STROKE REHABILITATION
QUESTIONS AND ADVANCED
ANSWERS
What is CIMT and who is it recommended for? ANSW✅✅Recommended for clients with minimal
cognitive and sensory deficits and min 20 degrees of active wrist extension and 10 active finger
extension
Characteristics
- restraint
- repetitive task practice
- shaping
Modified (mCIMT): lesser duration of therapy less time using mitt, more home-based therapy
What is bimanual therapy? ANSW✅✅Hand-arm bimanual intensive training (HABIT)
Bimanual tasks to stimulate active movement of impaired arm
How would you address sensation and proprioception in a hemiplegic UE? ANSW✅✅1. Provide
augmented sensory input and feedback
- WB exercises, joint compression, tapping, brushing, stroking, air sleeves, vibration, visual input
- practice functional NOT passive tasks
2. Promote simultaneous bimanual activities
- Activity and proprioception in less affected UE can help improve activation and control of affected
limb
- upper body ergometer, rolling pin, weight wand, open a jar, typing, writing
What "high tech" tools can be used to help improve UE function? ANSW✅✅EMG biofeedback
NMES
,FES
Robotic assistance
Virtually reality/active video games
How can atrophy and secondary weakness be prevented in the UE? ANSW✅✅Strength training
can improve strength, improve activity and do not increase spasticity
- grip strength
- theraband
- hand held weights or cuffs
- UBE
- etc.
How can muscle tone be modified? ANSW✅✅Medications - oral or injection
Hypotonic limb - positioning, protecting, resting splints, WB with good alignment, tapping
Hypertonic limb - positioning, splinting, serial casting, prolonged stretch, deep pressure on tendons,
neutral warmth
What are 2 strategies to address unilateral neglect? ANSW✅✅Top-down mechanisms: behavioral
strategies
Bottom up: limb activation therapy
What are Top-Down mechanisms? ANSW✅✅Behavioral strategies - encouraging scanning,
sustained attention and self alerting
What are Bottom-up activation strategies? ANSW✅✅Limb activation therapy
- active movements are preferred
- FES can be used as an adjunct
- mirror therapy if pt is not or minimally capable of active movement
- neck muscles vibration
, - optokinetic stimulation (prism glasses adaptation)
- Repetitive transcranial magnetic stimulation (inhibitory TMS over CL parietal lobe)
What type of drugs can be used to pharacologically treat unilateral neglect?
ANSW✅✅Dopaminergic drugs
Noradrenergic compounds
Frontoparietal attention system and working memory tasks - may increase selective attention during
spatial exploration
When would you se use Top-down strategies? ANSW✅✅Acute care: someone who is cognitively
able to participate in PT interventions focused on recovery, however, bottom-up should still be an
emphasis
Sub-acute to chronic: to improve independent function
Top-down is based on voluntary effort
When would you use Bottom-up approaches? ANSW✅✅Acute care: during most active periods of
recovery - ACTIVE motion is extremely important to stimulate sensory circuits and increase attention
to the side of neglect
What model can be used for selecting UE interventions? ANSW✅✅SAFE Model - shoulder
abduction, finger extension
Voluntary shoulder abd and finger ext by 2 days post stroke -> 98% probability of achieving limb
function
More pts develop these movements within first 12 weeks - this SAFE algorithm uses 12 weeks post
stroke to help guide interventiosn
3 UE-specific Outcome Measures ANSW✅✅Wolf Motor Function Test
Action Research Arm test
Fugl Meyer Assessment of Physical Performance
QUESTIONS AND ADVANCED
ANSWERS
What is CIMT and who is it recommended for? ANSW✅✅Recommended for clients with minimal
cognitive and sensory deficits and min 20 degrees of active wrist extension and 10 active finger
extension
Characteristics
- restraint
- repetitive task practice
- shaping
Modified (mCIMT): lesser duration of therapy less time using mitt, more home-based therapy
What is bimanual therapy? ANSW✅✅Hand-arm bimanual intensive training (HABIT)
Bimanual tasks to stimulate active movement of impaired arm
How would you address sensation and proprioception in a hemiplegic UE? ANSW✅✅1. Provide
augmented sensory input and feedback
- WB exercises, joint compression, tapping, brushing, stroking, air sleeves, vibration, visual input
- practice functional NOT passive tasks
2. Promote simultaneous bimanual activities
- Activity and proprioception in less affected UE can help improve activation and control of affected
limb
- upper body ergometer, rolling pin, weight wand, open a jar, typing, writing
What "high tech" tools can be used to help improve UE function? ANSW✅✅EMG biofeedback
NMES
,FES
Robotic assistance
Virtually reality/active video games
How can atrophy and secondary weakness be prevented in the UE? ANSW✅✅Strength training
can improve strength, improve activity and do not increase spasticity
- grip strength
- theraband
- hand held weights or cuffs
- UBE
- etc.
How can muscle tone be modified? ANSW✅✅Medications - oral or injection
Hypotonic limb - positioning, protecting, resting splints, WB with good alignment, tapping
Hypertonic limb - positioning, splinting, serial casting, prolonged stretch, deep pressure on tendons,
neutral warmth
What are 2 strategies to address unilateral neglect? ANSW✅✅Top-down mechanisms: behavioral
strategies
Bottom up: limb activation therapy
What are Top-Down mechanisms? ANSW✅✅Behavioral strategies - encouraging scanning,
sustained attention and self alerting
What are Bottom-up activation strategies? ANSW✅✅Limb activation therapy
- active movements are preferred
- FES can be used as an adjunct
- mirror therapy if pt is not or minimally capable of active movement
- neck muscles vibration
, - optokinetic stimulation (prism glasses adaptation)
- Repetitive transcranial magnetic stimulation (inhibitory TMS over CL parietal lobe)
What type of drugs can be used to pharacologically treat unilateral neglect?
ANSW✅✅Dopaminergic drugs
Noradrenergic compounds
Frontoparietal attention system and working memory tasks - may increase selective attention during
spatial exploration
When would you se use Top-down strategies? ANSW✅✅Acute care: someone who is cognitively
able to participate in PT interventions focused on recovery, however, bottom-up should still be an
emphasis
Sub-acute to chronic: to improve independent function
Top-down is based on voluntary effort
When would you use Bottom-up approaches? ANSW✅✅Acute care: during most active periods of
recovery - ACTIVE motion is extremely important to stimulate sensory circuits and increase attention
to the side of neglect
What model can be used for selecting UE interventions? ANSW✅✅SAFE Model - shoulder
abduction, finger extension
Voluntary shoulder abd and finger ext by 2 days post stroke -> 98% probability of achieving limb
function
More pts develop these movements within first 12 weeks - this SAFE algorithm uses 12 weeks post
stroke to help guide interventiosn
3 UE-specific Outcome Measures ANSW✅✅Wolf Motor Function Test
Action Research Arm test
Fugl Meyer Assessment of Physical Performance
