Neuro research and Rx

Question 1

Explain Emma’s left upper limb weakness?

Answer 1

As she is 2/5 throughout Emma can’t move her arm against gravity and so is unable to change independently and affecting pottery making, reducing happiness.

Question 2

What can the reduced hand strength and reduced muscle tone cause with WZF?

Answer 2

This can cause the hand to fall off the zimmer frame increasing her risk of falls and inability to mobilise independently.

Question 3

Explain the lower limb weakness for emma?

Answer 3

The 3/5 for knee and ankle means she lacks strength to transfer independently and walking instability increases falls risk

Question 4

Explain the sensory problems affecting tasks…

Answer 4

The reduced sensation may cause secondary injuries e.g. less feedback to afferent neuron may cause burns as can’t feel temperature and further affects balance

Question 5

How can speech dysarthria affect Emma?

Answer 5

This may affect her communication and professional interactions and may feel self-conscious withdrawing from social situations

Question 6

What can the impaired balance affect for Emma?

Answer 6

The reduced proprioception can increase risk of falls affecting mobilising and functional tasks

Question 7

What ethical considerations can be considered for Emma?

Answer 7

SDM to optimise treatment adherence, goal setting for PCC, gaining informed consent, ensure understading by repeating back yes/no, dignity and respect

Question 8

What should be considered in PMH for Emma?

Answer 8

Hypertension, as she’s in acute setting monitor her sats for moving, asthma may affect exercise tolerance in future, stress of stroke with her age and job, smoking.

Question 9

Who can we use in MDT for Emma?

Answer 9

OT can help with home adjustments and cognitive impairments, SALT due to dysarthria, financial support, psychologist or talking therapies such as Steps2Wellbeing for CBT or stroke association, family/friends involvement.

Question 10

What equipment can be used with help of OT for Emma?

Answer 10

Saebo mobile arm support, TENS, gaming technology for visual feedback and motivation and weight supported treadmill for aerobic endurance.

Question 11

What is the study on aerobic endurance increasing neuroplasticity by cortical reorganisation and brain connectivity?

Answer 11

A systematic review by Cardoso et al., 2024

Question 12

Why am I doing sliding arm on table exercise?

Answer 12

Gravity eliminated to improve her range of motion, cloth gives sensory feedback and mimics her wiping down clay station

Question 13

What things are we being mindful of for Emma’s upper limb exercise?

Answer 13

As she has such little strength, she is at risk of subluxation, may have incorrect technique so give passive support and encourage scapula control

Question 14

What research for upper limb weakness Emma?

Answer 14

A narrative review by Coleman et al., 2017 supported that early intervention is necessary to avoid compensation from unaffected limb despite main concern being walking again.

Question 15

How can we progress upper limb exercise?

Answer 15

Do it in standing up a door frame so working against gravity and can use a rolling pin to roll out clay to mimic pottery and grip strength

Question 16

Why have I chosen a STS for Emma?

Answer 16

It will increase her muscular strength as she has full range against gravity and so can help mobilise independently

Question 17

How can we regress and progress the STS?

Answer 17

Regress by increasing plinth height and more support from physio. Progress by placing weaker leg behind, doing on foam mat to challenge proprioception and ankle strategies, turn head and dual tasking.

Question 18

What research backs up my STS?

Answer 18

Cochrane data systematic review by Pollock et al., 2014 found moderate evidence that STS training improved STS time and lateral assymetry in post-stroke hemiplesia.

Question 19

What NICE guidelines back up muscular strengthening?

Answer 19

NICE 2013 and National Clinical guidelines for stroke 2023 suggest task-specific, repetitive and intense exercises to increase strength.

Question 20

What NICE guidelines and RCP 2023 can I explain for Emma?

Answer 20

She must have 3 hours of motor therapy 5 days a week with the addition of cognitive therapy with a MDT appoach of physio OT and SALT.

Question 21

Explain TUSS for an outcome measure for Emma…

Answer 21

Place side or plinth in front of Emma, take hands off and stand for as long as possible anything below 20 seconds may show increased falls risk

Question 22

How can I use a TUAG for Emma?

Answer 22

Seated on the command go she can stand, walk 3m with WZF, turn and walk to sit down. Anything over 13 seconds is high falls risk.

Question 23

What is the Barthel Index?

Answer 23

A way of assessing ADLs e.g. toileting, changing, feeding, etc, scored out of 100 to measure independence.

Question 24

What is the Fugl-meyer outcome measure for stroke with evidence?

