Practical

Question 1

name some impairments

Answer 1

Rancho level ___

R/L Brunstrom stage __

L/R hemiparesis

L/R UE/LE ROM decreased (specify type)

Apraxia (ideational,ideomotor)

Decreased sensation (light touch, proprioception)

L/R muscle endurance

Contractures (describe)

Spasticity, Rigidity, Flaccidity, Clonus

Decreased Vertical orientation

Decreased figure ground discrimination

aphasia (global, receptive, wernekies)

decreased midline orientation

L neglect (with right side lesion)

L/R Homonymous hemianopia

inattention (R/L) left sided inattention after R stroke

figure ground discrimination

topographical agnosia

impulsitivity

Question 2

name impairments associated with a Left sided stroke

Answer 2

Brunnstrom stage/spasticity/flaccidity
Right sided hemiparesis/weakness
Decreased ROM
Right sided sensory loss
Receptive aphasia
Expressive aphasia
Global aphasia
Apraxia
anxiety/fear
Right homonymmous hemianopsia
Decreased cardiovascular endurance
Decreased proprioception
decreased light touch sensation
Decreased figure ground orientation

Question 3

name impairments associated with a right sided stroke

Answer 3

Lneglect/inattention/decreased midline orientation
Brunnstrom stage
Left homonymous hemianopsia
Left sided weakness
Decreased ROM
Impulsive
Anosognosia
topographical agnosia
Decreased cardiovascular endurance
Spasticity
Decreased proprioception

Question 4

name impairments associated with a TBI

Answer 4

Rancho Level
Apraxia
Generalized weakness
Spasticity
Decreased proprioception
Decreased midline orientation

Question 5

name activity limitations

Answer 5

decreased standing/sitting balance

decreased step length, velocity on L/R

difficulty climbing stairs

difficulty dressing, grooming

difficulty sitting in chair

decreased ability to stand upright

decreased ability to walk independently (midline, WS)

inability to STS d/t poor WS

decreased ability to walk d/t decreased length of stance phase

decreased ability to walk d/t decreased foot clearance

inability to graps objects with R/L UE for ADLS

inability to prepare meals independently

difficulty walking d/t decreased arm swing in R/L

Question 6

how to work with a neglect

Answer 6

• bring attention to otherside
  Auditory strategies
  Tactile → deep pressure down long bones or firm pressure on arm

Bring unaffected side to affected side to find it

Putting affected hands on things

Question 7

Homonymous hemianopsia - visual field cut

Answer 7

Stand on R visual field to begin with

Question 8

UE WB progression
Brunstrom 1,2

Answer 8

WS possible lift offs

if this pt has good control of LE, keep it symmetrical so PT can control WB of UE

quadruped with ball

Question 9

Brunstrom 3

UE WB progression

Answer 9

Pt has peak spasticity so increase WB helps tone

do lift offs in symmetrical or asymmetrical

*need at least 3 for movement sequence

quadruped

Question 10

TBI

MMT required for UE movement progression

Answer 10

MMT at anterior deltoid: 2 / 2+ flat board

3-/3 : tone control do body on arm to get weight thru arm then move into movement sequences

stronger arms: skip clipboard –> directly into holding on objects and overhead

Question 11

Ladder sequence *

Answer 11

2 reps each

ISOMETRIC
*use arm mms and bring ladder towards you and squeeze shoulder blades and lower slowly
1. hand on rung
2. shift towards
3. step up with strong foot
4. step down
BACK TO MIDLINE
5. shift towards me
6. step up with strong
7. step down
BACK TO MIDLINE

ECCENTRIC
8. shift toward me
9. step up strong
10. push up and bring weak foot up
11. bend both knees
12. shift toward me
13. step down with strong
14. bring weak foot down
15. stand tall
16. shift toward me
17. step up
18, push up
19. bend both knees
20. shift toward me
21. step down

CONCENTRIC:
start with weak leg on rung

22. push off weak leg
23. step up with strong
24. bend both knees
25. shift toward me
26. step down with strong
    keep weak leg on rung
27. step up with strong
28. bend both knees
29. shift toward me
30. bring strong down
31. bring weak down

Question 12

step up/ step down

Answer 12

ISOMETRIC
1. shift towards me
2.step up strong
3. step down
MIDLINE
4. shift toward me
5. step up strong
6. step up weak (clear toes)
7. bend knees
8. shift toward me
9. step down and back strong
keep weak leg up -CONCENTRIC

