1
Q
Sahrmann and Scheets
A
impairment-based classification system used to diagnosis/classify pts with neurological conditions
2
Q
Interaction of the PT with the patient/client must be __________ & _______
A
purposeful & skilled
3
Q
What are the three elements of intervention?
A
- procedural interventions (manual, modalities, etc.)
- coordination, communication, and documentation
- patient/client related instruction
4
Q
What social determinants impact a patient’s health?
A
- social and economic environment
- physical environment
- health practices and coping skills
- biology
- health care services access
5
Q
How do PTs typically categorize medical diagnoses?
A
progressive or nonprogressive
6
Q
What are the levels of the Top-Down Model of Neurologic Rehabilitation?
A
- Roles
- Skills
- Resources
- Recovery
7
Q
The skills needed to reach meaningful goals should also take into account the patient’s ability to reach these goals with ___________, ___________, & __________
A
consistency, flexibility, & efficiency
8
Q
What is the fundamental unit of therapy?
A
the task
9
Q
What are the important components of the task?
A
- task selection
- structuring the context and environment
- task variation
- progressive difficulty
- switching to new tasks when appropriate
10
Q
Consistency
A
- rate of goal achievement (# of successes/# of attempts)
- accuracy (spatial errors, temporal errors)
11
Q
Efficiency
A
- time required
- speed
- duration
- distance
- dual-task performance
12
Q
Flexibility
A
- task performance under different conditions and in different environments (open vs. closed)
- predictable vs. unpredictable conditions
13
Q
What questions should be asked to evaluate a patient’s cognition/communication?
A
- Name
- Place (hospital name, city, state)
- Time (year, month, date, day)
- Event (Why are you here? What happened?)
14
Q
Aerobic Capacity/Endurance Measures
A
- pulse rate before and immediately after activity
- respiratory pattern/rate
- oxygen saturation before, during, and after activity
- HR, BP, RR, and ongoing oxygen saturation measures if specific to pt’s needs
15
Q
Task Analysis
A
systematic observation of kinematic changes that occur during changes in position or alignment
16
Q
What are the two components to look for when performing a task analysis?
A
essential & missing components
17
Q
What are the three fundamental factors of the task to observe?
A
- muscle activity to establish base of support
- alignment
- initiation, execution, and termination of weight shift
18
Q
Initiation
A
the patient’s ability to overcome inertia
19
Q
Execution
A
the patient’s ability to move the center of mass over the base of support
20
Q
Termination
A
the patient’s ability to stabilize after reaching the new position
21
Q
Task Analysis - Bed Mobility
A
- rolling
- supine to sit
- sit to supine
22
Q
Task Analysis - Sitting and Transfers
A
- quiet sitting
- sit to stand transfers
- surface to surface transfers
23
Q
Task Analysis - Advanced
A
- quiet sitting
- standing feet together and in more challenging positions
- step-up
- wheelchair skills
- gait and complex gait
24
Q
Task Analysis - Upper Extremity
A
- reach and grasp
- in-hand manipulation
25
What two general observations should be made of a patient's motor function?
spontaneous movement & fractionated (selective) movement
26
Motor Planning
the ability to conceive, plan, and carry out a skilled, non-habitual motor act in the correct sequence from beginning to end
*also known as praxis
27
What does the Sahrmann and Scheets model include?
1. descriptions of various types of individuals with neurological conditions
2. an outline of a physical examination to help lead PTs to the correct diagnosis
3. sample treatment ideas for each diagnostic category
28
What are the three pillars of evidence-based practice?
1. scientific literature
2. clinical expertise
3. patient values
29
The Sahrmann and Scheets classification system is based on which two criteria?
1. movement related impairments
| 2. potential of deficits to improve with natural recovery
30
What tests and measures are used in an examination of a patient with a neurological condition?
- mental status tests
- muscle tone tests
- movement analysis
- sensory tests
- activity tolerance measures
- mobility analysis (task analysis)
31
Mental Status tests/measures
- awake?
- alert?
