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211 exam 1

CVA part 2

deficits from R CVA Left side hemisensory loss Visual-perceptual impairments Agnosias Left side unilateral neglect Impulsive Difficulty sustaining a movement Poor awareness of deficits Poor judgement, inability to self correct Difficulty with perception of emotions
deficits from L CVA Left side hemisensory loss Speech and language impaired Broca’s – expressive aphasia Wernicke’s- receptive, global aphasia Slow, cautious Difficulty planning and sequencing; apraxia aware of deficits; difficulty expressing positive emotions Labile
deficits from brainstem damage Need to assess HR, BP, Temp and Resp. rate regularly Need to work on increasing arousal level Weakness or paralysis bilaterally
deficits from cerebellar stroke Decreased balance, ataxia, nystagmus Difficulty with postural adjustment
secondary impairments from stroke DVT's-calf pain, swelling and discoloration.  Risk for restroke and HTN Fall risk – due to impulsivity , poor judgment, neglect
neglect brain does not attend to that side, may not recognize their own extremity. Better recovery than HHA
s homonymous hemianopsia involves the visual nervous system. Rx have patient learn to turn eyes or head.
inattention lesser form of neglect, needs cues but is able to correct
shoulder dysfunction from stroke Paralysis of rotator cuff, subluxation of humerus
PROM of shoulder w/o adequate ____ mobility can increase pain scapular
stroke pts can develop ____ on the involved side CRPS
90% of recovery occurs in the first ___ months, can continue to one year 3
NDT treatment philosophy Based on neurophysiological function Postural control – learned and modified, uses feedback and feed-forward, is required for skill development Proximal stability is initiated from the patient’s base of support and precedes distal function
according to NDT principles the ___ should decrease as the pt ____ base of support, progresses
NDT wants to ____ abnormal movement and ____ normal movement inhibit, facilitate
what is emphasized in NDT? developmental sequences
brunnstrom 7 stages of motor recovery 1: flaccid, no voluntary movement 2: spasticity hyperreflexia, synergy 3: strong spasticity and synergy 4: decrease spasticity, movement out of synergy begins 5: more decrease spasticity, indep from synergy 6: isolation of movement 7: normal
what does brunnstrom emphasize movement therapy during recovery stages function/ does not use develop. Sequence Training the patient to move in and out of synergies Utilizes quick stretch for movement
Rood treatment philosophy Exercise must have sensory feedback (tapping, etc) Uses facilitation and inhibition of movement Uses icing, prone lying, for inhibition of CNS
facilitation techniques with rood Approximation Icing Quick stretch Tapping Traction
inhibition techniques with rood Prolong cold Deep pressure Warmth Prolong stretch
rood uses ___ sequence for function and recovery developmental
PNF facilitates the ____ with approximation and quick stretch muscle spindle
stages of motor leaning cognitive, associative, automatic
cognitive stage of motor learning Need a very controlled environment, expect large errors and inconsistencies
associative stage of motor learning intermediate stage, less controlled environment, able to perform one task with some cues
automatic stage of motor learning Almost error free, no need for feedback, can perform multiple tasks
what does motor leaning model emphasize visual, tactile, verbal feedback, problem solving and repetition, Feedback/feedforward
Habituation and plasticity at the ___ level synaptic
constraint induced movement therapy restraining the unaffected limb to force use of the affected side
how long does CIMT last? Practice 6 hrs/day every day for 2 weeks
what should PT eval for CVA contain? Mental Status Communication Ability Sensation Perception Joint mobility- ROM and Joint play, spasticity motor control gait functional assessment
what can be used to help asses motor control after CVA? (Ashworth scale), reflexes Strength – in and out of synergies Posture Balance – sitting, standing, dynamic, static, postural reactions, equilibrium reactions Coordination
avoid positions that increase ___ or ___ tone, synergy patterns
what can be used tot help asses function after CVA? Bed mobility, transfers, floor to chair, W/C mobility, etc, FIMS, Fugl-Meyer Assessment of Physical Performance (FMA) -226 points takes 30 minutes
when does acute stroke rehab begin? when medically stable (24 hours)
goals of acute stroke rehab Maintain ROM and prevent deformity Promote awareness, active movement, and use of hemi side Improve trunk control, symmetry and balance Improve functional mobility
is an overhead pulley good for stroke pts? no, can be an issue with shoulder subluxation CONTRAINDICATED
___ may be used for subluxation hemi sling if spasticity occurs D/C it.
what can help decrease shoulder subluxation Strengthen serratus – shoulder protraction Wt. bearing (on elbow or hand), joint approximation
Stretching of Ankle pflexors- slow elongated and activate weak ____ (seated weightbearing of foot on floor, rocking over ankle) is better than PROM dflexors
guidelines for functional mobility activities Focus on using both sides of the body Patient given only as much assistance that they need PNF midline orientation
early activities for functional mobility? rolling, sitting up, bridging, sitting, standing and transfers, both directions, sit to 1/2 stands
goals for post-acute stroke rehab Prevent or minimize secondary complications Compensate for sensory and perceptual loss Promote selective movement control and normalization of tone Improve postural control and balance Develop Ind. functional mobility skills and ADL's
how to help reduce tone post-CVA position out of reflexes avoid excessive resistance rhythmic rotation of limbs steady passive movement out of the spastic pattern reduction of trunk tone Local facilitation-tapping, icing, rubbing
how can you help pts compensate for sensory loss after CVA? using mirror initially, safety education program
tx for postural control and balance post CVA Upright static posture, dynamic posture using a rocker board, hitting balloons, kicking balls Sit to Stand, symmetrical weight bearing
tx for upper extremity control post CVA Scapular mobility-supine and sidelying Shoulder holding exercises Elbow ext with shoulder flexion in supine Wt bearing-quadruped, sitting
tx for lower extremity control post CVA Bridging, supine knee flex with hip extension, PNF D1 LE diagonal Hip abduction LTR Kneeling
NDT approach to gait training post CVA Be quick to get patient into standing (standing frame) Be slow to push gait/do a lot of pregait activities Avoid quad canes if possible Normal timing Cross stepping, stairs AFO or Dflex assists, Swedish knee cages
functional training post CVA Bed mobility, Sit to stands, transfers, Ambulation
motor learning strategies post CVA Exer unaffected side->cross over Bilateral activities Demonstration, use few words
family training post CVA car transfers Toilet transfers Bed mobility gait training/guarding Give accurate, factual information, avoid predictions, give only as much information as the patient or family needs, don't overwhelm them.
discharge planning for CVA pts Family training Assistive devices and orthosis Further therapy needed-homehealth, out patient PT, Pool program home modifications- rugs, grab bars etc.
Created by: bdavis53102
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