10. push up and step with strong
11. bend both knees
12. shift toward
13. step down strong

FORWARD
patient is on stool
14. bend both knees
15. shift toward me
16. middle
17. bend both knees
18 shift toward me
19. down and forward with strong then weak

BRING STOOL IN FRONT

Question 13

stepping backwards

Answer 13

1. shift weight toward me
2. step back with strong
3. bend weak knee
4. step back with weak leg
   PT foot ontop of pt foot
   5.stand tall on weak leg and shift weight onto that leg
5. bring strong leg back
6. stand tall on strong leg
7. bend weak leg

Question 14

What should you keep in mind when performing your motor learning skill?

Answer 14

• SAEFTY/ALIGNMENT
• simply ask the patient to do a task that is salient to them
• don’t boss patient around
• simple commands
• KR/KP
• type of feedback

Question 15

what are some options for trunk interventions

Answer 15

Lower trunk rotation - rhythmic initiation
Lower trunk rotation - slow reversals
Scooting
Rolling to weak side
Rolling to strong side
Supine to sitting to supine to weak side
Supine to sitting to supine to strong side
Supine to sitting for larger patient
Supine to sitting for LE extension synergy
Facilitation of APT from front and side
Facilitation of anterior weight shift from front and side
Facilitation of lateral weight shift from front and side
Anterior lumbar mobilization
Lateral lumbar mobilization
Scooting forwards (PT in front and side)
Scooting forwards with lift off (PT in front and side)
Scooting backwards with lift off (PT in front and side)
Scoot transfer
Modified stand pivot transfer
Trunk reversal of isometrics/alternating isometrics
Trunk rhythmic stabilization
lumbar/thoracic extension with swiss ball
Lateral weight shift with Pusher’s w/ swiss ball
STS (from front and side)
STS w/ table
Pre-gait sequence - stance phase
Pregait-sequence - swing phase
Turning/pivoting
Stepping backwards
Step up/down (isometric, eccentric, concentric, eccentric)
Ladder sequence (isometric, eccentric, concentric,)
UE bilateral symmetrical WB progression
UE bilateral asymmetrical WB progression
UE movement progression

Question 16

what are interventions for the LE?

Answer 16

Half bridging
Bridging
Timing for Emphasis
Primitive repeated contractions
Ramistes phenomenon
Rolling to strong side
Scooting forward with lift off (PT in front and side)
Scooting backwards with lift off (PT in front and side)
Scoot transfer
Quadruped → kneeling (AP weight shifts)
Alternating isometrics (hips, scapulas, both)
Rhythmic stabilization (hips, scapulas, both)
Rhythmic initiation (hips, scapulas, both)
Slow reversals (hips, scapulas, both)
Side sitting → kneeling
Kneeling → half kneeling
Slow reversals (hips, scapulas, both)
Half kneeling → standing
Standing slow reversal holds
Braiding
Half kneeling → chair
STS (from front and side)
STS w/ table
Pre-gait sequence - stance phase
Pregait-sequence - swing phase
Turning/pivoting
Stepping backwards
Step up/down (isometric, eccentric, concentric, eccentric)
Ladder sequence (isometric, eccentric, concentric,)
UE bilateral symmetrical WB progression
UE bilateral asymmetrical WB progression
UE movement progression

Question 17

what are stance balance interventions

Answer 17

Semitandem, eyes open, arm alternation
Semitandem, eyes closed, arm alternation
Draw letters w/ right foot
Draw letters w/ left foot
Perturbed forward standing while holding a ball
Perturbed backward standing while holding a ball
Midline orientation

Question 18

what are gait balance interventions

Answer 18

Walk forward/backward, normal BOS
Walk forward/backward, narrow BOS
Walk narrow BOS, step forward avoiding the obstacles (while holding a basket)
Walking while scanning environment
Walk and kick a ball to hit the cans
Walk and reach w/trunk twisting

Question 19

how do you challenge proprioception?

Answer 19

put em on a foam pad

Question 20

how do you challenge the vestibular system?

Answer 20

put em on a foam pad w/ EC

Question 21

rational for scoot transfer

Answer 21

increased time in controlled WB

multiple repetitions

Question 22

rationale for STS

Question 23

rationale for ladder sequence