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Neurological Physiotherapy > Week 3 > Flashcards

Week 3 Flashcards

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1
Q

What is diaschisis

A

sudden inhibition of function secondary to neurophysiological changes that occur distant to the focal brain lesion

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2
Q

What is tPA stand for

A

tissue plasminogen activator

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3
Q

what is the penumbra

A

moderately ischaemic tissue that surrounds the ischaemic core

is viable for up to 6 hours

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4
Q

What is the leading treatment for ischaemic stroke

A

tPA: thrombolysis

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5
Q

What is the time frame that tPA can be delivered in

A

up to 4.5 hours post symptom onset

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6
Q

neurointervention involves

A

intra-arterial thrombolysis and mechanical clot removal

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7
Q

Antithrombotic therapy involves

A

ingestion of aspirin orally/NGT/suppository within 48 hours after onset of stroke
-only if imaging excludes haemorrhage

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8
Q

If patients have received thrombolysis, how long do they have to wait until they can take aspirin

A

should be deferred for 24 hours and only prescribed if follow up imaging has excluded haemorrhage

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9
Q

Acute phase blood pressure lowering therapy can be used in ischaemic stroke id

A

BP is >220/120

no reductions past 10-20%

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10
Q

in acute primary intracerebral haemorrhage, with severe hypertension observed, Acute phase BP lowering therapy can be used

A

to maintain SBP <180mmHg

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11
Q

If the patient is already on antihypertensive therapy, what should you do

A

continue provided there is no symptomatic hypotension or any other reason to withhold

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12
Q

What are the current recommendations for patients with large MCA infarcts in terms of cerebral oedema

A

patients should urgently referred for consideration of decompressive hemicranectomy, due to the increased intra cranial pressure

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13
Q

Are corticosteroids recommended for management of brain oedema and raised ICP

A

no

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14
Q

Main focus of management in intracerebral haemorrhage management

A

rapid assessment
routine investigations
prevention of complications

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15
Q

Current recommendations in intracerebral haemorrhage management include

A

haemostatic drug treatment with rFVlla is experimental and not recommended for use

for patients receiving anticoagulation therapy prior to stroke and who have elevated INR, therapy to reverse anticoagulation should be initiated rapidly

surgical evacuation may be undertaken for cerebellar hemisphere haematomas >3cm in selected patients

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16
Q

Current recommendations involving physiological monitoring include

A

check of neurological status (GCS), Vital signs (HR, BP, Temp, Spo2, and glucose levels) and respiratory pattern monitored and documented regularly during the acute phase

frequency of observations should be determined by the patient’s status

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17
Q

Current recommendations for oxygen therapy includes

A

patients who are hypoxic (<95% oxygens sats) should be given supplemental oxygen

The routine use of supplemental oxygen is not recommended in acute stroke patients who are not hypoxic

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18
Q

prevalence of hyperglycemia in patients following stroke is

A

1/3

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19
Q

Current recommendations for glycaemic control includes

A

blood glucose monitoring (on admission) and appropriate glycaemic therapy instituted

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20
Q

Pyrexia is

A

“fancy word for fever” increased body temperature

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21
Q

pyrexia is associated with

A

poorer outcomes after stroke

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22
Q

common causes of pyrexia include

A

Respiratory or urinary infections

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23
Q

Current recommendations for pyrexia

A

antipyretic therapy, comprising regular paracetamol and / or physical cooling measures should be used routinely where fever occurs