- oriented x 4
- ability to follow instructions
32
Movement Analysis tests/measures
- spontaneous movement
- fractionated (selective) movement
- strength (MMT)
- fatigue (fatigue tests)
- motor planning (sequence tasks)
- non-equilibrium coordination
33
Sensation tests/measures
- protective sensation (light touch or pressure/ temp)
- joint position sense (proprioception)
- special senses (visual tracking and visual field tests)
34
What elements should be observed during a task analysis?
- muscle activity to establish base of support
- alignment
- initiation, execution, and termination of weight shift
35
What are the tasks that should be completed during a task analysis?
1. rolling
2. quiet sitting
3. sit to stand
4. quiet standing
5. step-up
6. gait
7. reach and grasp
36
What factors should be considered when determining the potential for recovery?
- premorbid status/comorbidities
- severity of health condition
- socioeconomic status
- living conditions
- information from the literature
37
For which impairment-based classification categories is recovery predicted?
- movement pattern coordination deficit
- mild or moderate force production deficit
- sensory selection and weighting deficit
- perceptual deficit
38
For which impairment-based classification categories is recovery not predicted?
- severe force production deficit
- fractionated (selective) movement deficit
- hypermetria
- hypokinesia
- sensory detection deficit (slight change with research)
39
According to Michael Majsak, therapists must always consider:
- cognitive and physical resources of the patient
- complexity of tasks to be learned
- amount of practice that is possible
40
In every plan of care, we __-______ recovery with our clients
co-manage
41
When performing a task analysis, it is important to also consider:
- the environment
- motor control of posture and movement DURING function
- temporal sequence of task (timing)
42
What are elements of procedural intervention?
- environment
- dose
- learning
43
The current theory of motor learning is based on the _______ ______ of motor control
Systems Theory
44
____ ________ is the single most important variable for motor learning
Task practice
45
What are the nine ingredients of motor learning?
1. Task practice is the single most important variable for motor learning
2. Task practice in the context of the top-down model
3. "What" is practiced is more important than mere repetition
4. Problem solving and implicit processes are required for skill acquisition
5. The fundamental differences between skill acquisition and functional training can not be forgotten
6. Critical to skill learning are motivation and meaning
7. The degree to which task practice can compensate for or restore function is directly impacted by impaired motor control
8. Working towards collaborative goals with confidence and an understanding for the perceived effort associated with the task enable you to individualize practice protocols
9. Focus on neuroplasticity, learning and recovery
46
Learned Nonuse
maladaptive plasticity; when attempting to use a more affective limb, frustration results; person begins using the stronger limb, missing the opportunity to use movement that is available
47
Long Term Potentiation
long-lasting enhancement in communication between two neurons that results from stimulating them simulatenously
48
Habituation
a decrease in response to a stimulus after repeated presentations
49
EXCITE Phase III
Extremity Constraint Induced Therapy Evaluation; the affected limb is constrained with use of a sling or a mitt and is forced to use the affected limb intensely to complete functional tasks
Results: patients exhibited improved precision grip, coordination, and coupling of grasping forces
50
LEAPS Phase III
Locomotor Experience Applied Post-Stroke
Results: locomotor training and exercise administered in the home were equivalent
51
AVERT
A Very Early Rehabilitation Trial for Stroke
Results: higher dose, early mobilization associated with less favorable outcome at 3 mos
52
Locomotor Training
patient is placed in harness over a treadmill; weight (≤ 40% of body) is removed to allow for movement with less effort exerted; high intensity walking practice and repetition on the treadmill
53
What principles should a PT incorporate in a pt's POC to promote motor learning?
- set measurable skill goals
- provide patient performance feedback
- select meaningful tasks to practice
- select appropriate level of difficulty
- engage problem-solving processes
- ensure client engagement
54
Why is it important to use outcome measures?
