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Questions and Answers
What is a common effect observed after a CVA regarding shoulder position?
Which technique is recommended for maintaining soft tissue length?
What is a primary goal of splinting in post stroke management?
Which of the following describes the function of orthoses for spasticity management?
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What is one of the risks associated with flaccid extremities post stroke?
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What should be considered when assessing the need for orthotics post stroke?
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Which strategy is crucial for managing shoulder subluxation after a stroke?
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What time frame should be considered in maintaining soft tissue length in stroke patients?
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What is the primary characteristic of apraxia?
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Which type of apraxia involves difficulty carrying out learned movements in the correct sequence?
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What does ataxia primarily refer to?
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Which type of agnosia is characterized by difficulty recognizing familiar objects or people?
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What visual perceptual skill is primarily assessed when following instructions to copy a drawing?
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Which of the following describes 'perseveration' in a clinical context?
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Which deficit is characterized by a lack of awareness of one side of the body or space?
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Which of the following visual perceptual skills involves recognizing parts of a whole in a visual field?
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What term describes the inability to recognize objects, despite having functional eyesight?
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Which skill specifically involves the ability to differentiate between similar visual stimuli?
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What does 'neglect' refer to in the context of visual processing?
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What is a potential indicator of a visual field cut (hemianopsia) during observation?
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For effective treatment, which approach could be taken to improve attention to the left side of the body in a stroke survivor?
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Identifying a hemianopsia or visual neglect can be challenging for what reason?
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Which therapy activity may be beneficial in enhancing a client's attention to their left side?
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What should be included in a discharge summary for a stroke survivor?
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Study Notes
Post Stroke Comorbidities
- Residual stroke complications can occur after a stroke
- Common: Shoulder subluxation, a common complication that frequently appears after stroke where the humeral head drifts inferiorly to the glenoid fossa due to malalignment of the scapula and trunk.
- Weight of arm: The weight of the affected arm, combined with instability and malalignment, contributes to subluxation
- Occurrence: Subluxation can occur anteriorly or superiorly and may not always lead to pain
- Neglect Patients: Stroke patients who experience neglect may not be aware of the subluxation or affected limb, posing a challenge to diagnosis and management.
- Virgil: A fictional patient named Virgil represents the challenges of managing spasticity after stroke highlighting the importance of tone management.
Management of Subluxation
- Protection of Unstable Joints: Flaccid extremities require protection, and ICE video: Upper Extremity Assessment: Acute Care provides guidance on assessing and managing flaccid extremities in acute care settings.
- Tone Management: Tone is affected by both low tone and high tone after stroke
- Virgil: Botox: Botox injections, as illustrated by Virgil's case, can help with managing spasticity
- Maintaining Soft Tissue Length: A 24-hour program with frequent position changes is vital to maintain soft tissue length in stroke patients with both low tone and spasticity.
- Low Load/Prolonged Stretch (LLPS): Submaximal stretch for prolonged periods can help manage tone
Orthotics
- Individually Assessed: Orthotics are individually assessed depending on individual needs and conditions.
- Low Tone Stage: Orthotics help maintain joint alignment, protect tissues, prevent injury, and control edema.
- Spasticity Stage: Orthotics are used to maintain soft tissue length, provide LLPS, and place muscles at resting lengths.
- Distal Relaxation: Orthotics aim to promote distal relaxation by focusing on proximal alignment
Orthoses as Management of Tonal Changes in the UE
- Resting Hand Orthosis: This type of orthosis is used to immobilize the hand, position it in functional alignment, and prevent deformity after stroke.
Apraxia
- It is the reduced ability to coordinate, plan, or carry out specific movements even when there is no paralysis.
- Ideomotor Apraxia: Difficulty with the motor planning of a movement but can perform the task when prompted with the object.
- Ideational Apraxia: Understanding the task but not able to perform it.
- Ataxia: A lack of muscle control or coordination of voluntary movements.
