Adult Neuro Rehab Chapter 10

Front 1

Upper extremity function-

Back 1

using the UE to support engagement in meaningful occupations

Front 2

ICF categories:

Back 2

Impairment of body systems and body structure
Activity limitations
Participation restrictions

Front 3

Jackson's classification of CCNS lesion:

Back 3

positive or negative symptoms

Front 4

Positive symptoms-

Back 4

spontaneous, exaggerated disturbances of normal function and react to specific stimuli.
Spasticity, increased DTR, hyperactive flexion reflexes.

Front 5

Negative symptoms-

Back 5

deficits of normal behavior or performance.
Loss of dexterity, strength, and restricted ability to move.

Front 6

Assessment of Motor and Process Skills

Back 6

W/in context of ADLs.
Skills include posture, mobility, coordination, strength, reach, manipulation, grip, lifting, effort, and energy expenditure.

Front 7

Arm Motor Ability Test

Back 7

Determine effectiveness of contstraint-induced movement therapy.

Front 8

Wolf Motor Function Test

Back 8

Used to document outcomes related to constraint-induced movement therapy including tasks such as reaching and manipulative tasks.

Front 9

Jebsen Test of Hand function

Back 9

Performance of 7 activities: writing a short sentence, turning over index cards, picking up small objectss and placing them in a container, stacking checkers, simulating eating, moving empty large cans, moving weighted large cans.

Front 10

Motor Activity Log

Back 10

Self-report questionnaire related to actual use of the involved UE outside of therapy.

Front 11

Fugl-Meyer Assessment

Back 11

Impairment-based.
ROM, sensation, balance, UE/LE

Front 12

Action Research Arm Test

Back 12

19 items, 4 categories: pinch, grasp, grip, and gross movement

Front 13

Motor Assessment Scale

Back 13

Includes sections of UE function , hand movements,, and advanced hand activities.

Front 14

Functional Test for the Hemiplegic/Paretic UE

Back 14

ADL activities.
folding a sheet, stabilizing a jar, hooking and zipping a zipper, etc.

Front 15

Frenchay Arm Test

Back 15

Includes 5 items such as hair combing and drinking water.

Front 16

Reaching and manipulation processes:

Back 16

ID the object and its position in space- visual and perceptual processes.
Select plan of action for moving object- what parts are needed and what direction should they move.
Execution of response- multiple commands sent to motor neurons specifying temporal sequence of m activiation, forces to be developed, changes in joint angles, orientation of the hand, coordiantion of the shoulder w/ the distal arm.

Front 17

2 components of UE function:

Back 17

transportation component- trajectory; of the arm between starting and the object.
Manipulation component- formation of grip by combined movements of thumb and index finger.

Front 18

Formation of the finger grip during the action of grasping an object involves 2 main functional requirements:

Back 18

Grip must be adapted to the size, shape, and use of the object.
The relative timing of the finger movements must be coordinated w/ that of the other componenent of prehension by which the hand is transported to the spatial location of the object.

Front 19

Finger posturing anticipates teh real grasp and occurs during __ of the hand

Back 19

transportation

Front 20

In-hand manipulation-

Back 20

Process of adjusting objects being grasped in the hand

Front 21

Translation- (in manipulation tasks)

Back 21

The object in the hand moves from the finger surface to the palm or vice versa.

Front 22

Shift- (in manipulation tasks)

Back 22

Movement occurs at the finger and thumb pads by alternating thumb and radial finger movements.

Front 23

Simple rotation (in manipulation tasks)-

Back 23

Object is turned or rolled between the finger pads and thumb pad by alternating thumb and finger movements.

Front 24

Complex rotation (manipulation tasks)_

Back 24

Object is rotated, which requires isolated, independent movements of the finger or thumb. Object turned between 180 and 360 degrees.

Front 25

Goals accomplished by UE WB

Back 25

inhibiting hypertonus by moving body proximally against distal UE.
Stimulating UE extension during protective responses.

Front 26

Points of contact between the WB surface and the hand to assure maintenance of palmar arches:

Back 26

thenar and hypothenar eminences, metacarpal heads, palmar surfaces of phalanges.

Front 27

The ___ demands of a task have a substatial effect on the level of UE function.

