Stoke: Interventions (Specific)

Front 1

Motor learning: cognitive stage. The PT first ___

Back 1

assists the pt in learning the desired task

Front 2

Motor learning: cognitive stage uses ___ to teach

Back 2

explicit verbal cues (clear and simple as to not overload the pt), critical task elements and successful outcomes are identified

Front 3

Motor learning: cognitive stage: The task is demonstrated at ___ speed and then the pt practices

Back 3

ideal performance

Front 4

Motor learning: cognitive stage. Active learning needed; there is no learning with ___

Back 4

passive movements

Front 5

Motor learning: As practice progresses, the pt is asked to ___

Back 5

self-examine and correct. The PT can prompt by asking questions about what went well and what didn't.

Front 6

Motor learning feedback: the PT provides ___ to shape performance

Back 6

extrinsic feedback and manual guidance

Front 7

During early learning, visual inputs are critical; as learning progresses, use __ to refine movement

Back 7

proprioception via weight bearing, manual contacts, tapping, stretch, light tracking resistance, antigravity postures

Front 8

Use of mirrors is contraindicated in pt with marked ____

Back 8

visuospatial perceptual impairments

Front 9

start with a closed environment and progress to a vaired enviornment that provides ____

Back 9

contextual interference

Front 10

Progress from a varied environment to ___ to simulate real life challenges

Back 10

open environment

Front 11

Tx should include positive/successful experiences to ____. Start and end tx on a positive note

Back 11

instill self confidence

Front 12

Improve sensory function: sensory retraining program includes the use of ___

Back 12

mirror tx, repetitive sensory discrimination activities, bilateral simultaneous movements, and repeptitive task practice

Front 13

Improve sensory function: sensory stimulation intervention includes ___

Back 13

compression technique (weight bearing, manual compression, inflatable pressure splints, intermittent pneumatic compression), mobilizations, e-stim, thermal stimulation, or magnetic stimulaiton

Front 14

Hemianopsia and Unilateral neglect interventions

Back 14

encourage awareness and use of environment to the hemi side; active visual scanning with head and trunk turning, marks on the floor, use imagery, UE exercises that cross midline to the hemi side (PNF), functional activities that use both hands, consistently reorient the pt

Front 15

Flexibility and Joint Integrity Interventions

Back 15

early initiation of soft tissue and joint mobs, passive and active (when possible) ROM; arm cradling, table top polishing, overhead movements contraindicated if lacking scap-humeral rhythm, trough on WC for arm to rest on, volar resting splint (night use), positioning to break up synergies

Front 16

Strength Interventions

Back 16

2-3x/week; 3 sets of 8-12 reps; combo of resistance exercise + task oriented enhances carryover; weights and bands add increased postural stability demand to the task; make adjustments for poor grasp

Front 17

Motor control Interventions

Back 17

begin with dissociation (single body segment and selective out of synergy movements --> PT provides guidance/stretch --> active movement ASAP

Front 18

Motor control Interventions: order of progression of contraction types

Back 18

isometric or eccentric --> concentric --> slow active reciprocal contractions of agonist and antagonist muscles limited ROM --> full ROM (PNF useful)

Front 19

Motor control Interventions for UE

Back 19

use WB in UE to improve scap stabilizers, decrease flexor hypertonus and flexion synergy; reaching, manipulation of objects, grasp and release; independent supination is difficult to achieve

Front 20

Motor control Interventions: constraint induced therapy

Back 20

6 hours/day for 10-15 days --> significant gains in UE function

Front 21

Simultaneous Bilateral training

Back 21

both arms alone or in combo with augmented sensory feedback; similar movement in the less affected extremity facilitates movement in the more affected extremity

Front 22

EMG Biofeedback

Back 22

allows pts to alter motor unit activity based on augmented audio and visual feedback info; can be used to up or down train; good for pts in late recovery (6 months post CVA); best when used as an adjunct to task specific training

Front 23

NMES

Back 23

used to reduce spasticity, improve sensory awareness, prevent or reduce shoulder sublux, and stimulate volitional movements; increases muscle force by perferentially activating the fast-contracting motor units

Front 24

Robot-Assisted Therapy

Back 24

used on pts with mod-severe motor impairments; used in conjunction with task-oriented training and motor learning principles; reach and grasp/release are esp used to train this way

Front 25

What to avoid in shoulders

Back 25

if lacking normal scap-humeral rhythm and position, do not do elevation of abd >90 degrees

Front 26

What activities traumatize the shoulder when scap humeral rhythm is lacking?

