16

Spasticity is marked
Synergistic movement can be elicited voluntarily
Pattern of movement within limited range

Question 17

Motor recovery stage 4 UE

Answer 17

Spasticity decreases
Less resistance to passive movement
Synergy patterns can be reverse if movement takes place in weaker synergy first
MOvement possible within greater range

Question 18

Motor recovery stage 4 LE

Answer 18

Spasticity decreases
Less resistance to passive movement
Synergy patterns can be reverse if movememnt takes place in weaker synergy first
Movement possible within greater range

Question 19

Motor recovery stage 5

Answer 19

Spasticity wanes, but is evident with rapid movement
Able to reverse patterns
Isolated movements possible
Movement becoming more specific

Question 20

Motor recovery stage 6

Answer 20

No resistance to passive movement
Controlled isolate movement
lacks normal speed

Question 21

What is the Chedoke McMaster Stroke assessment

Answer 21

A screening and assessment tool to measure physical impairment and disability of an individual following a stroke
- Valid and Reliable

Question 22

3 main purposes of the Chedoke?

Answer 22

1. To stage motor recovery
2. To predict rehabilitation outcomes
3. To measure clinically important change in physical function

Question 23

what are the 2 inventories of the chedoke

Answer 23

1. Physical impairement inventory - 6 domains

2. Activity inventory - 2 domains: gross motor function + walking function

Question 24

What are associated reactions

Answer 24

Unintentional/involuntary movements caused by a lack of inhibition from the CNS

Question 25

When do Associated reactions occur?

Answer 25

With a voluntary action of another limb or by another stimuli such as: yawning, sneezing, effort

Question 26

What occurs when an associated reaction is repeated

Answer 26

Can become a conditioned response: Reinforces neural circuits supporting the invariant pattern & potentially lead to biomechanical limitations and/or fixed deformity

Question 27

What is a muscle synergy?

Answer 27

Shortcut system in a normal CNS that allows us to do tasks that require firing of several muscle groups that contract simultaneously to work as a single functional unit - Does not control each muscle individually but rather as a group

Question 28

What occurs to muscle synergies after stroke?

Answer 28

They change - in an abnormal, stereotypical way (movement pattern that impact the performance of ADLs)

Question 29

What is seen in a flexor synergy in UE?

Answer 29

- Elevated + retracted scap - Abduction and ER of GH - Flexes and supinates elbow - Flexes wrist and fingers - Adducts fingers

Question 30

What is seen in a flexor synergy in LE

Answer 30

- Elevates and retracts pelvis - Adducts, flexes, and ER hip - Flexes knee - DF and Inversion at ankle - Extend great toe and flexes other toes

Question 31

What occurs in the UE in extensor synergies?

Answer 31

- Depress + protract scap - Adducts + IR GH - Extends + pronates elbow - Somewhat extends wrist - Flex and adduct fingers

Question 32

What occurs in the LE in extensor synergies?

Answer 32

- Adducts, extends, and IR Hip - Extends knee - PF and Inversion - May extend great toe

Question 33

What increases the likelyhood of developping post stroke shoulder pain

Answer 33

- Poor prognostic indicators - UE in low stage of recovery CMSA 1,2,3 - Scapular malalignment - IR of humerus in resting position - Posturing of arm in IR adduction - PROM limitations of abd<90, ET<60 - Neglect - Sensory loss - Incidence of shoulder pain varies between studies; estimates range from 9% to 84%

Question 34

What will you have initially post stroke for presenation of hemiplegic shoulder

Answer 34

- Cerebral shock - Flaccid presentation - Present in >90% of individuals

Question 35

What is continued flaccid paralysis

Answer 35

- Remains at stage 1 CMSA

Question 36

What are precautions for continued flaccid paralysis

Answer 36

- Development of shoulder pain - Tends to result in subluxation - inferior direction - Weakness in shoulder girdle - weights of unsupported arm, and gravitational pull, causes traction on various nerves, muscles, ligs

Question 37

is post stroke shoulder subluxation common?

Answer 37

yes

Question 38

How do you prevent post stroke shoulder subluxation

Answer 38

- Adequately support at all times in stages 1,2,3 - Education - Never pull on arm - Do not force ROM of affected arm - Support during transfers - Remove sling with Pt is sitting and support on solid surface

Question 39

What are some treatment strategy for joint approximation? (in hemiplegic flaccid UE)

Answer 39

- Muscle stimulation - Strengthening - shoulder girdle - Hemiplegic shoulder approximation braces - Taping - Supports throughout the day

Question 40

What is the strategy for positing in bed/wc/sitting for post-stroke hemiplegic flaccid UE

Answer 40

Hemi side always supported with pillows

Question 41

What are the strategies to maintain ROM/Muscle extensibility post stroke in hemiplegic flaccid UE

Answer 41

- maintain pain free functional ROm (maybe below 90 if not safe to go above) - Monitor pain - overstretching of lig and tendon, gravity keeping them on stretch - Monitor any tone development - For hyertonic UE, Position/stretch in position opposite to flexor synergy - Teach fam and caregivers to safely maintain - Self-management/self ROM by client - Do not use pulleys

Question 42

What are complications of spastic UE

Answer 42

- Shoulder pain , adhesive capsulitis - Decrease in functional movement patterns, hygiene, dressing - Loss of scap mobility - Loss of humeral aligment in GH joint (pulling into IR) - Contributes to risk of impingement of AROM and PROM - Humeral head may also be pulled anteriorly - ant dislocation - Contracture - Change to balance, postural control

Question 43

Treatment for spasticity UE

Answer 43

``` Same for tone Additionally - Prevent shoulder pain - Positioning program - Joint protection/education (shoulder subluxation prevention) - Maintain ROM (Especially ER) - Maintain scap mobility - promot adequate ER of GH - muscle stretch strategies - strengthening exercises - CV training ```