CVA interventions
What is the difference between a bobath and brunstrum transfer?
Bobath - towards the affected side
Brunstrum - away from affected side
What are the types of CVA? Specify what they mean.
Ischemic- thrombosis (clot) & embolism (dislodged)
Hemorrhage- aneurysm & arteriovenous malformation
Temporary Ischemic Attack - last 24hrs
Focal vs diffuse injuries
Focal - assaults, bullets, falls (hematoma)
diffuse - car crash, shear injury, brainstem pathway injuries
Short term vs long term disability
Short term- 6 weeks
long term- need yearly doctor notes
2/3 of salary
Focal vs Ambient vision
Focal- central “what is it” more attention to detail
Ambient- spatial “where is it” or “where am i”
List facilitatory techniques and how to do them (8)
Joint compression
manual resistance
quick stretch
tapping
vibration
fast brushing
vestibular stimulation
Types of aphasia and describe them (4)
Brocas - slow, labored output (can’t get it out)
Wernicke - can say words but don’t make sense
Anomic - pauses and interrupt (comprehension better)
Global - overall expressive and responsive
Discorticate vs decerebare posture
Discorticate - flexion of UE. And extension LE
decerebate - extension of UE and LE
interventions for physical changes
calm environment
weight bearing
ROM
gentle strengthening
positioning, splint, casting
balance progression
ADL progression
Forced use
nmes
pain modalities
7 core areas of visual perception
Visual discrimination- differentiate between objects and forms
Visual memory- store visual images in short term memories
Visual spatial relations- organize objects in space (judge volume and distance)
Form constancy- distinguish one object from similar one
Visual sequential memory- remember series forms, events, procedures
Visual figure ground- distinguish shapes from a background
Visual closure- complete missing info when given incomplete shape
List inhibitory techniques And describe how to do them (6)
Neutral warmth
slow stroking
light joint compression
vestibular stimulation
overpressure on tendon (golgi)
prolonged stretch
Level 1 - flaccid
level 2 - synergies begin
level 3 - high spastic and voluntary movement
level 4 - spasticity starts decrease and deviate synergies
level 5 - decreased tone and complex movements
level 6 - tone near normal
level 7 - normal
Levels of consciousness
Coma
vegetative state
minimally conscious state
emergence from minimally conscious state
what to do with ranchos level 1-2
Sensory stimulation
Coma- try face music, family voices, prom, familiarity
bed positioning, splinting, education
What is Mary Warrens visual perception hierarchy
Used for evaluation and treatment of visual perception dysfunction.
Each level is built on and dependent of the level below it
Name common modalities used for cva (7)
Biofeedback
ESTIM
Icing
Vibration
Manual therapy
Manual ROM
Mirror therapy
Progression of Rehab
ER
Acute Care
long term acute care OR inpatient
SNF, home health, outpatient
Describe the ranchos levels (10)
Level 1 - coma
level 2 - generalized response
level 3 - localized response
level 4 - confused agitation
level 5 - confused non agitated inappropriate
level 6 - confused appropriate
level 7 - robotic
level 8 - purposeful appropriate SBA
level 9 - purposeful appropriate SBA on request
level 10 - purposeful appropriate mod independent
Tips when working with ranchos level 3-4
Keep it simple and routine
calm environment
know deescalation techniques
What is the tonic labyrinthine reflex?
Assist with development of balance, linking vestibular and proprioceptive systems
vision issues if retained
how to test: stand w/ feet together arms at side, instruct client to illy extend neck like looking at ceiling with eyes closed 10s, then flex head like looking at toes with eyes closed 10s
Walk through all the types of PNF
facilitate movement, learning motion, increase strength, increase rom
F (rhythmic initiation & repeated stretch)
L (rhythmic initiation, combined isotonic, repeated contraction, replication)
IS (combined isotonic, reversals, rhythmic stabilization, repeated contractions)
IR (reversals, rhythmic stabilization, repeated contractions, contract relax, hold relax)
What are some of the assessments used in CVA and describe their main points
Fugl Meyer
STREAM
Barthel
COPM
Activity Card Sort
FIM
TUG, Berg balance, Functional reach text
Name all the TBI assessments and main idea of them
MFVP Test 4 - visual perception
biVABA - visual function and visual attention
BIVSS - self report for vision problems
MoCA - cognition
DLOTCA - cognition (see if they can try again with cues)
PCSS - self report to monitor concussion symptoms
what does it mean when someone talks constantly about a certain topic and has a hard time switching tasks?
Perseverating
Should you start with spatial or strengthening the eyes for binocular issues?
Spatial: helps determine midline and positioning