Back 26

elevation/abd >90 degrees, PROM w/o adequate mobs of the scap, traction or pulling on UE during a transfer, use of reciprocal pulleys

Front 27

In the flaccid stage, what is important for bed mobility and positioning?

Back 27

set the pt up so they cannot roll on the flaccid side

Front 28

Effective alternatives to use of a sling

Back 28

humeral taping/strapping to facilitate or inhibit musculature surrounding the scap; NMES; position hand in a pants pocket

Front 29

Strategies to Improve LE function

Back 29

all should prep the pt for gait and break up synergies; use PNF & bridging to break up synergies; include pelvic rotation; sit on stability ball for pelvic shifting; stress reciprocal action early

Front 30

Interventions for Function: general & initially

Back 30

focus on trunk symmetry and B use of body; progress from guided to active movement

Front 31

Interventions for Function: bed mobility

Back 31

roll to both sides with LE PNF patterns; side lying on affected side for early WB and elongation of trunk; emphasis on rising with involved side leading; controlled lowering; bridging for bed ADLs and transfers, out of synergy movement and WB through foot

Front 32

Interventions for Function: Sitting

Back 32

early: symmetrical posture with proper trunk and pelvic alignment; improve trunk upper and lower dissociation ability; gentle bounding on ball to stimulate spine

Front 33

Interventions for Function: sit < > stand

Back 33

symmetrical WB, coordinated muscular patterns, good timing; initially pt must use momentum from trunk flexion to rise; discourage UE us to stand; initially place stronger foot behind --> "weaker foot behind when pt is able to use the weaker leg more; encourage/train eccentric for lowered control (wall squats)

Front 34

Interventions for Function: standing

Back 34

modified plantigrade with affected UE in WB; forward trunk flex break synergy pattern; practice weight shifts and reaching in this position

Front 35

Interventions for Function: transfers

Back 35

B participation; practice to and from various surfaces and heights; progress to up and down from floor

Front 36

Posture/Balance: general

Back 36

stability --> COM control training within BOS --> manipulate further

Front 37

Posture/Balance: further manipulations

Back 37

BOS, support surface, sensory inputs, UE position/support, UE movements, LE movements, trunk movements, destabilizing functional activities (transfers), walking, dual task training, modifying environmental conditions

Front 38

Posture/Balance: force platform biofeedback

Back 38

kinda like the Wii expect the platform can move; holding on is discouraged, sue harness, if needed

Front 39

Posture/Balance: pushers

Back 39

pushing them will increase the pushing; use visual stimuli and active movement to good side, environmental prompts like a vertical pole or mirror, sit on stability ball; prognosis is good

Front 40

Gait Interventions: task specific overground

Back 40

improve quality of walking and walking endurance; need to stretch and strengthen to get max benefits; get rid of AD ASAP and use harness instead whenever possible

Front 41

Gait Interventions: types of walking

Back 41

forward, backward, side stepping, crossed, step up/down, stair climbing, in a community environment, with coincident timing (crossing a street), dual task activities, balance

Front 42

Gait Interventions: Body Weight Supported treadmill Training

Back 42

improve recovery of walking by using intensive take oriented training promoting the full gait cycle; possible for most since walking is an automatic activity in the brainstem and ventral SC via central pattern generators --> progress to overgound training; early intervention is better

Front 43

Gait Interventions: Robotic assisted Gait training

Back 43

increases the odd of pts becoming independent walkers when combined with tradition tx

Front 44

Gait Interventions: FES

Back 44

used to stimulate DF in pts with foot drop; has a positive effect on brain plasticity with its provision of high-level sensory-motor input into the CNS

Front 45

Gait Interventions: Orthotics for feet

Back 45

AFOs: least restrictive is posterior leaf spring

Front 46

Gait Interventions: Orthotics for knees: ankle set in 5 degrees DF -->

Back 46

limits knee hyperextension

Front 47

Gait Interventions: Orthotics for knees: ankle set in 5 degrees PF -->

Back 47

decreases flexor moment and stabilizes the knee during midstance