PTA Neuro - Hemiplegic Practical Flashcards
(58 cards)
1
Q
When do you facilitate?
A
when there is not enough tone or motor control
2
Q
When do you inhibit?
A
when there is too much tone
3
Q
Which bed position is most therapeutic?
A
side-lying on the involved side
4
Q
What is the measurement scale for balance?
A
Good
Fair
Poor
5
Q
What is the measurement scale for coordination?
A
Impaired
WNL
6
Q
What is the measurement scale for functional status?
A
I SBA CG MIN A MOD A MAX A DEP \+1
7
Q
when in doubt…
A
…weight bearing
8
Q
things to remember when preparing the area/environment
A
chair placement armrest/ footrest chair locked gait belt shoes/treads height of surfaces call bell (at end) clear the path
9
Q
Important thing to remember with interlaced fingers
A
the thumb of the involved UE is on the outside
- a bit of abduction to reduce tone
10
Q
List 5 important objectives for Hemplegic positioning
lying, sitting, standing
A
- increase weight bearing on involved side
- increase trunk rotation
- increase elongation of trunk on involved side
- facilitate separation of trunk and pelvic motor control
- maintain scapular and pelvic protraction (on involved side)
11
Q
List 5 goals for positioning of a hemiplegic patient in side-lying or supine
A
- prevent contracture/maintain normal ROM
- minimize abnormal tone
- stimulate motor function
- increase sensory input
- prevent skin breakdown
12
Q
describe side-lying on Involved side for patient with hemiplegia
A
- most therapeutic
- head and neck in neutral (pillow or two)
- Involved UE:
- scapula protracted (manually)
- shoulder flexed to 90
- arm supported on pillow (hand higher than shoulder)
- elbow extended
- forearm supinated
- neutral wrist
- fingers extended (cloth or splint)
- thumb abducted
- Involved LE:
- hip extended
- knee flexed slightly
- ankle neutral (supported off bed with pillow)
- nothing touching ball of foot (avoid PF)
- use boot to encourage DF
- pillow folded and tucked behind back
- Uninvolved LE:
- hip and knee flexed
- as many pillows as needed to prop uLE to neutral
13
Q
describe side-lying on Uninvolved side for patient with hemiplegia
A
- head and neck neutral (pillow or two)
- folded towel under ribcage for neutral trunk/elongate involved side (pre-positioned)
- Involved UE:
- scapula protracted (pillow prop)
- should flexed to 90 on pillow
- elbow extended
- neutral forearm (hand higher than arm & shoulder to prevent swelling)
- finger extended
- thumb abducted
- Involved LE:
- hip & knee flexed slightly on pillow(s)
- pelvis protracted
- ankle neutral with towel to keep malleolus off bed
- nothing touching ball of foot (avoid PF)
- use boot to encourage DF
- pillow folded and tucked behind back
14
Q
describe lying Supine for patient with hemiplegia
A
- head, neck, trunk in midline - one pillow
- small towels beneath involved scapula and pelvis for protraction
- Involved UE:
- on a pillow, hand higher than shoulder
- shoulder ER
- elbow extended
- forearm supinated
- wrist neutral/slightly extended
- fingers extended with towel or splint
- thumb abducted
- Involved LE:
- pelvis protracted (small towel), neutral rotation
- thigh neutral (towel prop) (avoid lateral rotation)
- hip, knee flexed slightly (pillow prop)
- ankle neutral
- heel not touching bed
- nothing touching ball of foot (avoid PF)
15
Q
describe wheelchair positioning for patient with hemiplegia
A
- head, neck neutral
- head, neck symmetrical
- spine midline
- hips equally weight-bearing (so, square)
- Involved UE:
- scapula protracted (arm forward with elbow supported on lap-board or trough)
- wrist neutral
- fingers extended
- thumb abducted
- Involved LE:
- hip, knee flexed to 90, neutral rotation
- femur parallel to floor
- ankle neutral, DF
- Uninvolved LE free to steer, no leg/footrest
16
Q
name two key points of control for spasticity in a patient with hemiplegia
A
scapula
pelvis
17
Q
UE tends to spasticity in which muscles?