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24
Q

Current recommendations for seizure management are

A

anticonvulsant meds to be used for patients with recurrent seizures post stroke

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25
What is spasticity
motor disorder characterised by a velocity dependant increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks resulting from hyper-excitability of the stretch reflex as one component of the upper motor neurone syndrome
26
When should interventions to reduce spasticity be undertaken
when the level of spasticity interferes with activity or the ability to care to the patient
27
what can be used as an intervention to decrease level of spasticity
botulinum toxin A - should be trialled in conjunction with rehab electrical stimualtion and or EMG biofeedback can be used
28
What is a contracture
shortening of soft tissue that results in reduced joint ROM due to impairments (weakness or spasticity)
29
What can be used to prevent contracture
conventional therapy for those at risk of contracture ` the routine use of splints or prolonged positioning of muscles in lengthened positions is not recommended
30
Usual position of hemiplegic limbs following ABI
``` Upper limb -Shx : abd/IR Elb, Wrx and fingers : F Forearm : pronation Thumb : adduction ``` ``` Lower limb - Supine Hip: ER Knee: E Ankle: PF ``` Sitting position Hip : F/ER Knee : F Ankle : slight PF
31
Conventional therapy for contracture includes
Encouraging active movement target muscles most at risk of shortening Implement a positioning program for UL/LL between therapy times and during rest periods Joints at risk of contracture should be positioned >20-30 minutes in outer range Passive positioning should be routine ward protocol Aim to keep humerus in the plane of the scapula Teach patients to attend to their own arm
32
Subluxation definition
partial or incomplete dislocation that usually stems from changes in the mechanical integrity of the joint head of humerus is lowered relative to the glenoid cavity (anterior and inferior)
33
What causes subluxation
Weakness (especially supraspinatus and deltoid) Overextensibility of capsular structures Spasticity
34
When is a subluxation most likely to happen
in the first three weeks
35
subluxation can be associated with
poor upper limb function shoulder pain reflex sympathetic dystrophy (now CRPS)
36
Management of patients with severe weakness who are at risk of developing a subluxed shoulder includes
electrical stimulation firm support devices (hemiplegic sling, collar and cuff, wheelchair attachments Education and training for the patient, family/carer and clinical staff on correct handling and positioning
37
Management for patients who have a subluxed shoulder includes
firm support devices
38
Evidence behind the functional electrical stimulation
Evidence supports use in early management of stroke (<2/12) for the prevention of subluxation Recommended to commence within 48 hours of stroke for patients with a MAS score of <4 for UL items Applied to posterior deltoid and supraspinatus
39
Parameters for the functional electrical stimulation
30 Hz Daily - commence 1 hour/day - 6hours /day commence with 1: 3 on/off cycle and gradually increase duration of on cycle and decrease duration of off cycle Cease once the MAS score for UL items is 4
40
Indications for shoulder strapping
reduce shoulder pain reduce glenohumeral subluxation (most effective when applied with slings) Facilitate appropriate glenohumeral and scapulothoracic alignment facilitate or inhibit muscle activity
41
Disadvantages of shoulder strapping
skin irritation needs to be applied by someone with experience requires regular application (aim for 1-2x per week to reduce skin irritation)
42
What is central post stroke pain (CPSP)
superficial and unpleasant burning, lancinating or prickling sensation, often made worse by touch, water or movement refer to neurologist or specialist
43
Swelling of the extremities can happen when
patients are immobile with limbs in dependant positions | - swelling of hands and feet
44
Prevention strategies for swelling of the extremities
dynamic pressure garments electrical stimulation limb elevation whilst resting
45
management of swelling of the extremities
dynamic pressure garments electrical stimulation limb elevation whilst resting continuous passive motion with elevation
46
Why does loss of cardiorespiratory fitness occur
deconditioning occurs as a result of the immobility imposed early after stroke rehab should include interventions aimed at increasing cardiorespiratory fitness once patients have sufficient strength in the large LL muscle groups Patients should be encouraged to undertake regular ongoing fitness training
47
Define fatigue
abnormal or pathological fatigue characterised by weakness unrelated to previous exertion levels and is usually not ameliorated by rest
48
Prevalence of fatigue in long term
16-70%
49
When should therapy for patients experiencing fatigue be done
periods of the day when they are most alert
50
management strategies for fatigue
exercise establishing good sleep patterns avoidance of sedatives avoidance of excessive alcohol
51
Incontinence
dysfunction of the bladder or bowel may be caused by a combination of stroke related impairments ( eg. weakness, cognitive or perceptual impairments) pelvic floor exercises
52
Pressure care is used for
pressure ulcers are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction
53
who should get pressure care
all stroke survivors are at risk therefore they should have pressure care risk assessment and regular evaluation all high risk patients should be provided with appropriate pressure relieving aids and strategies including a pressure relieving mattress
54
Main strategies for treatment (pressure care)
local treatment of wound (dressings, topical applications) Pressure relief (beds, mattresses, cushions, patient repositioning) Treatment of concurrent conditions which may delay healing (poor nutrition, infection ) EStim(electromagnetic, US, Laser)
55
prevalence of falls in inpatients
79% at risk
56
do balance and mobility predict falls
no
57
what should intervention target to reduce falls risk
stroke specific problems such as difficulty standing
58
when should falls risk assessment be undertaken
on admission to hospital
59
ICF analysis includes
environmental factors personal factors functioning factors physical impairments
60
treatment plans include
