Neuro Rehab stroke recovery

age

most recovery occurs early & is influenced by ____ and lesion size/location

adjacent

clinically, stroke recovery is primarily associated with brain plasticity in the affected/adjacent cortex

ipsilateral

__________ motor pathways are recruited when infarcts are so large that the affected hemisphere cannot recover

low

in acute care, _______ intensity rehab can begin as soon as medically stable

t

t/f there is a substantial benefit to a specialized stroke unit

shorter

acute LOS is getting longer/shorter

1

in acute, need organized plan for rehab & family education - discharge planning begins on day ___

risks

in acute care, be aware of __________ for medical emergencies

60

"inactive and alone" research study: in acute care, patients were alone >____% of the time

24

AVERT (a very early rehab trial) in 2008 implemented mobilization within ____ hours of stroke & continued BID x 14 days = safe and feasible

function

2011 AVERT subsequent study focused on ____________: ADL & time to walking 50m no assist

-early mobility group walked without help sooner (3.5 vs. 7 days)

-no difference in ADLs

dosing

2012 AVERT subsequent study focused on __________: schedule & nature of therapy provided

-mobilization was earlier, happened 3x/day with 2x the amount of out of bed activity

early

2015 AVERT subsequent study - 56 acute stroke units in 5 countries - difference in groups has dwindled, only 5 hours earlier for early vs standard care, length of stay 16 vs 18 days

-higher case fatality rate at 3 months for early/standard but not significant difference between groups

inpatient rehab (IPR)

moderate to severe residual impairments may require referral to __________ _________ or subacute

-timing is an important factor in predicting outcome

-team of rehab specialists for comprehensive services

basic mobility

in IPR, LOS is shortening & sending home before independent - goals are for ___________ ___________

-family teaching, obtaining equipment, transitioning to home care or OP services

maintenance

maintenance/intensives are more likely to be covered by insurance for chronic stroke rehab

60-90

chronic rehab provided in OP or home setting for ____-____ min visits 2-3x/week

all

programs targeting flexibility/strength/gait/endurance/balance/UE fxn/all have been shown to be effective in producing meaningful outcomes for chronic stroke

home

________-based programs focus on problem solving, reducing fall risk factors, home modification

-pt must be considered home-bound to qualify

chronic

acute/subacute/chronic stroke rehab assists in resuming social & recreational participation

young

________ stroke rehab is associated with better likelihood of neurologic recovery & unique social issues like vocation rather than specific health concerns

severe

________ stroke rehab should emphasize discharge planning & reduction in complications

-ethical decisions regarding care should be based on trial treatments

health

for severe stroke, specialized interdisciplinary stroke rehab units show better health/functional/neither/both outcomes

1

Brunnstrom stage __ = flaccid - no voluntary movement

2

Brunnstom stage __ = basic UE limb synergies emerge as associated reactions

-responses do not necessarily result in joint movement

-spasticity developing

3

Brunnstom stage __ = UE limb synergies performed voluntarily, max spasticity

4

Brunnstom stage __ = UE spasticity decreasing, basic movement synergies deviate from synergy

-hand behind back

-elevation of arm to forward horizontal position

-pronate/supinate with elbow at 90

5

Brunnstom stage __ = relative independence of limb synergies; spasticity present but minimal

-arm ABD without flex

-pron/sup with elbow extended

-arm raised forward over head

6

Brunnstom stage __ = UE free isolated joint movements, rapid movements may reveal spasticity

7

Brunnstom stage __ = full recovery

tone

passive changes with stroke include __________ - flaccidity or spasticity, impaired postural tone

passive

abnormal reflexes (clonus, clasp knife, babinski) are a(n) active/passive change

passive

associated reactions are a(n) active/passive change

associated

__________ reactions: passive overflow synergy - seen with effort

weakness

active motor dysfunction; abnormal & inefficient recruitment of motor units: incoordination, fatigue

UE

corticospinal tract lesion most commonly causes hemiparesis affecting UE/LE more

-mild ipsilateral deficits

synergies

abnormal ____________ = highly stereotypic, obligatory combinations of limb movements or postures

-loss of fractionated movement = unable to isolate movement

-cannot move in other combinations

-elicited voluntarily or reflexively as associated reactions

elbow hip

the strongest component of flexion synergy are _________ flexion (UE) and _________ flexion (LE)

adduction pronation adduction extension plantarflexion

the strongest components of the extension synergy are:

-shoulder ___________

-forearm ______________

-hip _____________

-knee _____________

-ankle _______________

extension eversion

neither synergy pattern has wrist/finger _____________ or ankle _____________

neither

flexion/extension/neither/both synergy has scapula stabilization

flexion

flexion/extension/neither/both synergy has scapula retraction & elevation

extension

flexion/extension/neither/both synergy has scapula protraction

flexion

flexion/extension/neither/both synergy has shoulder ABD and ER

extension

flexion/extension/neither/both synergy has shoulder ADD and IR

flexion

flexion/extension/neither/both synergy has forearm supination

extension

flexion/extension/neither/both synergy has forearm pronation

both

flexion/extension/neither/both synergy has flexion of wrist and hand

flexion

flexion/extension/neither/both synergy has hip ABD and ER

extension

flexion/extension/neither/both synergy has hip ADD and IR

flexion

flexion/extension/neither/both synergy has ankle dorsiflexion and inversion

extension

flexion/extension/neither/both synergy has ankle dorsiflexion and inversion

neither

flexion/extension/neither/both synergy has ankle eversion

neither

flexion/extension/neither/both synergy has wrist and finger extension

normal

if SAFE predicts complete recovery, promote __________ use

function

if SAFE predicts notable recovery, promote __________

movement

if SAFE predicts limited recovery, promote ____________

compensation

if SAFE predicts no recovery, promote ____________

TWIST

algorithm to predict whether and when a patient would walk after stroke

-trunk control test score >40 at 1 week predicts walking @ 6 weeks

-TCT <40 but hip ext MMT >3/5 = independent walking @ 12 weeks

-poor trunk, weak hip = dependent @ 12 weeks