Mayo Clinic 2 - 16 - Neurorehabilitation

Front 1

Role of plasticity in rehabilitation after stroke?

Back 1

Willful, repetitive, task-specific activity results in cortical structure changes, including an increase of dendritic arborization, synaptogenesis, and synaptic density. These changes translate into functional improvement in the patient's level of impairment

Front 2

How soon after stroke should rehabilitation begin?

Back 2

Within 72 hours; current research is exploring very early rehabilitation, which begins within 24 hours of admission

Front 3

Principles of established and emerging therapeutic techniques for patients after stroke? (5)

Back 3

1. Proprioceptive neuromuscular facilitation

2. Brunnstrom

3. Bobath

4. Rood

5. Constraint-induced movement

Front 4

Method of proprioceptive neuromuscular facilitation

Back 4

Use resistance provided by stronger muscles to favilitate the weaker components of the same motion pattern

Front 5

Method of brunnstrom

Back 5

1. Take advantage of both the stronger muscles and the primitive postural reactions to facilitate synergistic motor patterns in early recovery

2. Isolated movements are incorporated at later stages of recovery

Front 6

Method of Bobath?

Back 6

Use reflexive movement patterns to inhibit increased tone

Front 7

Method of Rood?

Back 7

Use tactile stimulation to facilitate muscle movements

Front 8

Method of constraint-induced movement?

Back 8

Require forced use of the affected limb by restraining the unaffected limb during treatment sessions

Front 9

Name of trial that demonstrated statistically and clinically significant improvement in arm motor function when compared with traditional therapy?

Back 9

The Extremity Constraint Induced Therapy Evaluation (EXCITE)

Front 10

Percentage of stroke patients who have impaired swallowing?

Back 10

One-third to three-fourths

Front 11

When should PEG be considered?

Back 11

If swallowing is not expected to improve within the first 2 to 3 weeks after the stroke

Front 12

If vocal cord paralaysis is suspected?

Back 12

Otolaryngologic evaluation may be indicated for consideration of vocal cord medialization

Front 13

Common methods for spasticity ,amage,emt

Back 13

1. Stretching

2. Splinting

3. Oral medication

4. Chemodenervation by either a lytic agent or a neuromuscular blocking agent

Front 14

Common oral medications used to treat spasticity?

Back 14

1. Baclofen

2. Dantrolene

3. Diazepam

4. Tizanidine

Front 15

Mechanism of action of Baclofen?

Back 15

Agonist of presynaptic GABA B receptors, inhibiting calcium into presynaptic terminals and suppressing the release of excitation neurotransmitters

Front 16

Side effects of Baclofen? (6)

Back 16

1. Sedation

2. Weakness

3. GI symptoms

4. Tremor

5. Insomnia

6. Confusion

Front 17

Baclofen dosage

Back 17

1. Initially, 5 mg x3 daily

2. Increase by 15mg daily every 3d

3. Maximum, 80mg daily divided 3-4 times daily

Front 18

Mechanism of action of Dantrolene?

Back 18

Reduces calcium release by SR, inhibiting skeletal muscle contraction

Front 19

Side effects of Dantrolene? (7)

Back 19

1. Hepatotoxicity (1%)

2. Drowsiness or sedation

3. Weakness

4. Fatigue

5. Diarrhea

6. Nausea

7. Vomiting

Front 20

Dantrolene Dosage

Back 20

1. Initially, 25mg daily

2. Increase by 25-50 mg every 4-7 days

3. Maximum, 400mg divided 4 times daily

Front 21

Diazepam mechanism of action

Back 21

Enhances action of GABA A receptors, inhibiting muscle contraction

Front 22

Side effects of Diazepam

Back 22

1. Memory impairment

2. Sedation

Front 23

Diazepam dosage for spasticity

Back 23

1. Initially, 2 mg twice daily

2. Increase as needed

3. Maximum, 60mg daily divided 2-4 times daily

Front 24

Tizanidine mechanism of action?

Back 24

a-adrenergic agonist, increasing presynaptic inhibition of motor neurons

Front 25

Side effects of tizanidine? (5)

Back 25

1. Drowsiness

2. Hypotension

3. Dry mouth

4. Bradycardia

5. Dizziness

Front 26

Tizanidine dosage for spasticity

Back 26

1. Initially, 2-4mg daily

2. Increase by 2-4 mg over 2-4 weeks

3. Maximum, 36 mg daily divided 3-4 times daily

Front 27

What happens to the bladder if there is a SCI above the sacral segments?

Back 27

UMN bladder, in which urination cannot be initiated by voluntary relaxation of the external sphincter; treatment is by catheterization intermittently or indwelling or suprapubic if quadriplegic

Front 28

If SCI injury occurs above the sacral levels, what happens to defecation?

Back 28

Cannot be initiated by voluntary relaxation of the external anal sphincter, although reflex-mediated colonic peristalsis can occur

Front 29

Spasticity management in SCI?

Back 29

Intrathecal baclofen delivery has been very effective in this patient group, although oral systemic medications such as baclofen, tizanidine, diazepam, and dantrolene are also used.

Front 30

Focus of rehabilitation in MS patients?

Back 30

Symptom management and in cludes management of neurogenic bladder and bowel, spasticity, weakness, fatigue, visual impairment, depression, and cognitive dysfunction

Front 31

Rehabilitation focus in ALS?

Back 31

Equipment procurement to prepare for the future expected changes, which will lead to activity limitation and participation restriction

Front 32

Exercise recommendations in ALS?

Back 32

Owing to the limitations of published studies, including small sample size, and the limited number of studies on this subject, it is unclear whether these results apply to humans (hastening of disease process with strenuous exercise). Because of the limitations, a 2008 Cochrane Review could not state the degree to which strengthening is harmful or beneficial