Back 27

Cognitive

Front 28

Levels of usage:

Back 28

Nonassistive
Minimal stabilizing assist
Minimal active assist
Maximal active assist
Incorporation into bilateral activities

Front 29

Nonassistive-

Back 29

Unable to use limb in any functional activities b/c of pain. ROM limits, apraxia, and neglect.
Compensatory techiniques and assistive devices are necessary.

Front 30

Minimal stabilizing assist-

Back 30

Patient uses limb passively to hold objects, such as stabilizing paper when writing.

Front 31

Minimal active assist-

Back 31

Patient uses the shoulder and elbow actively to place limb on lap or through sleeve of shirt or stabilize trunk when upright.
No active hand use.

Front 32

Maximal active assist-

Back 32

Patient uses arm actively w/ the shoulder, elbow and gross grasp and release. Fine motor function not present.

Front 33

Incorporation into bilateral activities

Back 33

Patient uses impaired hand and arm in all bilateral activities associated w/ ADLs and mobility.

Front 34

What should constraint-induced movement therapy (CIMT) be used for?

Back 34

To counteract learned nonuse.

Front 35

Motor inclusion criteria for CIMT

Back 35

Control of wrist and digits
20 degrees of wrist extension, and 10 degrees of finger extensio

Front 36

Main therapeutic factor of CIMT

Back 36

massed practice and shaping of affected limb during repetitive functional activities appears to be the change agent

Front 37

Typical flexor pattern post-CVA:

Back 37

Scapula retraction, IR, elbow/wrist/digit flexion)

Front 38

How must degrees of freedom be controlled?

Back 38

Stabilizing or eliminating use of some of the joints and therefore decreasing number of joints involved.

Front 39

How can degrees of freedom be manipulated?

Back 39

May manipulate degrees of freedom via positioning, splinting, movement retraining, and equipment

Front 40

Why do patients post CVA flex the elbow when trying to raise the arm?

Back 40

Movement strategy to shorten the lever arm making shoulder flexion easier.

Front 41

How are goals achieved in therapy?

Back 41

Altering task requirements
Altering environmental context
Guiding remediation of component deficits

Front 42

Using imagery and mental practice does the following:

Back 42

Activates cortical representation and musculature the correlates w/ the imagined movements
Improve learning and performance
Reorganize the motor cortex

Front 43

EMG biofeedback technique-

Back 43

Biofeedback provided by electronic instruments that measure and give info about neuromuscular or autonomic activity in the form of auditory or visual feedback signals.

Front 44

Uses of biofeedback-

Back 44

Training voluntary inhibition of spastic mm and restoring mm balance

Front 45

Uses of ESTIM

Back 45

Controlling variety of symptoms including subluxation, pain, and delayed motor responses.
Increasing passive humeral ER.

Front 46

Impairments to consider during eval and intervention (UE)

Back 46

Impaired postural control
Spasticity
Loss of soft tissue elasticity

Front 47

Postural adjustments are specific to...

Back 47

task

Front 48

When postural stability was increased,

Back 48

postural activity was reduced and voluntary movement enhanced.

Front 49

As support is increased, postural demand is ___.

Back 49

Decreased

Front 50

Control patient's level of postural stability by manipulating what env factors?

Back 50

positioning- supine to sitting to standing
Type of support surface- stationary or unstable
Positioning of objects- near or far, base of support, external stability

Front 51

2 types of postural adjustments

Back 51

Adjustments preceding voluntary movements and automatic postural adjustments following external perturbation.
Training in one type doesn't transfer to the other.

Front 52

Voluntary movements are accompanied by postural adjustments which show 3 main characteristics:

Back 52

1. They're anticipatory w/ respect to movement and minimize the perturbations of posture and equilibrium due to the movement
2. Are adaptable to conditions in which the movement is executed
3. Influence d by the instructions given to the subject concerning the task to be performed

Front 53

Spasticity-

Back 53

a motor disorder w/ persisten increase in involuntary reflex activity of a muscle in response to stretch

Front 54

4 phenomena observed variably in the constellation of spasticity:

Back 54

hyper tonia, hyperactive DTR, clonus, and spread of reflex responses beyond the muscle stimulated.

