Week 1 CVA/lateropulsion Case Management II

lecture, lab, team presentation material

What are the characteristics of lateropulsion

Patient actively pushes body across midline TOWARDS the more affected side.

Abducts and extends limb on unaffected side

T/F lateropulsion can happen in all upright positions

true

If a Lateropulsion behavior improves in standing, it will/will not improve with other alignments

will not

What other things is lateropulsion often accompanied with?

SVV impairments and neglect

lateropulsion requires a ___ approach

multimodal

Lateropulsion is most common in __ infarcts and small/large lesions

Right; large

Important aspects of assessment with lateropulsion

Sensation, motor function, visual screen, cognitive exam (multi-system exam).

Intervention should be informed by __

severity, sensory, motor, cognition, awareness, individual function

what is graviceptive

how one identifies themself in gravity

3 parts of perceiving vertically

subjective visal vertical (seeing)

subjective haptic vertical (touching to assess vertical)-not studied much

Subjective postural vertical (sense in body posture upright or sideways)

Rehab considerations for lateropulsion

inter-discenplinary team, consistency, education, patient-centered and inidivudalized

Most supported ways to measure severity of lateropulsion

4 point pusher score (quick and easy), burke lateropulsion scale (longer, deeper dive in all positions)

Burke or 4 PPS shows change over time better?

Burke

Overall goal for rehab with lateropulsion

re-oreint posture to upright/midline, fall risk decrease.

3 steps to addressing lateropulsion

1. self-awareness

2. Active correction

3. Translation

Difference between evidence-informed and evidence-based practuce

EIP seeks to address complexity of healthcare systems to improve EBP by using EBP and other resources.

The nolan article is an example of EBP or EIP?

EIP

The Babyar article is and example of EBP/EIP?

EBP (systematic review)

How did the Nolan article perform their research?

Asked many clinicians various open-ended question surveys to determine how they felt about POC, presentation, discharge, fall prevention of lateropulsion. Consisted of nuts and bolts on how to implement the evidence in the real world.

How did the Babyar article perform their reserach?

Performed meta-analysis to connect presentations to underlying mechanisms in order to form a clinical roadmap useful with assessment.

How to use somatosensory system for interventions in lateropulsion according to the research articles?

External cues (wall), robotics (locomat), knee brace for proprioception, vibration for awareness of bad side,

When transferring a patient with lateropulsion, how should they be transferred?

Transfer towards the hemiplegic side early in treatment, then incorporate other side transfer.