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Stroke Rehab (FINAL EXAM stuff)
Terms in this set (17)
Physical Therapy Approaches:
What type of training can be done? (functi.., and comp....) What should profoundly impaired patients utilize? (neurof..)
•Functional training / task practice
Motor learning approach
•Consider neurofacilitation for profoundly impaired patients
General Guidelines: Early Recovery:
Regaining volitional control requires what? (low or high level of attention/concentration? Uses behavior shaping to do what? (support what? Minimize or maximize effort? Initiates in or out of synergy movement? Progress to more simpler or difficult movement combos?
You want to promote dissociation of what? (bod... seg...)
Should you focus on concentric contractions first, or eccentric/isometric contractions?
Regaining volitional control requires:
high level of attention/ concentration
Use behavior shaping to:
Support early attempts PRN
Minimize effort / stress (limit ↑spasticity, associated reactions)
Initiate out of synergy movement with meaningful tasks
Progress to more difficult movement combos
promote dissociation of body segments
eccentric / isometric contractions before concentric
Movement Reeducation (part → whole):
Focus on movement combinations needed for what? (func..)
LE Combinations needed for normal gait? (Hip flexion with knee flexion orrr hip flexion with knee extension? Hip extension or flexion with neutral rotation? Ankle dorsi or plantarflexion with knee flexion or extension?)
UE/ hand functions? (reach with proximal or distal stabilization? What else is needed for feeding and dressing? (gra... and rel..)
•Focus on movement combinations needed for functional tasks
•LE: combinations needed for normal gait
Hip flexion with full knee extension
Hip flexion with neutral rotation
Ankle dorsiflexion with knee extension
reach with proximal stabilization
grasp & release for feeding, dressing
Focus on Motor Learning:
What does this include? (demonst..., feed... sched..., prac..., adaptation of tas... and environ..., active participation, movement leading to dependent or independent practice? Teach independent prac... rout..)
Engage patient what sort of learning and problem solving? (active or passive? )
•Adaptation of tasks and environment
•Active participation, movement → independent practice
•Teach independent practice routines (HEP): optimize out-of-therapy times
•Engage patient in active learning and problem solving
Strategies to Improve Sensory Function:
Encourage use of good or bad side?
What sort of sensory stimulation is done? (strok..., stre... pres..., approx..)
What splints are used? (a__)
Incorporate visual tracking to or across midline?
What therapy is used? (mir...)
Safety education to prevent trauma to what? (lim..)
•Encourage use of hemi side
•Sensory stimulation: (often paired with functional training)
•Incorporate visual tracking across midline
•Safety education to prevent trauma to limbs
Shoulder Pain and Prevention:
Positioning at least how many minutes a day?When patient is supine, hands are where? (behind hea..) When at the table, GH joint is in abduction or adduction alogn with IR or ER? )
Positioning in w/c? (arm trough with mid or max rotation?)
Pain-free AROM? (stress GH IR or ER in ab or adduction? Flex 90° to what level of elevation?) What can use on supraspinatus and post deltoid ms? (e-...)
•Positioning: at least 30min/day
supine: hands behind head
at a table: GHJ in abd, ER
•Positioning in w/c: arm trough with mid rotation
•Pain-free AROM: stress GH ER, ABD, Flex 90° > full elevation
•E stim to supraspinatus & post deltoid ms
Shoulder-Hand Syndrome (RSD, CRPS1):
What is stage 1 (reversible)? Pain felt where? (shld.. amd han..)
Stage 2 (difficult to treat)? Is there an ↑or↓ in pain? Early or late dystrophic changes? What else is seen with this? (some skin and muscle at..., and ↑or↓ sweating?
Stage 3 (irreversible)? Do you see pain and vasomotor changes? Is there atrophy? What contractures are seen? ( froz.. shl..., and cla...han..) DO patients have osteoporosis?
•Stage 1 (reversible): shoulder & hand pain, tenderness, vasomotor changes
Pale, pink or Cool temp
•Stage 2 (difficult to treat) ↓pain, early dystrophic changes, osteoporosis
Some skin and muscle atrophy
•Stage 3 (irreversible)
pain & vasomotor changes rare
contracture: frozen shoulder, claw hand severe
Strategies to Improve Flexibility? (soft... , ROM.., position... strat..)
Strategies for UE Flexibility:
For the scapula, emphasis on protraction or retraction & upward or downward rotation?
For the shoulder, you want to increase ROM for abd or adduction and IR or ER?
Avoid what ranges? (over..) UNLESS what? (scapula is moving fr.....)
