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UE Overview Flashcards

1
Q

what is a stroke?

A

Interruption of blood flow to the brain; inadequate supply of oxygen /
nutrients.

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2
Q

where can a stroke appear?

A

Can occur in any part of the brain

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3
Q

what are the 2 main types of stroke?

A
  1. ischemic
  2. hemmhoragic
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4
Q

what is thrombosis?

A

Blockage of blood vessel

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5
Q

what is an embolism?

A

Dislodged platelets, cholesterol, or other material that travels in
bloodstream and blocks a vesse

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6
Q

what does a hemorrhagic stroke occur from?

A

Results from rupture of blood vessel

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7
Q

effects of a stroke are determined by what?

A

location and how much brain tissue is damaged

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8
Q

what are some common symptoms of a right sided stroke?

A

contralateral weakness
contralateral sensory loss
hemispatial neglect of inattention
left visual feudal neglect
impulsive or overestimation of abilities

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9
Q

what are common symptoms of a left sided stroke?

A

contralateral weakness
contralateral sensory loss
aphasia, Alexia, agraphia
slow and cautious behaviour

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10
Q

what are the bones of the shoulder?

A

scapula
clavicle
humerus

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11
Q

what are the shoulder joints?

A
  1. Sternoclavicular
  2. Acromioclavicular
  3. Glenohumeral
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12
Q

what is the “pseudo joint” of the shoulder?

A

articulation
between the scapula and
the thorax

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13
Q

what makes the glenohumeral joint?

A

Humeral head + glenoid fossa of scapula

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14
Q

what direction does the head of the humerus face?

A

faces medially, posteriorly, and superiorly

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15
Q

what direction does the glenoid fossa face at rest?

A

laterally, superiorly, and anteriorly

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16
Q

what direction does the glenoid fossa face when the arm is in the dependent position?

A

inferiorly and posteriorly

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17
Q

how much surface area of the humeral head does the glenoid fossa cover?

A

1/3 to 1/4

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18
Q

why does the glenoid fossa cover such a small surface area on the humeral head?

A

to allow mobility with little articular stability

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19
Q

what are the functions of the glenohumeral joint?

A

-spreads joint loading
-allows movement of 2 opposing surfaces

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20
Q

what structures provide static stability to the shoulder joint?

A

-labrum
-joint capsule
-joint cohesion and geometry
-ligamentous support

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21
Q

when is contact between the humeral head and glenoid fossa significantly reduced?

A

when the humerus is positioned in:

-adduction, flexion, and internal rotation
-abduction and elevation
-adducted at the side, with the scapula rotated downward

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22
Q

less contact between humeral head and glenoid fossa =

A

less stability

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23
Q

what provides dynamic stability to the shoulder?

A

supraspinatus
rotator cuff
deltoid
serrates anterior

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24
Q

what is the function of the supraspinatus?

