Stages of Stroke Rehabilitation

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Test on 3/19/15
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1

How many stages of recovery are there regarding Stroke patients?

Six

2

UPPER EXTREMITY

SEE QUESTIONS BELOW

3

Describe Stage 1 in terms of muscle tone and movement.

Low tone - acute phase.

No movement (flaccidity)

4

Describe Stage 2 in terms of muscle tone and movement. UE

Minimal voluntary movement; muscle tone elicited through associated reactions: sneeze, cough, yawn.

Souques - shoulder above horizontal causes active finger extension.

Ramiste - Left UE Abduction resistance causes Rigth UE Abduction.

Contralateral limb resistance - Left UE flexion resistance causes Right UE flexion.

Homolateral limb synkinesis - Right LE flexion resistance causes Right UE flexion.

5

Describe Stage 3 in terms of muscle tone and movement. UE

Highest muscle tone "bing stage"

Voluntary control of movement synergies

Dominant flexion synergy component: -elbow flexion

Flexion synergy: "Come up & scratch behind your ear"

Dominant extension synergy components: shoulder adduction & forearm supination

Extension synergy - "reach forwards & downwards" - sword

6

Describe Stage 4 in terms of muscle tone and movement. UE

Muscle tone is still high, but not as high as in Stage 3. Movement patterns are able to break away from synergy patterns a little as follows:

Hand to Sacrum - straighten elbow and push hand down & medially.

Supination & pronation with elbows flexed 90 degrees

Shoulder flexion to 90 degrees horizontal, keeping elbows straight

7

Describe Stage 5 in terms of muscle tone and movement. UE

Muscle tone is still high, but not as high as in Stage 4; Movement patterns are able to break away even more from synergy patterns as follows:

Supination & pronation with elbows straight & shoulder flexed 90 degrees (horizontal)

Forward reach from horizontal (serratus anterior)

Shoulder flexion to 180 degrees

Shoulder Abduction 90 degrees (without bending elbow or supinating forearm)

8

Describe Stage 6 in terms of muscle tone and movement. UE

Normal muscle tone; UE coordination exercises.

9

LOWER EXTREMITY

SEE QUESTIONS BELOW

10

Describe Stage 1 in terms of muscle tone and movement. LE

Low muscle tone (acute)

No movement

Flaccid

11

Describe Stage 2 in terms of muscle tone and movement. LE

Increased muscle tone, but not normal.

Minimal voluntary movement; muslce tone elicited through associated reactions: sneeze, cough, yawn.

12

What are the specifics of Stage 2 recovery? LE

"Trick the patient phase"

Ramiste - ex. Left LE Abductions resistance caused Right LE Abduction

Contralateral limb resistance - ex. Left LE flexion resistance caused Right LE extension.

Homolateral limb synkinesis - ex. Right UE Flexion resistance causes Right LE Flexion.

13

Describe Stage 3 in terms of muscle tone and movement. LE

Highest muscle tone - "bing stage"

Voluntary control of movment synergies

Dominant extension synergy components: hip adduction, knee extension & ankle plantar flexion.

Extension synergy: in sidelying ( with LE in flexion), ask patient to straighten leg out.

Dominant flexion synergy components: hip flexion.

Flexion synergy: in supine, ask patient to bring knee up towards his/her chest.

14

Describe Stage 4 in terms of muscle tone and movement. LE

Muscle tone is still high, but not as high as Stage 3; movement patterns are able to break away from synergy patterns a little as follows:

Snow angels in supine (hip abduction without bending knee or hip)

Hip Flexion in short sitting "bring your knee to your chest"

Knee flexion in short sitting "slide your heel back."

Ankle dorsiflexion in short sitting "raise your toes up with your heels on the floor.

Knee extension from a short sitting position "straighten your leg out."

15

Describe Stage 5 in terms of muscle tone and movement. LE

Muscle tone is still high, but not as high as in Stage 4; movement patterns are able to break away even from synergy patters as follows:

Ankle d.f./p.f. motion in sitting with knee extended & heel off floor.

Ankle inversion/eversion motion in sitting with heel on the floor.

Pawing (isolated knee extension while keeping hip in extension)

16

Describe Stage 6 in terms of muscle tone and movement. LE

Normal muscle tone; LE coordination exercises.


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