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32 Cards in this Set
- Front
- Back
Role of plasticity in rehabilitation after stroke? |
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 |
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How soon after stroke should rehabilitation begin? |
Within 72 hours; current research is exploring very early rehabilitation, which begins within 24 hours of admission |
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Principles of established and emerging therapeutic techniques for patients after stroke? (5) |
1. Proprioceptive neuromuscular facilitation 2. Brunnstrom 3. Bobath 4. Rood 5. Constraint-induced movement |
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Method of proprioceptive neuromuscular facilitation |
Use resistance provided by stronger muscles to favilitate the weaker components of the same motion pattern |
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Method of brunnstrom |
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 |
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Method of Bobath? |
Use reflexive movement patterns to inhibit increased tone |
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Method of Rood? |
Use tactile stimulation to facilitate muscle movements |
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Method of constraint-induced movement? |
Require forced use of the affected limb by restraining the unaffected limb during treatment sessions |
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Name of trial that demonstrated statistically and clinically significant improvement in arm motor function when compared with traditional therapy? |
The Extremity Constraint Induced Therapy Evaluation (EXCITE) |
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Percentage of stroke patients who have impaired swallowing? |
One-third to three-fourths |
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When should PEG be considered? |
If swallowing is not expected to improve within the first 2 to 3 weeks after the stroke |
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If vocal cord paralaysis is suspected? |
Otolaryngologic evaluation may be indicated for consideration of vocal cord medialization |
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Common methods for spasticity ,amage,emt |
1. Stretching
2. Splinting 3. Oral medication 4. Chemodenervation by either a lytic agent or a neuromuscular blocking agent |
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Common oral medications used to treat spasticity? |
1. Baclofen 2. Dantrolene 3. Diazepam 4. Tizanidine |
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Mechanism of action of Baclofen? |
Agonist of presynaptic GABA B receptors, inhibiting calcium into presynaptic terminals and suppressing the release of excitation neurotransmitters |
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Side effects of Baclofen? (6) |
1. Sedation 2. Weakness 3. GI symptoms 4. Tremor 5. Insomnia 6. Confusion |
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Baclofen dosage |
1. Initially, 5 mg x3 daily 2. Increase by 15mg daily every 3d 3. Maximum, 80mg daily divided 3-4 times daily |
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Mechanism of action of Dantrolene? |
Reduces calcium release by SR, inhibiting skeletal muscle contraction |
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Side effects of Dantrolene? (7) |
1. Hepatotoxicity (1%) 2. Drowsiness or sedation 3. Weakness 4. Fatigue 5. Diarrhea 6. Nausea 7. Vomiting |
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Dantrolene Dosage |
1. Initially, 25mg daily 2. Increase by 25-50 mg every 4-7 days 3. Maximum, 400mg divided 4 times daily |
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Diazepam mechanism of action |
Enhances action of GABA A receptors, inhibiting muscle contraction |
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Side effects of Diazepam |
1. Memory impairment 2. Sedation |
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Diazepam dosage for spasticity |
1. Initially, 2 mg twice daily 2. Increase as needed 3. Maximum, 60mg daily divided 2-4 times daily |
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Tizanidine mechanism of action? |
a-adrenergic agonist, increasing presynaptic inhibition of motor neurons |
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Side effects of tizanidine? (5) |
1. Drowsiness 2. Hypotension 3. Dry mouth 4. Bradycardia 5. Dizziness |
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Tizanidine dosage for spasticity |
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 |
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What happens to the bladder if there is a SCI above the sacral segments? |
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 |
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If SCI injury occurs above the sacral levels, what happens to defecation? |
Cannot be initiated by voluntary relaxation of the external anal sphincter, although reflex-mediated colonic peristalsis can occur |
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Spasticity management in SCI? |
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. |
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Focus of rehabilitation in MS patients? |
Symptom management and in cludes management of neurogenic bladder and bowel, spasticity, weakness, fatigue, visual impairment, depression, and cognitive dysfunction |
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Rehabilitation focus in ALS? |
Equipment procurement to prepare for the future expected changes, which will lead to activity limitation and participation restriction |
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Exercise recommendations in ALS? |
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 |