A

maintains the humeral head in the glenoid fossa

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25
what is the function of the rotator cuff?
keeps/steers humeral head in glenoid externally rotates the humerus
26
what is the function of the serrates anterior?
moves scapula forward on ribcage (important for reach)
27
what is the function of the deltoid?
>90 degree compressive:pulls humeral head into glenoid <90 degrees superior shear: pulls humeral had superiorly
28
what does dynamic stability of the shoulder complex rely on?
1. Optimal alignment of the scapula 2. Correct Glenohumeral orientation 3. Length-tension relationship of * scapula pivoters * rotator cuff * biceps & triceps * static restraints (the G-H ligaments and the joint capsule)
29
what does arm elevation require?
1. Scapulothoracic motion * This significantly decrease the shearing effect between the humeral head and the glenoid 2. Scapulohumeral motion
30
what is scapulothoracic motion?
Rotation and translation about three axes of motion embedded in the scapula
31
what does scapulohumeral motion allow?
the glenoid fossa to be positioned directly under the humeral head during the end ranges of abduction to increase joint stability
32
what is the ratio of motion between the scapula and humerus during full ROM?
1. early abduction (0-80 degrees) involving more humeral motion 2. midrange (80-140 degrees) involving more scapular motion 3. end ranges (140-170 degrees) involving motion at neighbouring joints
33
what is a shoulder subluxation?
a partial dislocation of the shoulder joint
34
what is the mechanism for a shoulder subluxation due to an ABI?
-muscles supporting the shoulder are not ‘working properly’ -This causes INSTABILITY in the glenohumeral joint
35
what does glenohumeral stability require?
* angle of glenoid fossa (forward, upward and outward) * scapula properly aligned on ribcage * seating of the humeral head in the glenoid fossa * function of supraspinatus and ligamentous structures
36
what are the types of subluxation?
* inferior subluxation * anterior subluxation * superior subluxation
37
what are the key elements of upper extremity function for tool use?
1. Locate target (coordination of eye-head movements) 2. Volitional motor control * Reach * Grasp * In-hand manipulation
38
what is the role of the trunk while reaching for an object within arm's length?
trunk acts as a stabilizer for postural control
39
what is the trunks role while reaching for an object outside of arms length?
Trunk becomes part of the kinematic chain to extend reaching distance
40
what are the in hand. manipulation skills?
1. Shift 2. Simple rotation 3. Complex rotation 4. Shift + rotation
41
what are the key elements of upper extremity function for tool use?
1. Locate target (coordination of eye-head movements) 2. Volitional motor control * Reach * Grasp * In-hand manipulation
42
what is one of the most common and challenging sequelae post-stroke?
impaired upper extremity function
43
what is of primary importance for regaining independence?
recovery of arm and hand function
44
What post-stroke impairments directly impact the upper extremity?
1. Impaired motor control 2. Impaired sensory perception 3. Shoulder pain
45
what is typical posture post-stroke?
Head: lateral flexed toward involved side, rotation away from involved side Upper extremity: scapular depression and retraction, shoulder adduction and internal rotation, elbow flexion, forearm pronation, wrist flexion, ulnar deviation, finger flexion Trunk:posterior pelvic tilt, possible rotation, lateral flexion toward involved side
46
what happens to the scapula post stroke?
downwardly rotates
47
what happens to the glenoid fossa post stroke?
loses forward, upward and outward orientation
48
what happens to the head of the humerus post stroke?
loses alignment with the glenoid fossa
49
why is it common to have upper extremity subluxations post stroke?
* Motor impairments cause trunk/postural changes which pre-dispose the shoulder joint to malalignment and disadvantageous glenohumeral orientation * Motor impairments cause weakness in muscles responsible for static and dynamic stability
50
what are some movement pattern compensation strategies?
* lateral trunk flexion * trunk rotation * scapula adduction and elevation * elbow flexion
51
where to movement pattern compensation patterns stem from?
1) Spasticity 2) Inability to recruit appropriate muscles 3) Weakness 4) Soft tissue tightness
52
what is muscle tone?
resistance to passive movement of a joint
53
what is the continuum of tone?
Flacidity- hypotonia- normal-spasticity-rigidity
54
what are some examples of increased tone in an intact nervous system?
* Acquiring a new motor skill (riding a bike) * Fear of falling * Pain/expectation of pain * Trying to do something in a hurry
55
define spasticity
A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes
56
define rigidity
Heightened resistance to passive movement of the limb, independent of the velocity of stretch (non velocity dependent)
57
is rigidity unidirectional or bidirectional?
bidirectional
58
what is the triangle of impact of tone?
increased spasticity- immobilization and disuse- contracture
59
what is the impact of tone post stroke?
* Ranges from minor effects on the quality of movement to significant difficulties for caregiving and ADL * Spasticity, contracture and weakness all contribute to loss of function
60
what is the greatest contributor to tone 0-4 months?
spasticity
61
what is the greatest contributor to tone more than 4 months?
weakness
62
how many tone present?
synergy patterns
63
what is a synergy pattern?
* Mass movement patterns * Not selective or isolated movement * Can be elicited voluntarily or as a reflex response
64
what is an upper extremity flexor synergy?
* Retraction/elevation of the shoulder * Abduction of the shoulder * Flexion of the elbow * Supination of the forearm * Flexed wrist and fingers
65
what does impaired sensation post stroke impact?
1. Sensory feedback (resulting in dysthymic/uncoordinated movement) 2. Response or urge to move 3. Functional use even with intact motor function
66
what is shoulder pain post stroke correlated with?
* loss of external rotation * lack of biomechanical alignment * impingement syndromes * tendonitis (overuse or traumatic) * supraspinatus * subacromial bursitis * spasticity
67
what is the definition of hemiplegic shoulder pain?
Shoulder pain present at rest, or during passive or active movement on the hemiparetic side after stroke with no history of trauma or injury
68
is hemiplegic shoulder pain a symptom of diagnosis?
symptom
69
whaat are contributing factors to hemiplegic shoulder pain post stroke?
1. impaired motor control 2. soft tissue lesions 3. altered peripheral and CNS activity
70
initially, what percentage of stroke survivors have severe UE motor impairments?
30%

OCCU Neuro (12 decks)

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