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211 exam 1
CVA part 2
| Question | Answer |
|---|---|
| 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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