CVA

Question 1

What are common OT frames of reference that are used when working with clients following a CVA? What is the difference between each frame of reference? How do you decide which one(s) to use?

Answer 1

• Rehabilitative- really focused here- for case study, focus on rehab. resotoration of skills
• Compensatory- practice of tasks, emphasizes intact skill training, uses ways to compensate
• Adaptive- find adaptive equipment
• Modifying- alter task

Question 2

What are 4 areas that are addressed for the physical evaluation of a client with a CVA? What is important to assess in each of these 4 areas?

Answer 2

•First thing to look at of a stroke pt is: remedial ideally then compensatory if needed

1. Pelvis- are they sitting balanced/ squarely? sitting- common posterior tilt, second look at lateral tile posture
2. Trunk- flex/ext/rotation/ lateral flexion
3. Lower Extremity
4. Upper Extremity

Question 3

For the client with a CVA, identify functional limitations while seated, and identify interventions for seated postures.

Answer 3

Loss of Trunk and Postural Control

• Dysfunction of limb control
• Increased risk for falls
• Decreased interaction with environment
• Visual Dysfunction
• Dysphagia
• Decreased independence in ADL
• Inability to perceive midline due to spatial relations dysfunction
• Assumption of static postures that do not support engagement in functional activities
• Multidirectional trunk weakness
• Loss of Trunk and Postural Control- if you don’t do something about it à likely to get
  
  • Spinal contracture
  • Inability to move trunk segmentally
  • Inability to weight shift through pelvis

Interventions for Seated Postures

• Establishing a neutral yet active starting alignment
• Attempt reaching activities from a neutral yet active starting alignment- challenging balance, strengthen, weigh shifting. Want them to go to midline and come from midline.
• Establishing the ability to maintain the trunk in midline using external cues
• Maintaining trunk range of motion by wheelchair and armchair positioning that maintains the trunk in proper alignment
• -Trunk Ranges:

1) Flexion; 2) Extension; 3) Lateral Flexion; 4) Rotation
* Prescribing dynamic weight-shifting activities to allow practice of weight shifts through the pelvisStrengthening the trunk, best achieved by using tasks that require the client to control the trunk against gravity
* Using compensatory strategies and environmental adaptations when trunk control does not improve to a sufficient level and the client is at risk for injury

Question 4

For the client with a CVA, identify functional limitations while standing, and identify interventions for standing postures.

Answer 4

Functional Limitation While Standing

Inability to bear weight through the affected leg

• Fear of falling
• Buckling of the knee
• Patterns of weakness that do not support body weight
• Spasticity that impedes proper alignment
• Perceptual dysfunction
• Gait deviations or dysfunctions
• Inability to transfer
• Inability to perform ADL and IADL in an upright posture
• Inability to climb stairs.
• Increased risk of falls

Interventions for Standing Postures

• Establishing a symmetrical base of support and proper alignment to prepare to engage in occupations (a NDT approach, handling to facilitate)
  
  • Feet approximately hip width apart
  • Equal weight bearing through the feet
  • A neutral pelvis
  • Both knees slightly flexed- avoid involved hyperextension-don’t let them lock their knee!!
  • Aligned and symmetrical trunk
• Establishing the ability to bear weight and shift weight through the more affected lower extremity.
• Encouraging dynamic reaching activities in multiple environments to develop task-specific weight-shifting abilities.
• Using the environment to grade task difficulty and provide external support
• Training upright control within the context of functional tasks that are graded

Question 5

For a client with a CVA, what are intervention techniques to facilitate recovery in the UE with hemiparesis?

Answer 5

Upper Extremity Intervention
in Function

• After postural control- should be able to get proximal to distal immediately so get into–>
• Weight bearing immediately!!seated and standing- always have weight bearing opportunity
• Moving objects across a work surface with a static grasp (Supported Reach) maybe in gravity eliminated. Ie just “wiping table”.
• You may want to do this lying down first!!
• Scap mobs- scapula should not be tight, get range, then get movement.
• SETUP as many places to use involved arm…chair tipping.
• Arm first used as assist, but then need to really engage that arm.
• As they gain movement then go to fine motor, grasp and release
• Reach and Manipulation
• 4. Reach and Manipulation: Objects of different sizes and shapes
• Available Motor Control: Appropriate activitie
• 1. Weight-bearing in function
• 2. Level of Anti-gravity Control
• 3. Resistance of task

Question 6

What are common areas for language dysfunction following a CVA, and what are methods to facilitate communication?

Answer 6

• Aphasia
• Dysarthria

Facilitating Communication:

• One person talking at a time
• Increased time for client response
• Carefully phrased questions
• Visual cues or gestures with speech
• Never force a response
• Concise sentences

Question 7

Following a CVA, what are common psychosocial issues, and what are interventions for psychosocial issues?

Answer 7

• Depression
• Anxiety
• Agoraphobia
• Substance Abuse
• Sleep Disorders
• Mania
• Aprosidy
• Behavioral Problems
• Lability
• Personality Changes

Psychosocial Intervention

• Internal Locus of Control
• Improve self-efficacy through use of therapeutic activities
• Adaptive coping strategies
• Success in chosen occupations
• Social support networks or support groups
• Occupations to promote social participation