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47 Cards in this Set
- Front
- Back
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Problems with hemiplegia |
Shoulder pain, sublux, complex regional pain syndrome |
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Support and protection of GH joint |
Joint capsule, ligaments, nonactive muscles |
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Causes of shoulder subluxation |
Gravity- dependent position Paralysis or severe muscle weakness- supraspinatus and deltoid |
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Sublux and pain |
Uncertain if sublux causes pain |
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Shoulder pain in six months |
Resolved in 80% of pts |
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Shoulder pain major causes |
Spasticity, muscle weakness, adaptive structural changes, neglect, trauma |
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Spasticity and shoulder pain |
Alone- may or may not contribute Causes IR and adduction Association |
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Adaptive structural changes and shoulder pain |
Associated with loss of ER and flexion ROM Usually found in shoulder IR/add, elbow flex, forearm pronation, and wrist/finger flex Care should be taken in acute stage to prevent degenerative changes |
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CVA tears and tendinopathies |
35% at least one year in bicep, rot cuff or delt 53% at least tendinopathy in rot cuff, biceps or delt or combo |
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Muscle weakness and shoulder pain |
Flaccid stage significantly related to shoulder pain |
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Spasticity/neglect and shoulder pain |
Not different between those with or without pain |
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Trauma and shoulder pain |
Lifting pt by arm, PROM, impingement |
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CRPS prevalence |
39-46% in post stroke |
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CRPS characters |
Numerous peripheral changes and CNS changes without obvious nerve injury -vasomotor tone -tenderness -protective immobility -trophic skin changes |
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CRPS causes and symptoms |
Unknown causes Symptoms Stage 1- shoulder pain, painful edema in wrist/hand, loss of mobility (claw hand) Stage 2- dystrophic changes, PIP & DIP enlarged and stiff Stage 3- soft tissue dystrophy, frozen shoulder, lost hand mobility Cannot skip stages, once lost hand mobility-wont get it back |
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CRPS management |
Good positioning, avoid trauma, PROM, AROM, Estim, mirror therapy, mental practice, CIMT |
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Evidence for CRPS intervention |
Conflicting in acute CVA Strong with mCIMT in acute/subacute CVA and compared to traditional in chronic CVA CIMT- with some active wrist/hand mvmts |
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Glutamate post stroke |
Excitotoxicity |
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Changes distant to infarct |
Cortical depression Neuronal hyperexcitability- from deafferentation of inhibitory neurons |
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Recovery of fxn post stroke |
Neural plasticity 3 acute overlapping stages -reversal of diaschisis -cell genesis and repair, alter pathways -formation of new connections "Relearning process" that can extend many years post CVA |
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Cell Genesis location |
Dentate gyrus of hippocampus Subventricular zone |
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Drivers of neuroplasticity |
Changes in behavioral, sensory, and cognitive experiences Adaptive or maladaptive |
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Vestibulocerebellum |
Flocculonodular lobe Controls balance and she mvmts Inputs- semi canals and otoliths Output- vestib nuclei Lesion- increased postural sway, impaired balance, staggering gait, nystagmus, difficulty coordinating mvmts of head and eyes |
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Spinocerebellum |
Central ant and post lobes- vermis and intermediate hemis Control ongoing execution of mvmts Inputs- spinal cord, 3 sensory systems Connects to motor cortex Regulates load variations Ongoing vs intended mvmts Regulate muscle tone Lesion- inability to adapt to changing environment, inappropriate amplitude of muscle force and timing muscle activation for situation, hypotonia |
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Cerebrocerebellum |
Lateral parts Feed forward, agonist/antagonist, coordination to visual target Lesion- problems with mvmt preparation, delays in initiation and timing, dysmetria, mvmt decomposition |
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Cerebellum in motor learning |
Procedural learning, adaptation, mental practice, shifts in sensory focus |
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Friedreich's ataxia |
Early onset 8-15yo Autosomal recessive Degeneration of ascending and descending fibers of spinal cord 60% develop cardiomyopathy Ataxic gait, motor restless, loss of DTRs, muscle atrophy, dysarthria, nystagmus, saccidc eye mvmts, unable to suppress VOR, loss of vibr and position sense, diminished LT P and T distally, scoliosis, Pes cavus 95% wheelchair by 45yo Death mid 30s |
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Olivopontocerebellar atrophy |
Degeneration of inferior olives, pons, cerebellum 3rd-5th decade of life Starts with cerebellar syndrome Parkinsonian features, dementia |
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Cerebellar dysfxn signs |
Unilateral lesion with ipsilateral affects Dysmetria, mvmt decomposition, dysdiadochokinesia, tremor, hypotonia, gait disturbances, speech disturbances, eye mvmt disturbances, nystagmus |
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International cooperative ataxia rating scale (ICARS) |
Walking capacities, gait speed, base of support, body sway, CTSIB, sitting balance |
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Aphasia in pts with stroke |
23-40% |
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Paraphasic speech |
Substitution of words or sounds in words Literal- bat for hat Semantic- bat for ball |
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Neologism |
Made up word |
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Jargon |
Real words and made up words in a sentence without real context |
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Perseveration |
Repetition of a stimulus that is no longer correct |
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Stereotypy |
Repeated utterances that carry little or no meaning |
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Dysprosody |
Disturbance of stress, timing, and melody of speech |
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Fluent aphasia |
Flowing speech with many errors Poor comprehension Wernicke's |
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Anomic aphasia |
Persistent inability to supply words for things that they want to talk about Lack of nouns and verbs Understand speech well Read adequately Poor writing ability "Fluent" |
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Non fluent aphasia |
Speech is slower Short and choppy Broca's Vocab limited Good comprehension |
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Apraxia |
Disorder of performing voluntary learned motor acts due to lesions in the motor association pathways |
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Dysarthria |
Motor speech disorder resulting from paralysis, weakness, or in coordination of speech musculature Right hemisphere |
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Spastic dysarthria |
Slow labored speech Low monotone pitch Consistent imprecise articulation Harsh, strained strangled vocal quality |
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Flaccid dysarthria |
Hypernasality Audible inhalation Imprecise consonant articulation Vowel distortions Tongue atrophy or fasciculations |
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Ataxic dysarthria |
Altered prosody with prolongation of sounds Undue stress on unstressed syllables Irregular pitch and loudness |
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Hypokinetic dysarthria |
Flattened loudness or monotoned Short rushes of speech |
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Hyperkinetic dysarthria |
Dystonia- variations in loudness, facial mvmts Choreoathetosis- bursts of loudness |
