STROKE REHABILITATION
QUESTIONS AND CORRECT OPTIONS
Sustained Attention and Self-Alerting ANSW✅✅Bring more awareness to affected side (ex. always
keep affected limb in visual field)
Bottom-Up Mechanisms ANSW✅✅Limb activation therapy
Sensory input strategies
Focus on fixing cognitive issue (focus on impaired side)
Limb Activation Therapy ANSW✅✅Focus on active movements
FES as adjunct
Encourage
-Looking at limb
-Bilateral activation
*Mirror therapy if minimal or no capability of active movement
Mirror Therapy ANSW✅✅Beneficial if struggling with anti-gravity movement
Moving involved side with perception of involved side moving
-Increases neuronal activity
Sensory Stimulation Strategies ANSW✅✅Neck muscle vibration
Optokinetic stimulation
Repetitive TMS
Neck Muscle Vibration ANSW✅✅Vibrating on affected side to improve awareness of head in
space
Optokinetic Stimulation ANSW✅✅AKA prism adaptation
Glasses displace vision to R (neglect on L) with repeated goal-directed movement
-Must compensate for altered visual field
,Examine after-effect to see if visual attention shifted appropriately with more awareness of L side
-Can last some time but limited carryover
Repetitive TMS ANSW✅✅Transcranial magnetic stimulation
Can be
-Excitatory (over ipsilesional lobe) to increase activity
-Inhibitory (over contralesional lobe) to decrease dependence and encourage activity of affected
side
Unilateral Neglect Pharmacological Therapy ANSW✅✅Dopaminergic drugs
Noradrenergic compounds
*No consistent approach currently
Top-Down Indications ANSW✅✅Cognitively able to participate in PT interventions focused on
recovery (acute care)
-*Emphasis should still be on bottom-up
Improve independent function (sub-acute to chronic)
Bottom-Up Indications ANSW✅✅Most active periods of recovery (acute care)
Neglect PT Intervention Evidence ANSW✅✅Insufficient for reducing disability related to spatial
neglect or improving functional independence
No rehab approach can be supported or refuted based on evidence
UE-Specific Outcome Measures ANSW✅✅WMFT
ARAT
WMFT ANSW✅✅Wolf Motor Function Test
Timed UE motor tasks
-Truncated at 120s
For
-Stroke
,-TBI
Widely used in research
Free
No training
6-30min to administer
ARAT ANSW✅✅Action Research Arm Test
Observational assessment of UE function
For
-Stroke
-TBI
-MS
Fine motor
-Grasp
-Pinch
Gripping
Hand/arm movements
19 tasks
-0-4 rating scale for each (4 unimpaired)
-Begin with most challenging (can skip easier tasks if successful)
No training
Efficient to administer
Primary Trunk Impairments Post-Stroke ANSW✅✅Motor control/activation
Altered muscle tone
Loss of sensation
Coordination problems
Perceptual deficits
Secondary Trunk Impairments Post-Stroke ANSW✅✅Weakness
Atrophy
, Muscle length
ROM
Pain
*Postural deficits*
*Vital capacity/respiration*
Trunk Bed Positioning Post-Stroke Considerations ANSW✅✅Can be on unaffected or affected side
Bolsters as needed
HOB elevation if ICP precautions
Trunk Wheelchair Positioning Post-Stroke Considerations ANSW✅✅Harness may be used if at risk
or constraint needed
Post-Stroke Respiratory Considerations ANSW✅✅If patient hypotonic and in forward flexed
position will have decreased
-Lung capacity
-Breathing
-Secretion clearance
Methods of Improving Trunk Function ANSW✅✅Begin with
-Tone modification
-Stretching
-Postural alignment
Facilitate normal weight shifts
-Active lengthening/shortening
Use functional activities
-Bridging
-Rolling
-Sitting/standing balance
-Transitional movements
--Scooting
QUESTIONS AND CORRECT OPTIONS
Sustained Attention and Self-Alerting ANSW✅✅Bring more awareness to affected side (ex. always
keep affected limb in visual field)
Bottom-Up Mechanisms ANSW✅✅Limb activation therapy
Sensory input strategies
Focus on fixing cognitive issue (focus on impaired side)
Limb Activation Therapy ANSW✅✅Focus on active movements
FES as adjunct
Encourage
-Looking at limb
-Bilateral activation
*Mirror therapy if minimal or no capability of active movement
Mirror Therapy ANSW✅✅Beneficial if struggling with anti-gravity movement
Moving involved side with perception of involved side moving
-Increases neuronal activity
Sensory Stimulation Strategies ANSW✅✅Neck muscle vibration
Optokinetic stimulation
Repetitive TMS
Neck Muscle Vibration ANSW✅✅Vibrating on affected side to improve awareness of head in
space
Optokinetic Stimulation ANSW✅✅AKA prism adaptation
Glasses displace vision to R (neglect on L) with repeated goal-directed movement
-Must compensate for altered visual field
,Examine after-effect to see if visual attention shifted appropriately with more awareness of L side
-Can last some time but limited carryover
Repetitive TMS ANSW✅✅Transcranial magnetic stimulation
Can be
-Excitatory (over ipsilesional lobe) to increase activity
-Inhibitory (over contralesional lobe) to decrease dependence and encourage activity of affected
side
Unilateral Neglect Pharmacological Therapy ANSW✅✅Dopaminergic drugs
Noradrenergic compounds
*No consistent approach currently
Top-Down Indications ANSW✅✅Cognitively able to participate in PT interventions focused on
recovery (acute care)
-*Emphasis should still be on bottom-up
Improve independent function (sub-acute to chronic)
Bottom-Up Indications ANSW✅✅Most active periods of recovery (acute care)
Neglect PT Intervention Evidence ANSW✅✅Insufficient for reducing disability related to spatial
neglect or improving functional independence
No rehab approach can be supported or refuted based on evidence
UE-Specific Outcome Measures ANSW✅✅WMFT
ARAT
WMFT ANSW✅✅Wolf Motor Function Test
Timed UE motor tasks
-Truncated at 120s
For
-Stroke
,-TBI
Widely used in research
Free
No training
6-30min to administer
ARAT ANSW✅✅Action Research Arm Test
Observational assessment of UE function
For
-Stroke
-TBI
-MS
Fine motor
-Grasp
-Pinch
Gripping
Hand/arm movements
19 tasks
-0-4 rating scale for each (4 unimpaired)
-Begin with most challenging (can skip easier tasks if successful)
No training
Efficient to administer
Primary Trunk Impairments Post-Stroke ANSW✅✅Motor control/activation
Altered muscle tone
Loss of sensation
Coordination problems
Perceptual deficits
Secondary Trunk Impairments Post-Stroke ANSW✅✅Weakness
Atrophy
, Muscle length
ROM
Pain
*Postural deficits*
*Vital capacity/respiration*
Trunk Bed Positioning Post-Stroke Considerations ANSW✅✅Can be on unaffected or affected side
Bolsters as needed
HOB elevation if ICP precautions
Trunk Wheelchair Positioning Post-Stroke Considerations ANSW✅✅Harness may be used if at risk
or constraint needed
Post-Stroke Respiratory Considerations ANSW✅✅If patient hypotonic and in forward flexed
position will have decreased
-Lung capacity
-Breathing
-Secretion clearance
Methods of Improving Trunk Function ANSW✅✅Begin with
-Tone modification
-Stretching
-Postural alignment
Facilitate normal weight shifts
-Active lengthening/shortening
Use functional activities
-Bridging
-Rolling
-Sitting/standing balance
-Transitional movements
--Scooting
