Untitled Quiz

Subacute Assessment Study Guide

• Table of Contents:
  • Case-based questions: page 2
  • Week 6 Masterclass - Stroke: page 6
  • Week 6 Workshops – Stroke – Modalities: page 12
  • Week 7 Workshops – Stroke: Bed mobility, Sitting, STS, Standing and Equipment: page 17
  • Week 8 & 9 Masterclass – Stroke: LL: page 28
  • Week 8 Workshops – Stroke: LL: page 34
  • Week 10 Masterclass – Stroke: UL: page 39
  • Week 10 Workshops – Stroke: UL: page 42
  • Week 11 Masterclass – Parkinson's Disease: page 46
  • Week 11 Workshops – Parkinson's Disease: page 53
  • Week 12 Masterclass – Multiple Sclerosis: page 57
  • Week 12 Workshop - Multiple Sclerosis: page 64
  • Week 13 Masterclass + Workshops – Life of a Rehabilitation Physio: page 68
  • Week 5 Online Module – Secondary and non-motor impairments: page 72
  • Week 5 – Workshop Using technology in Rehabilitation: page 77

Case-Based Questions

• Component in Healthy People: Describe essential components for rolling, SOEOB, sitting, dynamic sitting, sit to stand, standing, dynamic standing, walking, reaching, and manipulation.
• Compensation/Adaptive Strategies: Understand and describe compensation/adaptation strategies in patients with acquired neurological injuries for rolling, SOEOB, sitting, dynamic sitting, sit to stand, standing, dynamic standing, walking, reaching, and manipulation.
  • Outline potential underlying impairments
  • Suggest exercises at impairment or activity level (part or whole task)
  • Provide evidence for recommendations.
• Observing Activities: Identify missing components, adaptive strategies, and potential impairments in patients with acquired neurological injuries (e.g., stroke, MS) performing activities
  • Suggest exercises for part and whole task practice for the identified missing components (Using the principles of part task and whole task training).
  • Suggest how to make training more difficult and easier based on patient progress.
  • Provide evidence for recommendations.
• Discharge Destination and Services: Discuss discharge destinations, potential services required for patients.

Essential Components

• This section details essential components for bed mobility, sitting and reaching/manipulation, including compensatory movements.

Stroke in Australia

• Facts: Stroke is the 3rd leading cause of death, predicted to increase to 1 million by 2050.
• Affected Population: ~30% of stroke survivors are under 65 years old.
• Disability Cost: 65% of stroke survivors are disabled, requiring assistance with activities of daily living.
• Financial Cost: ~$5B per year.
• Indigenous Australians: Have 1.7x higher stroke rate, 2x higher hospitalization, and 1.6x higher death rate compared to non-Indigenous Australians.

Stroke Risk Factors

• Ischemic (85-87%): Previous TIA, high cholesterol, gender (F>M), atherosclerosis, atrial fibrillation, blood disorders.
• Haemorrhagic (13-15%): Prior ischemic stroke, bleeding disorders, vascular malformations, dissection/tear, use of anticoagulants.

Stroke Signs and Symptoms

• FAST: Face drooping, arm weakness, speech difficulty, time to call 911.

Neuroplasticity

• Time sensitive and task-important.
• Strongly influenced by environment: enhanced sensory, cognitive, motor and social stimulation.
• Adjuvant (additional) or adjunct (supporting) therapies: motor imagery, mental practice, stimulation-based therapy or pharmacology.
• Patient characteristics: younger age generally promotes neuroplasticity
• Stress can impair plasticity, so a relaxed environment is better.

Medical Management for Acute Stroke

• Time Sensitivity: Assess 0-4.5 hours (tPA, thrombectomy), 6-24 hours (thrombectomy only), 24+ hours (no tPA or thrombectomy).

Practice Variability

• Intensity: High repetitions
• Specificity: Task specific
• Variability: Start with minimal, increase as patient progresses.

Clinical Considerations for Instructions and Demonstrations

• Instruction Types: Long sentences (before movement), short sentences (during movement), nonverbal cues (during movement)
• Frequency: Depends on the patient's attention span and skill level
• Timing: Before, during, or after movement
• Sensory Considerations: Incorporate multiple sensory inputs (visual, auditory, proprioceptive and tactile)
• Other Guidelines: Amount of information should accommodate patient's attention capacity, consideration for working/short-term memory capacity, and patient’s experience with the skill.