Emphasis on what aspects of the hand? (finger flexors or extensors? Thumb abd or adductors? Forearm pro or supinators?) Emphasis should also be on GH abd or adduction and IR or ER?
•Soft tissue/joint mobilization
•ROM: PROM, AROM
•Positioning strategies: bed, w/c
•Scapula: emphasis on protraction & upward rotation
monitor during all ROM activities
•Shoulder: ↑ ROM in abduction and ER
Restoring ER ROM is key in managing shoulder pain
•Avoid overhead ranges unless scapula is moving freely
•Emphasis on long finger flexors, thumb add, pronators, GH add and IR
Strategies to Improve Strength:
Graded Strength training: How many reps for how many days a week?
What exercise modalities are used? ( fre..., elas... ,mach..)
Muscles less than 3/5 utilize what? (pow... boa..., ba..., sling... sus)
What other exercise is good for low weight acceptance? (aqu..)
Functional exercises? (sit..., step..)
•Graded strength training
8-12 reps x 2-3x/wk
Machines (Leg press or stepper)
•Muscles less than 3/5:
Sling suspension systems
• Aquatic exercise
What do you look at? ( HR, BP, RPE)
Monitor breath hold...
Warning signs you should look out for? (diz.. ang.., palp.., SOB, persis.. )
Prolonged Bed Rest leads to ↑or↓ endurance? ↑or↓ muscle injury?
Use low or high-intensity training initially?
Include a warm up or cool down?
•HR, BP, RPE
•Breath holding/ Valsalva
•Prolonged bed rest: ↓ endurance,↑ risk of muscle injury
•Use low-intensity training intially
•Include warm-up, cool down
Monitor and prevent what sydromes? (pa...)
What sort of elongation should be done to maintain soft tissue length? (slow, passive elongation or fast, active elongation?)
Maintained static or dynamic positioning?
Should you use prolonged or expedited inhibitory pressure? What splints? (a.. and inh...)
Utilize what techniques? (R__) and what stimulation? (ves..)
What are examples of UE weightbearing? (sit.., quad..., and plant..)
Avoid postures that provoke what reflexes? (ton... )
Support limb for appropriate use of motor patterns PRN to avoid what? (excessive eff. dur.. movm)
Utilize recip inh...
Teach what sorts of patterns? (fun..)
Focus on what? (ta.. prac.. )
•Monitor/prevent pain syndromes
•Slow, passive elongation to maintain soft-tissue length
•Maintained static positioning
•Prolonged inhibitory pressure, air splints, inhibitory splints/casts
•Utilize techniques of RRo, slow vestibular stimulation
•UE weight bearing
•Avoid postures that provoke tonic reflexes, associated reactions
•Support limb for appropriate use of motor patterns PRN to avoid excessive effort during movement
•utilize reciprocal inhibition
e.g. triceps activity to inhibit biceps
•Teach functional patterns
•Focus on task-practice
Improve proximal impairments:
For trunk extensors, work on supine ==> ? , sit..., and brid...
For the abdominals, what should be worked on? (sit.., sup.., roll.. )
For lateral trunk flexors, what is done? (sitting mid..==> lateral tilting to good or bad side?)
For the trunk rotators what is done with UTR? (sidelying to si...)
Improve flexibility where? (c, t, or l spine and the ham....)
supine > sit, sitting, bridging
•Abdominals: sitting, supine rolling
•Lateral trunk flexors:
sitting midline > lat. tilt to sound side
UTR sidelying > sitting
Improve flexibility thoracic spine, hamstrings
Focus on Static & Dynamic Postural Control:
Weight shifting sitting ==> ? (rea..)
Perform what activities to develop midline control? ( rot.., let.. flex..)
Progress to sitting on what surface? (mov.. )
Weight shifting in what postures leads to standing? (higher or lower?)
•Weight shifting sitting > reaching
•Use rotation, lat. flex activities to develop midline control
•Progress to sitting on moveable surface: disc, ball
•Weight shifting in higher postures > standing
Encourage patients to feel difference between what position? (al.. and mal..) For those with disturbed orientation to upright, provide what reference for them? (vis..)
How should you adapt the environment? (simulate where?)
Task-orientated trainig for what? (gra... and rel... in all planes)
What are examples bimanual practice? (arm cy..., push... ,fold what? usncrew what? pour what? use cut.., throw.., and catch.. what? What walk while carrying what?)
•Encourage patients to feel difference between aligned and malaligned position
For those with disturbed orientation to upright provide visual reference (self, pillar, doorway)
Use mirrors with caution: visuospatial deficits
•Adapt environment: simulate home
•Task-oriented training for grasp and release in all planes
•Push-ups against wall
•Fold a towel
•Unscrew lid of jar, use rolling pin
•Pour water jug > cup
•Throw & catch ball, bounce ball
•Walk while carrying a loaded tray
Postural Malalignment - Sitting:
DO you typically see an anterior or posterior pelvic tilit?
