What is shaping in the context of contraint-induced therapy?
Behavior techniques that approach a desired motor outcome in small successive increments
They are successful in those activities and slowly increase in difficulty
What are four components of task-oriented OT rehab in strokes?
- Encourage weight-bearing over the involved side
- Encourage trunk rotation
- Encourage trunk elongation
- Encourage scapular protraction
What are the three components of DIM model?
- Person
- Context
- occupation
What is the most effective factor factor in all forms of CIT?
Instensive practice
Functional use of an affected limb
Across different contexts
Many hours a day for many days
What UE pathologies can limit the success of CIT?
Shoulder subluxation
Soft-tissue shortening
Joint contractures/deformities
How many hours of continuous practice a day is good for CIT?
six hours
What amount of UE function would you need to see before CIT?
Shoulder: 45 degrees flexion and abduction
ARM: 90 degree flexion extension
Wrist: 20 degree extension
MCPs: 10 degree ext of
T/F You can still use CIT with someone who has cognitive impairments
False
Cognitive impairments may prevent adequate participation in the strict protocol
What is the difference between an ischemic and hemorrhagic stroke?
Ischemic: Insufficient blow flow to brain. May be a result of an embolism to brain
Homorrhagic: Weakened blood vessel ruptures and blood leaks in to the brain
What are 7 modifiable stroke risk factors?
- Hypertension
- Cardiac disease
- Diabetes
- Smoking cigarettes
- Alcohol consumption
- Illegal drugs(cocaine, LSD., PCP, weed
- Obesity, inactivity, diet, emotional stress
What is the most common brain artery rupture?
Middle Cerebral artery
What are the deficits associated wtih middle cerebral artery hemorragic strokes?
Contralateral hemiplegia.
Visual field impairmen
Ideational apraxia
Perseveration
Depression
R: anosognosia, visuospatial imapairment, L. unilateral motor apraxia
L: Bilateral motor apraxia Broca’s aphasia
Be able to name 10-15 items scored on teh NIH stroke scale
1a: Level of conciousness: lower score=more alert
1b: Level of consciousness: questions: month and age
1c: Level of conciousness Commands: open and close eyes adn then grip and release hand
2: Best gaze: horizontal eye movement
3: Visual: Visual field tested by confrontation
4: Facial palsy: show teeth or raise eyebrow
5: Motor arm (look for drifting)
6. Motor leg: look for drifting
7. Limb ataxia: move finger to nose and heel to shin
8. Sensory: pinprick
9: Best language:describe what is happening in attached image, identify items and read sentenses
10: Dysarthria
11: Extinction and innattention
Name four non-motoric reasons person with stroke have difficulty in performing hemi-adl task
- Premotor perseveration
- Spatial reasoning difficulties
- Ideational apraxia
- Attention deficit
WHat are five interventions (with a task-oriented approach)?
Practice functional tasks
Provide opportunities to practice outside of therapy
Minimize ineffective movement patterns
Help clients adjust to role and task performance limitations by exploring new roles and tasks
Create an environment that includes challenges of everyday life
What are three effects a stroke can have on a person’s trunk?
- Inability to percieve midline
- Multi-directional trunk weakness
- Inability to shift weight through pelvis in all three directions
List three ADL tasks that promote improved trunk control
Oral care: Anterior weight shift to spit
Meal prep: Trunk flexes into gravity controlled fashion to reach into fridge
Transfer: Trunk extends with hip flexion to stand up
List 7 components that you can manage in helping a person with a stroke better perform ADL in sitting
- Establish a neutral yet active starting alignment (think of ergnomic position for a computer)
- The client should attempt reaching activites from the above posture
- Establish the ability to maintain the trunk in midline using external cues
- Maintain trunk ROM
- Prescribe dynamic weight-shifting activities
- Strengthen the trunk (control 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 of injury
List 5 strategies for improving task performance in standing
- Establish symmetrical base of support and proper alignment
- Establish the ability to bear weight and shift weight through more affected lower extremities
- Encourage dynamic reaching activities in multiple environments to develop task-specific weight-shifting abilities
- Use the environment to grade task difficulty and provide external support
- Training upright control within the context of functional tasks that are graded
What are the benefits of sidelying on teh affected side after a stroke?
- Sensory input
- Increasing awareness of this side
- Less fearful of putting weight on weak side
- Helps prevent painful shoulder
- Reduces increased tone in flexion synergies
How is the shoulder at risk in sidelying and how can you fix it?
- Increased risk of subluxation
2. Teach pt. to protract scapula and support position with a pillow
T/F It is good to discourage clasped hands overhead ranging of UEs after stroke. Why or why not?
True. Risk of increasing pain, impingement or stressing carpal ligaments
List 5 contraindications for the use of a bioness FES device
- Pacemaker
- Malignant tumor/skin cancer
- Fracture/disslocation
- Don’t use simultaneously with high frequency surgical equipment
List 5 contraindications for the use of a REO Go therapy device1
- Clients without supervision
- Who can’t be active for 60 m without cardiac or respiratory problems
- Fixed contractures in affected limb
- Signif. sensation impairment
- Sever cognitive/linguistic/percpetual impairments
-
Sleep24
-
Bed mobility and Transfers6
-
Orthopedics17
-
Amputations and Orthotics28
-
Spinal Cord Injury40
-
Home safety and modifcations24
-
Dysphagia13
-
TBI42
-
Burns33
-
Sexuality and Disability14
-
Geriatric Conditions and OT21
-
Work Hardening and Vocational Training11
-
Cancer OT and End of Life Care22
-
Managing UE injuries44
-
Adapted Driving/Driving Rehab13
-
Degenerative Neurological Disorders21
-
Stroke37