A
flexors
so, position in extension
18
Q
LE tends to spasticity in which pattern?
A
extensor pattern
19
Q
why is pelvis positioned in “protraction”?
A
to inhibit extensor pattern in LE
20
Q
in sitting, what will involved side tend towards?
A
shortening
- need to work to keep it elongated
21
Q
describe UE Flexion Synergy
A
scapular retraction or elevation * shoulder ER * shoulder abducted to 90 elbow flexed * forearm supinated wrist flexed fingers flexed
22
Q
describe UE Extension Synergy
A
scapular protraction * shoulder IR * shoulder adducted elbow extended * forearm pronated wrist extended fingers flexed
23
Q
describe LE Flexion Synergy
A
hip flexed hip abducted hip ER knee flexed to 90 ankle DF foot inverted toes extended
24
Q
describe LE Extension Synergy
A
hip extended hip adducted hip IR knee extended ankle PF foot inverted toes flexed
25
name activities/exercises good for both
- trunk and pelvic motor control
- balance
in sitting
1. A-P pelvic tilts for neutral pelvis (leads to upper trunk extension for erect posture)
2. lateral weight-shifting (leads to sitting properly midline)
3. weight-bearing on UEs
4. upper trunk rotation w/i-UE cradled (leads to dynamic sitting balance)
5. alternating isometrics (build stability -> balance) (slower than rhythmic stabilization)
6. rhythmic stabilization (build stability -> balance) (slower than perturbations)
7. rolling ball with iUE
8. reaching activities (cone stacking)
9. chopping/lifting (for UE and trunk) (pt watches with his eyes)
10. knee -rolling pin, towel slide, reciprocal knee extension
11. ankle - tapping, heel-toe, kicking ball
12. marching in place
13. scooting forward
14. scooting laterally
26
things to think about during trunk and pelvis balance and motor control
- use the string imagery for sitting tall
- cue to sit tall always
- think about where I put my hands
- don't push or pull, only touch to facilitate
- I can sit beside pt
- I can hold pt elbow
- in PNF-type, I stand in diagonal
27
What is the difference between Alternating Isometrics and Rhythmic Stabilization?
In AI, resistance is applied on the same side of the joint
| In RS, resistance is applied on opposite sides of the joint
28
What is the same between Alternating Isometrics and Rhythmic Stabilization?
- both encourage stability of the trunk, hip, and shoulder girdle
- no motion should occur from the pt; pt should simply resist the therapist's movements
- The therapist's movements should be smooth, fluid, and continuous
- For example, the patient can be in a sitting, kneeling, half-kneeling, or standing position when the therapist applies manual resistance to the shoulders
29
describe Alternating Isometrics
- SLOW and CONTROLLED
- looks kind of like MMT
- "don't let me push"
- antagonistic groups: side-to-side or front-to-back
- build up & down
30
describe Rhythmic Stabilization
- rapid and quick (but not as quick as perturbation)
- pt holds position while PTA pushes all over (?)
- looking for co-contraction all around
- "You are a mountain"
- side-to-side, forth-and-back, rotation
31
progression for sitting balance
1. sit up
2. front-to-back plane
3. side-to-side plane
4. rotations
5. add challenges
32
best thing to keep in mind for everything
"what is the goal?"
33
what is process for working on sit -> stand?
1. raise mat a bit to facilitate activity
2. scoot to edge as needed
3. sit up tall (erect posture)
4. feet a bit behind knees (or uUE a bit forward to increase WB on iUE)
5. stabilize iUE with uUE
6. flex at hips (lean, lean, lean)
7. press through feet
8. when hips clear mat, extend through ankles, knees hips to stand upright
34
What are PTA cues for sit -> stand?
- cues forward/downward femur
- cues forward at pelvis or at scapula
- cues upright at upper chest
35
What are PTA cues for stand -> sit?
