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Year 2: Neuromuscular > Test 1: Stroke Rehab pt 2 > Flashcards

Test 1: Stroke Rehab pt 2 Flashcards

(53 cards)

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1
Q

what is tone

A

resistance of muscles to passive stretch or elongation

amount of tension at rest

can be normal or abnormal

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2
Q

what is elasticicty

A

tone in all muscle groups must be balanced for smooth movement

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3
Q

what CNS involvement can cause disturbances in muscle tone

A

impairement of the brain, spinal cord, and other receptors/ability to work together

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4
Q

what is spasticity

A

abnormal tone

increased involuntary, velocity dependent muscle tone (faster passive movement, stronger the resistance)

UMN motor disorder

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5
Q

what is flaccidity

A

hypotonicity; often present immediately after stroke

due to effects of cerebral shock

lasts a few days/weeks

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6
Q

how does spasticity present following a stroke

A

early in stroke following falccidity (90% of cases)

pts lack ability to adjust/stabilize proximal limbs and trunk

spasticity patterns influence resting posture and limit active movements outside of synergistic patterns

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7
Q

what is posturing

A

the tightness/stiffness that is a result of spasticity in muscles (i.e. elbow remaining flexed)

can lead to spasms, degenerative changes, and fixed contracturesw

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8
Q

what are synergistic patterns

A

autonomic adjustments of postural muscles that occurs normally in prep for and during movement task

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9
Q

synergy definition

A

working together

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10
Q

characteristics of normal synergies

A

create orderly, purposeful, precise, efficient movements

movements not limited outside of biomechanical ability

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11
Q

characteristics of abnormal synergies

A

movement bound together

“massed patterns of movement”

primitive/reflexive/automatic

limited movement combos; cant be adapted to environment

attempt to activate one muscle results in activation of abnormally coupled models

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12
Q

where are flexor synergies more commonly seen

A

UE

possibly due to primitive reflex of brining hand to mouth to feed

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13
Q

where are extensor synergies more commonly seen

A

LE

possibly due to primitive reflex to stand legs extended

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14
Q

flexion synergy of shoulder girdle

A

elevation and retraction

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15
Q

flexion synergy of shoulder

A

abduction to 90 deg

ER

hyperext

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16
Q

flexion synergy of elbow

A

flexion

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17
Q

flexion synergy of forearm

A

supination

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18
Q

flexion synergy of wrist and fingers

A

flexion

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19
Q

extension synergy of hip

A

extension

abduction

internal rotation

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20
Q

extension synergy of knee

A

extension

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21
Q

extension synergy of foot/ankle

A

plantar flexion

inversion

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22
Q

which neurofacilitation model uses relflexive synergies to define the stages of motor learning and recovery following a neuro injury