Front 55

Clinical presentation of spasticity:

Back 55

Patients having difficulty initiating rapid alternating movements.
Abn ormally timed EMG activation of antagonistic mm.
Fluctuation of spasticity as a result of change in position.
Usual patterns include UE flexion and LE extension.

Front 56

Rather than focusing treatment on inhibiting spasticity, therapists should train patients to...

Back 56

perform alternating movement patterns efficiently

Front 57

Which has the most significant effect on impaired voluntary movement: a- agonist muscle paresis
b- antagonist muscle hypertonia

Back 57

a

Front 58

Gold standard for rating resistance (spasticity):

Back 58

Ashworth or Modified Ashworth scale

Front 59

Treatment of spasticity:

Back 59

Prevent pain syndromees.
Guide appropriate use of available motor control
Maintain soft-tissue length.
Avoid using excessive effort during movement.
Encourage slow and controlled movements.
Teach specific functional synergies during tasks.
Avoid use of repetitive compensatory movement patterns
Keep spastic mm on stretch via positioning or orthotics to prevent contracture.
Teach the patient or caretaker specific stretching techniques.
Use activities to enhance agonist/antagonist relationship.
Refer for pharmacologic or surgical interventions when appropriate.

Front 60

Secondary problems that may occur if spasticity isn't managed:

Back 60

Deformity of limbs, esp. distal UE.
Impaired upright function caused by soft tissue contracture.
Tissue maceration of palm.
Pain syndromes resulting from loss of normal joint kinematics.
Impaired ability to manage basic ADLs.
Loss of reciprocal arm swing.
Falls risk.

Front 61

Contracture in stroke patients results from:

Back 61

immobilization

Front 62

Contracture in stroke patients may be attributed to:

Back 62

spasticity, flaccidity, improper positioning, postural malalignment, lack of variation in limb postures, combination.

Front 63

What soft tissues do contractures occur in?

Back 63

skin, subcutaneous tissue, muscle, tendon, ligament, joint capsule, vessels, and NN

Front 64

Categories of contracture:

Back 64

arthrogenic, soft tissue related, and myogenic.

Front 65

How do you differentiate between myogenic and joint contracture?

Back 65

flexing the proximal joint and noting resulting position of distal joints. Joint contracture is unaffected by change in proximal joint position.

Front 66

How is contracture prevented?

Back 66

deliberate and frequent limb movement. Active when possible.

Front 67

Therapist should pay particular attention to the following ranges:

Back 67

Protraction and upward rotation of the scapula
ER of GH joint.
Elbow extension.
Wrist extension w/ radial deviation.
Flexion of digits.
Extension of wrist and digits.
MCP flexion and IP extension

Front 68

What should be used if contracture has developed?

Back 68

low-load prolonged stretch

Front 69

ROM activity: towel on table-

Back 69

Both arms on top of towel.
Less affected arm guides towel around table w/ majority of movement occurring in trunk and hip flexion.
Enhances GH and elbow range and encourages capula protraction and weight shifting

Front 70

ROM activity: rock the baby

Back 70

Less affected arm cradles more affected arm, lifts it to 90 degrees, and places it into horizontal ab and adduction.
Encourages scapula protraction and trunk rotation

Front 71

ROM activity: dangle arms

Back 71

Encourages extension of elbow, wrist, and digits and forward flexion of humerus w/ scapular protraction.

Front 72

ROM activity: resting forearm on table and rotating trunk

Back 72

W/ extremity WB on surface, rotate trunk away and reach posteriorly.
ER of shoulder increases

Front 73

Lesion that precipitates shoulder-hand syndrome/complex regional pain :

Back 73

Proximal trauma such as shoulder, neck or ribcage injury or a visceral source such as stroke.

Front 74

How does SHS present?

Back 74

Begins w/ severe pain and progresses to stiffness in the shoulder and pain throughout the extremity.
Swelling of wrist and hand, vasomotor changes, and atrophy

Front 75

If untreated, what does SHS result in?

