Stroke Examination

functional activities and participation, strategy level, impairments of body structure and function

order of the objective examination with a stroke

5x sit to stand, 6 minute walk, BERG, FGA, ABC, 10MWT

6 core task specific outcome measures for stroke

impairments

Fugl-Meyer assessment only looks at ____, NOT function; gold standard to assess motor recover **DO NOT DO THIS

functional independence measure (FIM)

outcome measure that indicates level of function using level of assistance (older)

IRF-PAI/QI

GG codes

postural assessment for stroke (PASS)

outcome measure that assesses postural control following stroke; good for low level patients

stroke impact scale (SIS)

self report measure to assess function and quality of life post stroke

Trunk impairment scale

outcome measure that measures motor impairment of trunk after stroke; completed in sitting, for lower function patients

Stroke Specific Quality of Life Scale (SS-QOL)

selft report measure; 10-15 minutes to complete, validity established by NOT reliability

physiological walker

an individual that walks for exercise at home or in parallel bars only

limited household walker

an individual that relies on walking to an extent in the home but also uses a wheelchair

unlimited household walker

an individual that walks for all household activities; difficulty with stairs and leaving home independently

0.4

a household walker is defined by a gait speed < ____ m/s

most limited community walker

an individual that is able to enter/leave the home independently in at least 1 community activity, needs assist with others

0.4 0.8

most limited community walker is defined by a gait speed of ____-____ m/s

least limited community walker

an individual that can independently manage stairs, independent in walking for at least 2 community activities

0.8 1.2

a least limited community walker is defined as a gait speed of ___-___ m/s

community walker

an individual that can walk for all home and community activities, can deal with crowds and uneven terrain, variable environments

1.2

a community walker is defined by a gait speed of > ____ m/s

0

Modified Ashworth scale for spasticity; no increase in muscle tone

1

Modified Ashworth scale for spasticity; slight increase in muscle tone manifested by a catch and release or by minimal resistance at the end of the ROM when the affected part is moved in flexion or extension

1+

Modified Ashworth scale for spasticity; slight increase in muscle tone manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

2

Modified Ashworth scale for spasticity; more marked increase in muscle tone through most of the ROM but affected parts move easily

3

Modified Ashworth scale for spasticity; considerable increase in muscle tone, passive movement difficult

4

Modified Ashworth scale for spasticity; affected part is rigid in flexion or extension

shortened lengthened

spasticity is tested moving from a _____ to a ____ position

flexion

_____ synergy is more common in UEs

___ synergy is more common in LEs

stage 1

Brunnstrom's stages of recovery: recovery from hemiplegia occurs in stereotyped sequence of events that begins with a period of flaccidity immediately following the acute episode. No movement of the limbs can be elicited

stage 2

Brunnstrom's stages of recovery: As recovery begins, the basic limb synergies or some of their components may appear as associated reactions or minimal voluntary movement responses may be present. At this time, spasticity begins to develop

stage 3

Brunnstrom's stages of recovery: Thereafter the patient gains voluntary control of the movement synergies, although full range of all synergy components does not necessarily develop. Spasticity has further increased and may become severe

stage 4

Brunnstrom's stages of recovery: Some movement combination that do not follow the paths of either synergy are mastered, first with difficulty, then with more ease, and spasticity begins to decline

stage 5

Brunnstrom's stages of recovery: If progress continues, more difficult movement combinations are learned as the basic limb synergies lose their dominance over motor acts

stage 6

Brunnstrom's stages of recovery: With the disappearance of spasticity, individual joint movements become possible and coordination approaches normal. From here on, as the last recovery step, normal motor function restored, but this last stage is not achieved by all, for the recovery process can plateau at any stage

selective capactiy

ability to move a single joint or muscle independently; examine voluntary, isolated movement **IF present, strength is indicated to assess muscle performance

ataxia

proprioceptive loss can result in _____

cerebellar ataxia

stroke affecting the cerebellum can cause _____ _____ and motor weakness

motor praxis

ability to plan and execute coordinated movement

apraxia

difficulty planning/executing purposeful movements; more evidence with L hemisphere damage

Ideational apraxia

inability to produce movement on command or automatically; no idea HOW to do the movement

Ideomotor apraxia

unable to produce movement on command but CAN move automatically; can perform habitual tasks, often perseverates

hemorrhagic

type of stroke that generally has a faster and more pronounced recovery