Is the pelvis usually equal or unequal?
Is there an increase or decrease in lumbar curve?
What side of the spine do you see shortening? (good or hemi side?)
What head/neck malalignments are seen? (rotation toward or away from the hemi side? Lateral flexion toward or away from the hemi side?)
UE's: use good or bad UE for postural support, with more or less activity from the hemi UE?
LE: Is there typically equal or unequal weightbearing through the feet?
Seated Position - Readiness for Function:
Is the pelvis in anterior or posterior tilt?
Do you see equal or unequal weightbearing?
Is the trunk erect and in midline or does it have kyphosis?
Are shoulders symmetrical or asymmetrical over the hips?
How is the head and neck postioned?
Are knees in or out of line with the hips?
Are feet equally or unequally weightbearing and under the knees?
•Posterior pelvic tilt
•Pelvic obliquity / unequal weightbearing unilateral retraction
•Loss of lumbar curve / ↑kyphosis
•Lateral spine flexion / shortening hemi side
•Ribcage rotation / loss of abdominal control
Rotation away from hemi side
Lateral flex toward hemi side
•UEs: use of sound UE for postural support, little activity hemi UE
•LEs: unequal weight bearing feet
•Pelvis neutral to anterior tilt
•Equal weight bearing both ischial tuberosities
•Trunk erect, midline, appropriate spinal curves
•Shoulders symmetrical and over hips
•Head / neck neutral
•Knees in line with hips
•Feet equally weight bearing and underneath knees
Seating, Wheelchair Mobility:
It will provide what for the individual? (post.. all.. ,stab.., and contr..)
Will you see an ↑or↓ in ms contracture and skeletal deformity?
Enhance? (comf.. and appear... )
Minimize or maximize development of pressure sores?
Increase or decrease sitting tolerance and endurance?
Enhance what for the patient? (func..)
Matching equipment to function:
What should the seat height for the hemi wheelchair be from the floor? (inches) What does this height allow for? (propulsion from what limbs?)
Should seat depth be slightly longer or short?
Consider elevating leg rests for patients with what? (ed..)
Caution with ↓ ROM hamstrings? (tight hamstrings will result in an anterior or posterior pelvic tilt?)
•Provide overall postural alignment, stability & control
• ↓ms contracture, skeletal deformity
•Enhance comfort & appearance
•Minimize development of pressure sores
•Increase sitting tolerance and endurance
•Enhance function of patient
•Hemi wheelchair: seat height 17 1/2 inches from floor, allows propulsion with unaffected arm & leg
•Check also seat depth: should be slightly short
•Consider elevating leg rest for patients with edema, poor circulation
•Caution with ↓ ROM hamstrings: tight hamstrings will result in posterior tilt pelvis
Matching equipment to function:
Hand rims/one-arm drive w/c has what on the same side? (rim..)
Concerns with what dysfunction? (cog.. or percep... )
Should armrests be full length?
Removable armrests help facilitate what? (trans..., table... )
Seating: Use a cushion with a solid or pliable base of support to avoid hammock effect of seat?
A firm base leads to ↑or↓ pelvic rotation and obliquity, and ↑or↓ leg add and IR?
Lateral trunk supports for what? (lat... flex..)
UE: What is used to ↓ posturing and stabilize shoulder along with bringing ↑ awareness to UE? (lap tr..., or arm trou..)
Wedged arm trough can ↑or↓ edema?
Instruct in the patient on what? (management of parts of what?)
Instruct in propulsion how? (what foot moves diagonally across path, while good or bad hand assists in steering?)
Improve what over time? (end.. and adap..)
•Hand rims / one-arm drive wheelchairs: has both R & L-hand rims on same side
•Concerns with cognitive or perceptual dysfunction
•Armrests: consider full length armrests if arm trough is to be used
• Removable armrests facilitate transfers, tabletop activity
•Seating: use cushion with solid base of support to avoid hammock effect of sling seat
•Firm base: ↓s pelvic rotation & obliquity;
↓ leg add & IR
•Lateral trunk supports for severe lateral flexion
•UE: lap tray or arm trough to ↓ posturing and stabilize shoulder, ↑ awareness of UE
•Wedged arm trough to ↓edema
•Instruct in management of parts of w/c, locking brakes for safety
•Instruct in propulsion: sound foot moves diagonally across path, sound hand assists in steering
•Improve endurance, adaptability
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