Back 75

frozen shoulder and permanent hand deformity

Front 76

4 main clinical factors in prognosis of complex regional pain syndrome type I:

Back 76

motor deficit, spasticity, sensory deficits, and initial coma

Front 77

Major diagnostic criteria of SHS:

Back 77

Shoulder: loss of ROM and pain during abduction, flexion and ER movements
Wrist: intense pain during extension movements, dorsal edema, tenderness during deep palpation.
Digits: moderate edema, intense pain during MCP flexion and loss of skin lines

Front 78

Stages of SHS/Complex regional pain sydrome type I:

Back 78

1. Shoulder and hand pain, tenderness and vasomotor changes. Chances of reversal are high at this stage.
2. Early dystrophic limb changes, muscle and skin atrophy, vasospasm, hyperhidrosis (increased sweating), and radiographic signs of osteoporosis. Increasingly difficult to treat.
3. Rarely have pain and vasomotor changes, but do have soft tissue dystrophy, contracture, and severe osteoporosis. Irreversible.

Front 79

Physiologic changes contributing to weakness:

Back 79

Loss of agonist motor units, changes in recruitment order of motor units, and changes in firing rates.
Changes in peripheral N conduction.
Changes in morphologic and contractile properties of motor units in the mechanical properties of mm.

Front 80

Adhesive changes in the hemiplegic shoulder are considered to result from:

Back 80

immobilization, synovitis, or metabolic changes in joint tissue.

Front 81

Common orthopedic UE injuries in patients w/ hemiplegia:

Back 81

Rotator cuff and bicep tendon lesions, adhesive changes, and BPI

Front 82

Physical exam findings in BPI:

Back 82

flaccidity and atrophy of supraspinatus, infraspinatus, deltoid, and biceps w/ increased m tone or distal movement.

Front 83

After stroke, patients commonly lose ability to perform postural adjustments and maintain postural alignment b/c:

Back 83

weakness, loss of equilibrium, and righting reactions.

Front 84

Patients typically WB ___ through their pelvis resulting in...

Back 84

asymmetrically; lateral spine flexion.

Front 85

Patients tend to assum a ___ pelvic tilt, resulting in...

Back 85

posterior; spine flexion

Front 86

Abdominal weakness results in...

Back 86

destabilization of rib cage.

Front 87

Lack of balance between obliques results in...

Back 87

trunk and rib rotation

Front 88

In hemiplegic patients, the scapula loses its orientation on the thoracic wall and a ssumes a position of...

Back 88

relative downward rotation

Front 89

Biomechanics of shoulder subluxation in hemiplegia:

Back 89

spine laterally flexed, scapula downwardly rotated, supraspinatus loses mechanical line of pull.

Front 90

Typical alignment of humerus post-stroke

Back 90

IR

Front 91

What is the effect of position of humeral IR on distal arm motion:

Back 91

blocked forearm rotation

Front 92

shoulder supports-

Back 92

any device used to align, protect or support an affected proximal limb.

Front 93

Shoulder supports include:

Back 93

bed positioning devices, adaptations to seating systems, and slings.

Front 94

Goals of using a sling:

Back 94

decrease and prevent s/l and pain.

Front 95

If the goal of treatment is to provide GH joint stability, the device must support:

Back 95

the scapula on the rib cage w/ glenoid facing upward, forward, and outward and must compensate for lack of support by cuff.

Front 96

Proper positioning of humeral head:

Back 96

abduction, ER, and elbow extension.

Front 97

Single strap hemisling-

Back 97

2 cuffs that support the elbow and wrist. Arm held in adduction, IR, and elbow flexion. Corrected vertical displacement

Front 98

Bobath roll-

Back 98

Strap includes foam roll that is placed in axilla beneath proximal humerus. Abduction and ER w/ elbow extension. Produced significant lateral displacement of humeral head.

Front 99

Rolyan humeral cuff sling-

Back 99

figure eight strap w/ arm cuff sized to fit on distal humerus. Slight ER. Only support that significantly decreased total s/l assymetry.

Front 100

Cavalier shoulder suppport-

Back 100

bilateral axillary support integrated posteriorly into a brace that rests between teh scapula. Didn't alter vertical displacement; Produced significant lateral displacement of humeral head.

Front 101

Sling guidelines:

Back 101

Minimize sling use during rehab process.
Useful for supporting more affected extremity during initial transfer and gait training.
Never use sling that position in a flexor pattern unless patient is in an upright posture.

Front 102

Most effective way to reduce level of s/l:

Back 102

provide patient w/ activities that enhance trunk and scapula alignment, activate rotator cuff, and enhance functional use of extremity during WB and reach