23
Q

how to test for spasticity in PROM

Study These Flashcards
A

repeat specific movements passively at different speeds to check for spasticity

quicker = higher spasticity

can use Modified Ashworth Scale

24
Q

describe clonus testing

Study These Flashcards
A

quick stretch of muscle that causes sustained beating of muscle

common in plantar flexors but can occur in jaw or wrist

+ when spasmodic contraction of antagonist muscle occurs

25
what is the modified ashworth scale (MAS)
used to measure/grade spasticity observe position of affected limbs at rest and during voluntary movement
26
describe the grades of the MAS
0 = no increase in tone 1 = slight increase; catch and release at end ROM 1+= slight increase; catch/release through rest ROM (1/2) 2 = more marked increase through ROM but affected part moved easily 3 = considerable increase in tone; PROM difficult 4 = affected part in rigid flexion or extension
27
middle stages of brunnstrom synergies focus on what
moving out of synergies and into functional movements
28
Words that mean that the pt is exhibiting isolated control of a movement following a synergy
selective capacity individualization fractionation
29
recovery following synergies occurs in what direction
proximal to distal
30
description and goal of Brunnstrom's stage 1/falccid paralysis
marked flaccidity; no reflex/voluntary movement Goals: -PNF to regain motor function (reciprocal initiation) -encourage facilitation and support against gravity
31
description and goal of brunstrom's stage 2/development of minimal movement in synergies
minimal voluntary movement movement in partial or whole synergy patterns spasticity begins to develop Goals: -continue to progress PNF to gain motor function
32
description and goal of Brunnstrom's stage 3/voluntary movement synergy dependent
voluntary control of movement synergies (stuck in synergy) movement may not be through full ROM spasticity peaks Goals: -break pt out of imporper synergies to develop active, isolated movements -recovery vs compensation: is pt using spasticity to allow for functional movility
33
Brunnstrom's stage 4/some movements out of synergy description/goal
development of some isolated voluntary control of movement out of synergy (can break synergy) selective capacity; can isolate movement against gravity spasticity declining but still present goal: -cont to break pt of imporper synergies to further develop active/isolated movement (i.e. knee ext with hip flexion or shoulder flexion with elbow ext)
34
Description and goals of Brunnstrom's stage 5/movements almost independent of synergy
can perform more difficult movements out of synergy increased selective capacity spasticity declining but still slightly present goal: -continue to break improper synergies -develop active isolated movement and incorporated functions -i.e. knee ext exercises with hips in flexed position while advancing limb during swing phase
35
Description and goals of Brunnstrom's stage 6/normal movement
ability to perform selective capacity movement individual active/isolated joint movements out of synergy patterns no spasticity goals: -continue rehab to incorporate function and return to full recovery -avoid any learned compensatory movements (bad habits)
36
Brunnstrom's stage 7 vs 6
stage 7 is normal motor function restored (back to pre-stroke levels)
37
reasons UE use is compromised post stroke
hemiplegia spasticity contractures non-use MCA involved
38
common strength findings in UE limb screen
strength losses typically greater in distal aspect of extremity compared to proximal
39
is UE or LE more commonly affected post stroke
UE more frequent high incidence of MCA involvement
40
residual deficits often seen in UE following stroke
20% of individuals with MCA strokes fail to regain functional use of affected UE
41
concern of flaccidity in UE following stroke
can result in shoulder sublux need to monitor position of arm/gap in glenohumeral joint disuse/atrophy can cause further problems
42
as contractures develop, what other factros can further restrict mobility
edema spasticity pain
43
what is coordination
ability to execute smooth, accurate, controlled movement characterized by appropriate: -speed -amplitude -direction -timing -muscular tension -fluidity of movement
44
coordination deficits due to neuro injury
dyssynergia dysmetria dysdiadochokinesia gait ataxia speech dysarthria
45
clinical considerations for coordination testing
- screening often not performed if other deficits are present prior -perform 1UE and 1LE bilaterally -test EO and EC to determine if vision is compensating
46
what to observe with coordination test
-movement direct/precise/easily reverse? -reasonable time frame? -affected by speed? -can adjustments be made? -does vision affect? -greater proximally or distally? -one side more involved? -consistent over time?
47
describe finger to nose coordination test
abd arm to 90 have pt bring tip of finger to nose with EO and EC + = jerky/wandering movement, discrepency between sides, between EO/EC, or consistently missed target
48
describe finger to finger test
touch therapist finger then touch your nose longer path = greater challenge for dysmetria therapist can move finger while pt is going toward their nose + = jerky, missed target
49
describe the rapid alternating movements test
tests for dysdiadochokinesia ask pt to rapidly pronate/supinate with arms extended or on thighs + = uneven/jerky/slow movement/need to change amplitude
50
describe finger opposition test
touch every fingertip with thumb + = uneven/jerky/sliding finger for stability speed differences expected between dominant and non dominant hand
51
describe heel to shin test
stroke heel of foot up and down other shin + = uneven/k=jerky
52
describe rapid alternating movemnent test
rapid DF and PF feet or bend and straighten knees ask to do unilaterally and bilaterally and compare
53

Year 2: Neuromuscular (20 decks)

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