Answer 24

A systematic review by Santisteban et al., 2016 found Fugl-Meyer to be used in 36% of studies and it looks at upper and lower limb function, sensation, balance, joint ROM and joint pain so valid and reliable. Each scored out of 3, 0 = can’t perform, 1 = semi able and 2 = performs fully

Question 25

What can we do to work on sensation before physio for Emma?

Answer 25

As part of GRASP (graded repetitive arm suplementary program) could do sense priming before e.g. with different texture and temperature.

Question 26

What are the ten principles of neuroplasticity?

Answer 26

Use it to lose it, use it to improve it, salience, specificity, reps, intensity, interference, transference, age and time matters (more neuroplasticity in acute stage).

Question 27

Explain Suk's lower limb weakness affecting ADL....

Answer 27

Bilateral lower limb weakness has lead to heavy reliance on upper limbs so can't do ADLs independently, can't manage stairs or curbs when walking.

Question 28

Explain how Suk's poor balance can affect activities...

Answer 28

The poor balance and proprioception reduces confidence with walking unaided so increased falls risk and avoids social interactions.

Question 29

Explain how the reduced left leg sensation can affect Suk?

Answer 29

As he can't differentiate between light touch he is at risk of secondary injury e.g. standing on something sharp also affects his balance i.e. can't stand without leaning on counter

Question 30

Explain how the fatigue and anxiety affecting functional tasks for Suk?

Answer 30

Limits endurance for standing at an easel and won't attend social events due to fear avoidance so likely to suffer social isolation

Question 31

What ethics should be considered for Suk?

Answer 31

Respect his autonomy while adopting SDM to improve treatment adherence and PCC, ensure Suk fully understands before gaining informed consent and active listening

Question 32

What holistic factors and PMH should be considered for Suk?

Answer 32

Physical along with psychological impact, suffers from anxiety, reliant on husband

Question 33

Who can we use in MDT for Suk?

Answer 33

OT can utilise home support for art business, MS nurse for fatigue and DMT review, psychologist or talking therapy for anxiety e.g. MS society, actively involve husband in goals and motivation

Question 34

Why have I chosen ankle PF and DF?

Answer 34

This is the most impaired with 2/5 on the left so this is likely to be causing footdrop affecting walking and fatigue.

Question 35

What is the research on muscle weakness in MS?

Answer 35

Meta-analysis by Usman et al., 2025 showed home based strength and balance training positively improved leg strength, walking speed and ability, QoL and pt satisfaction in MS patients.

Question 36

How can we make DF and PF more functional?

Answer 36

Add a marker to reach on bottle as it gives him motivated to reach a target

Question 37

How to progress and regress the DF and PF?

Answer 37

Regress by performing in side lying so gravity eliminated and progress doing with band

Question 38

What other exercise have I chosen and why for Suk?

Answer 38

Balance exercise standing in parallel bars for support or at home in front of easel for more functional, turn head to challenge vestibular rehab as reliant on visual cues so likely to fall at night

Question 39

What research has been done on vestibular rehab?

Answer 39

A meta-analysis and systematic review by Garcia-Munoz et al., 2020 found balance training with vestibular rehab improved MS related fatigue, dizziness and balance issues.

Question 40

How can we progress the balance exercise?

Answer 40

Reduce the base of support by placing feet together, place easel to one side if he falls to one side, remove parallel bars

Question 41

How would I strengthen lower limb for Suk?

Answer 41

P bars step inbetween step taps initially to work on his balance if this is too easy progress to a step up.

Question 42

Why use MSIS-29 for Suk as an outcome measure?

Answer 42

It is patient reported to assess how physical and psychological health is affecting MS (Young et al., 2024).

Question 43

What other OM for Suk?

Answer 43

Timed 25ft or 10m has been more relevant for walking limitations can look at 6MWT for aerobic endurance on a good day (Bethoux and Bennet 2011).

Question 44

What orthotics can be used for Suk?

Answer 44

Can look at use of AFO for helping to improve the foot drop to help his walking ability reducing risk of falls and walking aids as no upper limb weakness.

Question 45

What are the NICE guidelines 2022 for MS related fatigue?

Answer 45

Offer MS related fatigue CBT for stress management and use aerobic endurance, balance training, yoga and pilates to treat MS related fatigue.

Question 46

What NICE 2014 can we link to vestibular rehab for Suk?

Answer 46

Consider vestibular rehab for people with MS related fatigue and limited standing balance and consider supervised exercise programme and progressive resistance training.

Question 47

What must we do in neuro when moving pt?

Answer 47

Takes socks off as slippery and check plinth brakes.