CVA Interventions

Question 1

what should you do when strength program is initiated

Answer 1

monitor BP, HR, RPE, RR and breathing patterns closely

Question 2

indications for immediate cessation of exercise program

Answer 2

• lightheadedness
• dizziness
• chest heaviness, pain or tightness; angina
• heart palpitations or irregular heart beat
• sudden SOB not due to increase activity
• volitional fatigue and exhaustion

Question 3

what exercises are beneficial for LE strengthening

Answer 3

closed chain

Question 4

neuromuscular facilitation -

Answer 4

• manual resistance
• tapping
• joint approximation
• joint traction
• quick stretch
• aid in promoting required lead-up activities required for tasks
• good for pt’s with more significant weakness

Question 5

PNF aids in what -

Answer 5

• aid in promoting required lead-up activities required for tasks
• good for pt’s with more significant weakness

Question 6

motor learning techniques relies heavily on what

Answer 6

• actual practice, mental practice and feedback
• best relearned when practice within context of the actual desired activity
• pt should demonstrate some recovery of isloated movement

Question 7

gross grasp

Answer 7

something that is in contact with your palm

Question 8

prehension patterns

Answer 8

• palmar grip

- lateral grip

Question 9

what exercises are beneficial for UE strengthening

Answer 9

• majority of ADLs are open but both are beneficial

Question 10

constraint induced movement therapy (CIMT)

Answer 10

response to learned nonuse by instead promoting forced use of involved extremity

Question 11

limitations of CIMT

Answer 11

• patient compliance
• staffing at therapy clinics
• reimbursement

Question 12

when should exercise begin after stroke

Answer 12

within 24 hrs of first onset of symptoms

Question 13

acute endurance recommendations: goal

Answer 13

prevent deconditioning, orthostatic intolerance, depression

Question 14

acute endurance recommendations

Answer 14

• < 11-12 RPE (3-4 mRPE)
• resting HR + 10-20 bpm
• interval approach
• mode: walking, ADLs, standing activities

Question 15

IP rehab & outpatient endurance recommendations: goal

Answer 15

• increased walking speed & efficiency
• improve exercise tolerance
• increase independence ADLs
• reduce motor impairment
• improve cognition
• improve vascular health

Question 16

IP rehab & outpatient endurance recommendations

Answer 16

• 11-14 RPE (3-5/6 mRPE)
• 40-70% VO2 reserve or HR reserve; 55-80% HRmax
• 20-60 min/session, 3-5x week + adequate warm up/cool down
• mode: large muscle activities

Question 17

management of painful and/or subluxed shoulder

Answer 17

• strengthening high rep of RTC, deltoid and scapula
• KT tape
• NMES
• slings
• positioning

Question 18

what are shoulder slings used for

Answer 18

work to withstand gravity

Question 19

neoprene sleeve

Answer 19

• comfortable
• gentle compression
• stretchy
• not always best option

Question 20

alimed sling

Answer 20

• hard shell

- adjusts how much pull on shoulder

Question 21

givmohr sling

Answer 21

• cradles elbow and hand
• better accounts for whole arm
• takes hand fxn away

Question 22

shoulder saddle sling

Answer 22

• risk for contracture

- no use of hand

Question 23

hypotonic, and what are the functional implications

Answer 23

• floppy movements
• injury risk
• power movements are impaired
• resist gravity
• increased stress on joint
• balance impaired
• fatigue
• lack of postural control
• clumsy, incoordinated movements

Question 24

what are the functional implications of stroke

Answer 24

• contractures
• skin breakdown
• pain
• abnormal posture
• abnormal movement patterns
• impaired balance

Question 25

what is the main management of spasticity

Answer 25

medication: baclofen

Question 26

side effects of baclofen

Answer 26

decreased muscle strength and lethargy

Question 27

when is med appropriate for spasticity pt's?

Answer 27

- spasticity is interfering with fxn - clonus present --> skin breakdown - pain

Question 28

what are you monitoring with tone present

Answer 28

- clonus - impact on functional tasks - evidence of contractures

Question 29

what are you managing with tone present

Answer 29

- stretching program --> joint mobs - positioning of limbs to avoid shortening positions of spastic muscles - e-stim can be used for short term effects