- shoulders forward
| - hips back
36
name therapeutic activities to increase trunk motor control from supine
- bridging w/approximation
| - lower trunk rotation
37
name therapeutic activities to increase LE motor control from supine
- Raimiste's phenomemon for hip add- and abd-duction
- hip flexion with traction-facilitation
- ankle DF with hip and knee movements
- SLR with uLE while iLE in hooklying position
- bed mobility
38
name therapeutic activites to increase UE motor control from supine
- modified PNF diagonals (chop, lift) (because not so much trunk rotation)
- bilateral UE elevation
- bed mobility
39
describe chopping PNF
clasp hands
iUE start palm down, at opposite shoulder
chop on the diagonal
iUE ends palm up, by involved knee
- follow with eyes to also get trunk rotation
40
describe lifting PNF
```
clasp hands
iUE starts palm down, at opposite knee
lift on the diagonal
iUE ends palm up, by involved shoulder
- follow with eyes to also get trunk rotation
```
41
name activities to facilitate flaccid LE
- bridging (w/approx)
- raimiste's
- passive ankle stretch
42
clues for cues
- be concise
- be clear
- attend to how you say it
- choose activity based on the deficit
43
difference between Traction and Approximation
Traction
- to facilitate initiation of flexion
- separate joint surface
- promote movement
- used where motion is pulling
Approximation
- to faciliate extension
- compress joint surface
- promote stability or maintenance of posture
- used where motion is pushing
44
Where might one apply Approximation?
- at shoulders to work on trunk control in sitting
- at pelvis to work on standing balance
- arm?
45
quick stretch: facilitory or inhibitory?
Facilitory
46
prolonged stretch: facilitory or inhibitory?
Inhibitory
47
What is the number one thing the PTA must remember?
To always let the patient do as much as possible.
| Patient needs to do all the work!!
48
name activities for Pre-Gait, facing the table/support/barre
- two hands on the bar
- lateral weight-shift, with hands moving
- anterior-posterior weight-shift, stagger stance
- look over shoulder
- side-stepping
49
name activities for Pre-Gait, one hand on the barre
- lateral weight-shift
- anterior-posterior weight-shift, stagger stance, uLE first
- stepping out with iLE (toe sock)
- a-p weight-shift with step forward and back
- look over shoulder
50
when in doubt, think about how a baby develops
```
prone
elbows
quad
tall kneel
stand
```
51
CVA cane gait?
uninvolved
cane
involved
52
wheelchair instructions
1. brakes
2. foot and armrest
3. steering forward and back and right and left
- your free leg is for steering
- your free arm is for driving
- pull the floor toward you (forward, right, left)
- push the floor away (backward)
- pull back on wheel to turn towards uLE (right or left)
53
things to watch out for
gait deviations
facial expressions
posture deviations
watch for not wanting to extend through weak leg
54
what is our job?
to facilitate
stabilize where needed (with leg and hand and head)
be the supporting shadow
start proximal, work to distal
know that we won't fix it all at once
tie it in with motivation -> make it mean something
talk to the patient - tell them what you want them to do.
55
PT interventions to decrease rigidity
slow gentle rocking
| slow rhythmic rotational movements
56
PT interventions to decrease spasticity
```
prolonged stretch
weight-bearing
weight-shifting
deep pressure on long tendons
rhythmic rotation
activation of antagonist muscles
slow stroking to paravertebral muscles (calming)
```
57
list exercises to improve Static Balance
```
Romberg standing
Staggered standing
Tandem standing
Single leg stance
To progress, perform:
- With eyes closed
- With head movement
- With arm movement
- On compliant surface
- While doing cognitive task
```
58
list exercises to improve Dynamic Balance
```
Weight shifting
Reaching to limits of stability in all directions
Stepping all directions
Alternate stepping up and down on step
Throwing/kicking ball
Rocker board, compliant disc, foam
External perturbations
Multidirectional walking
Tandem walking
Walking with head turns
Carrying objects while walking
Walking with 180˚ and 360˚ turns
Walking with sudden stops
Stepping over objects
Braiding
Figure eights
```