Perceptual Deficits after Stroke
- Agnosia: Impairment in recognizing familiar objects, people or sounds despite intact sensory function
- Visual Spatial Loss: Distortion of spatial relations, affecting perception of one’s body and environment
- Inattention/Neglect: A tendency to ignore or fail to respond to stimuli on one side of the body or environment.
Agnosia
- Auditory Agnosia: Inability to recognize sounds
- Tactile Agnosia: Inability to recognize objects through touch
- Visual Agnosia: Inability to recognize objects by sight
- Body Agnosia: Difficulty recognizing one's own body parts or perceiving the position of one's body in space.
Agnosia Simulation
- Simulation activities help understand Agnosia by providing a temporary experience of this deficit.
Visual Spatial Skills- Simulation Activities
- Essential Skills: Visual spatial skills, such as spatial awareness, figure ground, visual closure, visual memory, and visual discrimination, are essential for everyday activities.
- Simulation: Activities simulating these skills provide a framework for understanding their importance in post-stroke rehabilitation.
Inattention or Neglect
- Peggy: A fictional patient named Peggy demonstrates Inattention or Neglect, showcasing the challenges of this condition.
- Unilateral Neglect: The tendency to ignore or fail to respond to stimuli on one side of the body or environment.
Perseveration
- Getting Stuck: Perseveration refers to the repetition of a word, phrase, action, behavior, or emotion.
Relate Deficits to Function
- Each deficit can negatively impact a stroke patient’s function and daily occupations
- Agnosia: Impacts the ability to recognize objects, people, or sounds which can interfere with tasks such as dressing, cooking, and communication.
- Spatial Awareness: Impacts tasks requiring spatial awareness, such as driving, navigating familiar environments, and dressing.
- Figure Ground: Impacts the ability to distinguish objects from background and can interfere with tasks such as reading, searching for objects, and dressing.
- **Visual Closure:**Impacts the ability to perceive an incomplete object and fill in missing information.
- Visual Memory: Impacts the ability to retain visual information and can interfere with tasks such as remembering routes, recognizing faces, and following directions.
- Visual Discrimination: Impacts the ability to distinguish between similar objects and can interfere with tasks such as dressing, cooking, and driving.
- Neglect: Impacts the ability to attend to and be aware of one side of the body or environment, interfering with tasks such as dressing, eating, and reading.
- Perseveration: Impacts the ability to switch between tasks or thoughts resulting in repetitive behaviors or actions.
Time to Apply: Ellanora
- Ellanora: A fictional patient named Ellanora is used to demonstrate the application of principles in a treatment session.
- Assessment of Ellanora: The scenario focuses on assessing Ellanora's awareness of her left side, her response to cues, and potential visual deficits.
- Treatment Goals: The scenario highlights the importance of providing cues and activities that encourage attention to the left side.
Stroke Survivor Stories
- Stories of stroke survivors such as Joe can be an inspiring source of understanding and hope.
Team Questions
- Teams are asked to prepare questions for a guest speaker, focusing on the impact of stroke effects on occupation.
Discharge Summary Documentation
- Homer: A fictional patient named Homer provides a case study for creating a discharge note.
- Discharge Note: Creating a discharge note using DocuLearn, incorporating subjective statements and referencing relevant resources.
SOAP Note Discharge Documentation Guide
- Guides are available to provide structure and support in documenting discharge summaries.
Discharge Summary Example of Contents
- Contents: Discharge summaries provide a detailed record of the patient's history, evaluation findings, treatment plan, and recommendations for continued care.
Example of d/c Summary Note
- Gateley, C.(2024): This example demonstrates using Gateley, C.'s guide to write a standard discharge note.
Next
- Subsequent topics: OSC 605 OT process for CVA, Part 2 and Parkinson’s disease
- Siena Hall 1115: Location of upcoming classes.
- Monday 9/30: Date of upcoming quiz and guest speaker.
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Description
This quiz covers the complications and management of post-stroke conditions, with a focus on shoulder subluxation and its implications for patient care. Explore the challenges faced by patients like Virgil, who illustrate the importance of effective management strategies for arm stability and awareness.
