Stroke Flashcards
Motor Learning
Acquisition/modification of learned movement patterns over time. Cognitive/perceptual processes code motor programs.
Motor Control
Outcome of motor learning; ability to produce purposeful movements of extremities and postural adjustments in response to activity/environmental demands.
Cortical Map Reorganization
Form of brain plasticity that recent studies show can play a major role in regaining functional use of a hemiparetic upper extremity after a CVA.
Dynamic Systems Theory
Motor control approaches are based on this; views motor behavior as dynamic interaction betw client factors (ie: sensorimotor, cognitive, perceptual, psychosocial), and occupations that must be performed to enact the client’s roles. Based on HETERARCHICAL MODEL in which component (client, environment, occupational performance) is viewed as being critical in a dynamic interaction to support client’s ability to engage in occupation.
Ex: A CVA can lead to changes in client’s sensorimotor, cognitive, and perceptual skills, which affects motor control, engagement in occupation, and ability to master the environment.
Hierarchical Model
Contrast to heterarchical model in dynamic systems theory. Views higher centers in CNS as having control over the subordinate lower centers. (ie: neurodevelopmental treatment or proprioceptive neuromuscular facilitation).
Task-Oriented Approach
Approach to motor recovery based on dynamic systems principles in which occupational performance and motor recovery are achieved by dynamic interaction of person, environment, and occupations being performed. Uses real objects, environments and meaningful occupations.
GRASP
Graded Repetitive Arm Supplementary Program. A self-administered delivery model that improves arm function and upper limb recovery.
Constraint-Induced Movement Therapy (CIMT) - Definition
Forced use; therapeutic strategy designed to promote functional use of a hemiparetic UE and credited with speeding up cortical map reorganization. Based on principles of dynamic systems theory and task-oriented approach to acquisition of motor control. Avoids LEARNED NON-USE (neglect) of affected UE.
Shaping
Therapeutic strategy using behavioral techniques that approach a desired motor outcome in small, successive increments providing explicit feedback. Allows subjects to experience successful gains in performance with small motor improvement.
Rehabilitation methods for CVA or other neurological insult to the brain
- Biofeedback
- Neuromuscular facilitation
- Operant conditioning
- CIMT
- Compensatory rehab strategies (often used in combination with one of the above; may cause learned non-use)
How CIMT is practiced
In rehab of hemiparetic UE, CIMT forces client to use the more involved UE by immobilizing the less affected UE in a sling, mitt, or combination. Clients then practice using affected UE on an intensive basis for several consecutive weeks by using SHAPING movements with the affected UE. Shown to be most effective in the CHRONIC stage of stroke (at least one year post stroke, not during acute phase), and with
those who have some active wrist/hand movements.
Requires repetitive, supervised, constant practice, and calls for 6 hours of continuous task practice per day.
WMFT and MAL
Two measures for effectiveness of CIMT.
Wolf Motor Function Test (WMFT): 15 motor items examining contributions from distal and proximal muscles of arm. Rated from 0 to 5, and timed.
Motor Activity Log (MAL): Assesses activities attempted outside clinical setting. Self-reported, 30-item test administered in an interview format. Rates functional use 0 to 5, and quality of movement 0 to 5.
Robotics
Robot-assisted therapies; robot used to assist in initiation of movement, guidance, and resistance to movement and to provide feedback. Studies show sensorimotor training with robotic devices improves UE functional outcomes and motor outcomes of shoulder and elbow.
Mirror-Image Motion Enabler (MIME)
Robotic devices developed to enable unrestricted unilateral or bilateral shoulder or elbow movement. Applies force to the affected forearm during goal-directed movements.
Bilateral Training Techniques
Technique in which clients practice the same activities with both upper limbs simultaneously. Use of intact limb assists in promoting functional recovery of impaired limb through facilitative coupling effects between UEs. Activation of intact hemisphere facilitates activation of damaged hemisphere through neural networks linked via the corpus callosum. Best used in subacute and chronic phases of motor recovery.
LEFT CVA
Causes RIGHT sided deficits!
- Hemiparesis
- Aphasia
- Dysphagia
- Depression
Acute Phase:
• Right hemiparesis upper and lower body
• Flaccid stage may last much longer which leads to edema
• More significant sensory impairment
• Joints must be supported
• ROM and soft tissue length MUST be maintained
• Aphasia-inability to speak
• Global Aphasia-inability to speak or comprehend
language (spoken or written)
- Words may come out automatically
- When patient concentrates-words jumble
- Patient IS aware that they are unable to speak the
way they are intending
Dysphagia-difficulty swallowing:
• Patient may cough with thin liquids or tough consistencies (meat)
• Silent aspiration-food/liquids go into lungs instead of stomach due to malfunctions in the throat
• VERY dangerous if left untreated
• Swallow study can diagnose
• Due to language deficits, motor impairments and swallowing impairments:
- Patients often become depressed
- Emotionally Labile
- Family members need support and education
Early medical tx for stroke
- Maintenance of open airway
- Hydration with intravenous fluids
- tx of hypertension
- Evaluation/tx of coexisting cardiac/systemic diseases
- Prevention of DVT (pulmonary embolism most common cause of death in first 30 days post-CVA)
- Monitor for respiratory problems/pneumonia (increase inspiratory/expiratory muscles and cough effectiveness)
- Bowel and bladder dysfunction common
Impairment of Trunk Control May Cause:
- Dysfunction of limb control
- Increased risk of falls
- Impaired ability to interact w/environment
- Visual dysfunction secondary to resultant head/neck malalignment
- Symptoms of dysphagia secondary to proximal malalignment
- Decreased independence in ADLs
Effects of Stroke on the Trunk
- Inability to perceive midline (spatial relationship dysfunction), leading to misaligned sitting postures
- Assumption of static postures that do not support engagement in functional activities
- Multidirectional trunk weakness
- Spinal contracture secondary to soft tissue shortening
- Inability to move trunk segmentally (cannot twist)
- Inability to shift weight through pelvis anteriorly, posteriorly and laterally.
Global Aphasia
Aphasia typical with left CVA. Loss of ALL language skills. Oral expression is lost, except for some persistent or recurrent utterance.
Broca’s Aphasia
Poor speech production and agrammatism. Manifested as slow, labored speech with frequent misarticulations. Good auditory comprehension except with rapid/lengthy speech. Reading, writing and calculating difficulties as well.
Wernicke’s Aphasia
Impaired auditory comprehension and feedback, along with fluent, well-articulated paraphasic speech (word substitution errors). Speech may occur at excessive rate and hyperfluent. Uses many function words. Running speech in meaningless sequence. May mix English with nonsense words. Also has reading, writing, math impairments.
Anomic Aphasia
Difficulty with word retrieval. Occurs in all types of aphasia, but can be the only symptom (hence Anomic Aphasia). Fluent, grammatically correct, but accompanied by difficulty finding words. Results in hesitant/slow speech, substitutions. Mild to severe reading, writing, math deficits.
Dysarthria
Articulation disorder, in the absence of aphasia, because of dysfunction of CNS speech mechanisms. Paralysis and incoordination of organs of speech, which causes thick, slurred, sluggish sounding speech.
Neurobehavioral Deficit
Functional impairment of an individual manifested as defective skill performance resulting from a neurological processing dysfunction that affects performance components such as affect, body scheme, cognition, emotion, gnosis (perception), language, memory, motor movement, perception, personality, sensory awareness, spatial relations, and visuospatial skills.
Determine which of these deficits is blocking a CVA patient’s function of occupations? OT interventions may be based on adaptive/compensatory approach or restorative/remedial approach.