SMART goals specific treatment strategies for each problem identify resting positions (bed/chair) Identify handling/assistance requirements for health pros or family/carer during bed mobility, transfers, sitting, standing and mobility identify mobility level identify practice that can be carried out independently by patient or with assistance from family/carer
61
Functional activity retraining is centred around
bed mobility, sitting balance, sit to stand, standing balance, transfers, gait, UL function, outdoor/community mobility and high level balance
62
Strengthening is centred around
targeted areas of weakness with consideration of optimisation for neuroplasticity
63
flexibility treatment is centred around
management and prevention
64
What types of specific impairments might need to be considered as part of any treatment plan
``` respiratory dysfunction pain oedema subluxation joint stiffness vestibular dysfunction ```
65
Ways to maximise sensory feedback to ensure optimal motor performance
visual feedback : mirrors, video, targets, scales Auditory feedback : verbal, biofeedback Sensory feedback : handling, tactile facilitation, strapping, compression (bandaging/tubigrip)
66
What are the aims of physiotherapy following stroke
``` prevent/manage secondary complications optimise cardiorespiratory function optimise motor performance increase physical fitness and strength inspire interest and motivation promote mental and physical vigour ```
67
what are some benefits of physiotherapy in stroke cases
prevention of complications such as contracture, subluxation, swelling of extremities, pressure ulcers, falls fatigue loss of cardiorespiratory fitness improved positioning and handling by health professionals and the family/carer overcoming learned non-use or compensations through positive movement experiences management of impairments such as weakness, sensory loss, flexibility, tone and spasticity
68
How much?
rehab should be structured to provide as much practice as possible within the first 6 m after stroke minimum PT 1h/day 5x/week task specific circuit classes/video self modelling can increase amount of practice pts should be encouraged to practice skills learnt in therapy throughout the remainder of the day
69
Timing
patients should be mobilised as early and as frequently as possible upper limb training should commence early acutely, commence as soon as possible with frequent short sessions out of bed
70
Weakness
most common impairment most significant contributor to reduced function one or more interventions used - progressive resistance exercises Estim EMB biofeedback in conjunction with conventional therapy
71
loss of sensation
sensory specific training can be provided to stroke survivors who have sensory loss sensory training designed to facilitate transfer can also be provided to stroke survivors who have sensory loss
72
visual loss
patients who appear to have difficulty with recognising objects or people should be screened using specific assessment tools and if a deficit is found, referred for comprehensive assessment by relevant health professional
73
Sitting
practising reaching beyond arm's length while sitting with supervision/assistance should be undertaken by people who have difficulty sitting Practice should ideally be integrated into everyday tasks (eg. reaching for a cup)
74
Standing up
practicing standing up should be undertaken by people who have difficulty in standing up from a chair repetitive task specific training
75
Standing
task specific standing practice with feedback can be provided for people who have difficulty standing no intervention approach is superior to another minimal evidence to support significant differences in standing balance with regards to postural sway or outcome measures
76
Walking
people with difficulty walking should be given the opportunity to undertake tailored, repetitive practice of walking/components of as much as possible extra interventions that can be including with walking are cueing of cadence mechanically assisted gait (treadmill/robotic device) joint position feedback virtual reality training ankle foot orthoses, individually fit, can be used for people with persistent foot drop
77
high intensity resistance training has shown what outcomes
improved gait speed and functional outcomes
78
fitness training has what effect on walking
significant positive effect
79
what is limb apraxia
impaired planning and sequencing of movement that is not due to weakness, incoordination or sensory loss
80
what is agnosia
inability to recognise sounds, smells, objects or body parts despite having no primary sensory deficits - disabling and dangerous the presence of agnosia should be assessed by appropriately trained personnel and communicated to the stroke team
81
What is neglect
failure to attend to sensory or visual stimuli on or to make movements towards one side of the environment typically left side due to lesions in the right hemisphere Deleterious effects on all aspects of ADL's and is a predictor of functional outcome
82
interventions that can be trialled on patients presenting with neglect
simple cues to draw attention to affected side visual scanning training in addition to sensory stimulation Prism adaptation eye patching mental imagery training or structured feedback
83
Treatment planning includes
``` prioritising functional limitations analysing each functional limitation with consideration of the task and ICF -Task analysis - movement dysfunction ICF analysis - environmental factors -Personal Factors - Functional factors -Physical impairments ```
84
comprehensive treatment plans include
SMART goals specific treatment strategies for each problem identify resting positions identify handling/assistance requirements for health professionals or family/carer during bed mobility, transfers, sitting, standing, mobility identify mobility level identify practice that can be carried out independently by patient or with assistance from family/carer
85
how to maximise feedback during treatment sessions
visual feedback: mirrors, video, targets, scales Auditory feedback : verbal, biofeedback Sensory feedback: handling, tactile facilitation, strapping, compression (bandaging/tubigrip)
86
Interventions must be
goal directed with measurable outcomes functional tasks or components of functional tasks distance achieved, time to perform, number of reps, number of errors to make it measurable

Neurological Physiotherapy (13 decks)

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