WEEK 10 - PROGNOSIS IN ABI; ADJUNCTIVE TREATMENTS Flashcards
(7 cards)
Prognostic indicators after stroke sub acute stroke / rehab - factors at 2 weeks that predict non ambulation at 6-12 months (7)
- Incontinence of urine (strongest level evidence)
- Initial ADL disability and ambulation
- High age
- Severe paresis
- Impaired swallowing (dysphagia)
- Higher cortical dysfunction
- Stroke complications (cerebral oedema, size of haemorrhage)
Prognostic indicators after stroke sub acute stroke / rehab - 72 hours - indication at 72 hours (20
- Sitting balance
- Able to sit unsupported for 30 seconds
- Strength of the paretic leg
- Visible contraction of hip flexors, knee extensors & dorsiflexors
- Day 2 post-stroke – presence of both = 98% probability of walking at 6 months
- Absence of both at 72 hours = 27% probability of walking independently at 6 months
- Declines to 10% at day 9
Prognostic Indicators after stroke : Upper limb recovery - accurate prediction of UL function at 72hrs
- Patients with finger extension & shoulder abduction on day 2 had 98% probability of achieving some dexterity at 6 months
- 60% of patients with some early finger extension achieved full recovery at 6 months _on action research test score
- Patients without this voluntary movement control had probability of 25%
strategies to enhance motor recovery after stroke (5)
Cortical reorganisation
- move through the movements to show the patient what correct movement should look and feel like
- repetition
- task specific
- environmental training
Medical and psychological management
- medical issues, pain management, poststroke depression
pharmacological interventions
- spasticity - botulinum toxin
Approaches to exercise
- CIMT - constraint induced movement therapy
- BWSTT - body weight supported treadmill walking
Technology
- robotics
- functional electrical stimulation
- transcranial magnetic stimulation
Putting a treatment session together
Physio management - sub acute stroke / rehab
- Usually 45 mins to 1 hr treatment sessions (often longer as student)
- Treatment is directed by the patient centred goals
- Within session goals (sub-goals) help you plan your session
- Focus at this stage is on movement patterns as near normal as possible rather than compensations (e.g. delay introduction of walking aids)
- Based on the quantity and quality of motor experience, the brain can be reshaped in either adaptive or maladaptive ways
General session incoorporations (6)
- Address PROM & muscle length _ UL; LL & trunk , neck
- If the patient has pushing behaviour this must be addressed first
- Muscle activation in appropriate position _ UL; LL & trunk
- Put muscle activation into functional practice _ eg LL activation into STS, mini squats
- Progress patient through function as appropriate – supine to sit , postural control sitting, STS, postural control standing, transfers, walking
- Think about how you will modify Rx for a patient with higher cortical dysfunction
goal setting in chronic stroke / outpatient scenarios
- consider prognostic factors - indicating their potential for recovery
- maintenance of function is a valid reason for treatment
- collaborative goal setting - do not be dismissive, assist in reframing
- assessments will tend to be more function based