1. establish yourself as a professional
2. show interest in objective outcome
3. demonstrate accountability (patient, profession, payers)
4. state an expectation of improvement
55
Task Oriented Training should be:
challenging, progressively adapted, salient, and should involve active participation
56
Initially performance may _______ due to altered CNS condition
decline
57
The Investment Principle
ultimately there is often potential for performance well beyond that afforded by the compensatory strategy; i.e. greater return on investment
58
Explicit (Declarative) Learning
facts, events, verbalized, "recalled"
59
Implicit (Procedural) Learning
skilled movement, forms over time (practice), not accessible to conscious recall
60
Basal Ganglia Stroke
explicit instruction benefits implicit learning
61
Cerebellar Stroke
explicit instruction benefits implicit learning
62
Middle Cerebral Artery Stroke
explicit instruction interferes with implicit learning
63
What is the process of clinical decision-making?
examination, evaluation, diagnosis, prognosis, intervention, outcome measures
64
In order to create the therapeutic environment for the individual, it is important to:
understand motivation and its components, including: autonomy, competence, and social relatedness
65
Intervention in neuro rehab should be:
1. evidence-based
2. appropriate for diagnostic classification
3. applied with "art" of PT
66
Task Oriented Motor Learning is based on which theory of motor learning?
dynamic systems theory
67
What are two reasons for recovery of function after injury?
spontaneous, natural recovery and induced changes (activity/rehab)
68
What are the barriers to measurement?
- time
- patient perception
- equipment/space
- knowledge of application of the test
69
Sensory Electrical Stimulation
below motor threshold; restoration of sensory loss d/t CNS condition
70
What is the recommended duration for task-oriented training as suggested by the GRASP protocol?
one hour per day, six days per week
71
Pathophysiology of Thrombus/Embolus
1. Interruption of blood flow
2. Focal infarction and ischemia
3. Triggers release of chemicals (causing
damaging and irreversible effects). Target of TPA.
4. Further neuronal death-within hours
5. Extension of infarct
6. Widespread tissue necrosis and rupture of cell membranes
7. Cerebral edema (within hours of insult-max: 4 days; grad. subsides at 3 weeks
8. elevates intracranial pressure
9. shifts brain structures
72
What are the diagnostic test options for pts. experiencing a stroke?
- CT
- MRI (most Sn, but costly)
- Angiography (highest risk for complication)
73
What are the advanced in MRI related to CVA?
- diffusion weighted imaging is quickly sensitive to changes in the lesion as swelling occurs
- appears w/in 5-10 mins of onset of stroke sx (4-6 hrs w/ CT scan)
- coupled w/ cerebral perfusion may help identify regions to salvage by perfusion w/ blood by raising HR and BP
74
Immediate Medical Intervention for Ischemic Stroke
tPA w/in 4-4.5 hrs after onset of stroke sx
75
Immediate Medical Intervention for Hemorrhagic Stroke
- surgery to alleviate intracranial bleeding
| - reduce compression of brain tissue...reduce elevated intracranial pressure
76
Stents
- mechanical "recanalization" or opening of blocked aa.
| - using catheters to remove large clots
77
Later Medical Intervention for Ischemic Stroke
-Thrombosis/TIA/Embolus: anticoagulant drugs (Heparin, Coumadin, Plavix, Eloquis), reduction of cerebral edema (aspirin), surgical treatment (endarterectomy)
78
Neuroplasticity: Principle 1
"Use It or Lose It"; neural circuits can degrade w/o activity and brain area can shift responsibility
79
Neuroplasticity: Principle 2
"Use It and Improve It"; practice of specific tasks can increase the number of areas of the brain that respond during the task
80
Factors that positively influence motor recovery and plasticity
- skilled training (task challenge)
- specificity of task changes the brain
- repetition
- intensity
81
Diagnostic Tools for Brain Mapping
- PET Scan
- Functional MRI
- Transcranial Magnetic Stimulation (TMS)
82
What are the stages of Recovery from Stroke?
Stage 1: Flaccid - little to no mvmt
Stage 2: minimal voluntary mvmt (spasticity may develop)
Stage 3: strong synergies with some mvmt w/in synergies
Stage 4: mvmt out of synergies; spasticity declines
Stage 5: more refined selective mvmt develops
Stage 6: individual joint mvmt and coordination approach normal
83
What is the 'gold standard' for measuring impairment after stroke?
Fugl Meyer Assessment of Physical Performance
84
What is the pathophysiology of stroke?
1. interruption of blood flow
2. focal infarction and ischemia
3. triggers release of chemicals causing damage and irreversible effects
4. further neuronal death w/in hours
5. extension of infarct
6. widespread tissue necrosis and rupture of cell membranes
7. cerebral edema
8. elevates intracranial pressure
9. shifts brain structures
Neurological Systems I
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