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PHTY302: Neuro Physio1, STROKE GUIDLINES FOR Mx Secondary Impairments: A…

- - - - Sensorimotor
        
        Sensory
        
        Visual field deficit
        
        Ax of Visual Fields: looking at nose of assistant ahead, bring finger in to field of vision
        
        Loss in tactile sensation
        
        Ax of localisation and intensity of light touch on arms and legs
        
        Vestibular deficit
        
        Ax of Eye movements and Balance
        
        Loss of Proprioception
        
        Ax Joint Position Sense: eyes closed, passive movement, copy position
        
        If no Joint Position Sense: Ax Passive movement Sense: which joint is moving and is it bending or straightening
        
        Motor
        
        ataxia (voluntary coordination)
        
        Ax of eye movements and ADLs
        
        Loss of Strength
        
        Hemiparesis (weakness)
        
        Hemiplegia
        
        MMT: remembering to avoid position changes
        
        Spasticity
        
        Ax Modified Tardieu Scale (V1 and V3)
        
        ashworth (muscle tone) vs. tardieu scale (spasticity)
        
        Both sensory and motor inputs
        
        Loss in coordination
        
        Ax ADLs --> Look for: decreased speed, decreased accuracy, increased muscle activity
        
        Loss in Balance
        
        Balance Ax:
      - Perceptual-Cognitive
        
        Limb Apraxia
        
        Ideation
        
        Ideomotor
        
        Ax when doing tasks (formal Ax done by OT)
        
        Neglect
        
        Neglect vs. learned non-use
        
        OBS with ADLs (show one-sided behaviour)
        
        decreased Cognitive function
        
        Attention deficit
      - secondary impairments
        
        Contracture and joint stiffness
        
        PROM
        
        common:
        shoulder - IR, Add.
        Elbow - flex. pronators
        Wrist/hand - flexors, thumb webspace
        Hip - flex. ER
        Knee - flex,
        Ankle - PF, invertors
        
        Swelling
        
        OBS: especially affected forearm, hand, leg
        
        Shoulder subluxation/soft-tissue damage
        
        OBS: asymmetry, gapping
        
        Shoulder Pain (VAS)
        
        CV deconditioning
        
        field tests or clinical tests (eg. arm ergometry)
        
        Pain
        
        VAS
        
        Depression and Fatigue
        
        Ax done by psychologist or questionnaires
      - Loss in Speech
    - - dominant - more likely to language (aphasia) and apraxia
      - non-dominant - very likely to have neglect with non-dominant side
- - - - Spatial parameters (eg. lowest height STS)
      - temporal parameters (eg. time to do STS)
      - Accuracy of Reps
      - number of reps
      - Level of Assistance
- - - - Progressive resistance training + E-Stim/robotics/smart arm for grade 0-2
      - Eccentric = regression, inner-range = progression
      - List of devices used for increasing strength: tilt-table, E-stim, robotics, mental practice, smart arm, EMG biofeedback
      - Task Training
    - - task training
    - - for spasticity --> task specific training giving feedback about excessive muscle activity
    - - sensory re-education
      - active sensorimotor tasks with touch involved
    - - functional balance training (sitting/standing balance, STS, Gait)
    - - functional task training with proprioceptive cues/feedback, mirror therapy?
- - - - Part task components and demonstration
  - - - Dynamic splinting (SaeboFlex for grasp-release activities)
      - robotics (for upper arm)
      - Smart Arm (reach)
    - - task training and mental practice
      - Mirror Therapy as an adjunct
  - - - circuit class with focus on overground walking (lite-gait, obstacles/different terrain)
      - treadmill training +/- BW support
      - can cue cadence to improve step length
      - part task training
      - Can use virtual reality, E-stim, biofeedback
  - - - practice reaching beyond arms length in sitting
      - strengthening LL
      - Sitting practice (scales under affected leg, wall on intact side)
    - - functional and challenging task training in standing
- - - - at least 2-5hrs/day, 5days/week of active, intensive supervised practice
      - 6hrs in total with constraint (mitt/sling)
      - Can use trunk restraint as well
  - - - Mx: treat like acute MSK pain - shoulder strapping, Estim
      - Prevention: shoulder strapping, education, active motor control