Factors predicting poor ADL outcome

¹ Advanced age

¹ Comorbidities: myocardial infarction (MI), diabetes mellitus (DM)

severe weakness

poor sitting balance

visuospatial deficits

mental changes

incontinence

low initial activities of daily living (ADL) scores

¹ Time interval: onset to rehabilitation

MOTOR ASPECTS

1) Paralysis and weakness

² In evaluating the extent and amount of paralysis or weakness or both, manuel muscle testing is of limited because the response of individual muscle groups to testing depends upon a wide variety of factors, such as spasticity, incoordination, apraxia, uninhibited reflexes, relationship to gravity and posture

² During the recovery phases, the limbs affected by the stroke progress from a state of flaccidity to increased stretch reflexes (spasticity), clonus, and clasp-knife reaction to flexor and extensor synergies and finally to return of voluntary motor function

² This general pattern of recovery may cease to progress at any phase. Hence, spasticity can not always be considered to herald of voluntary motor function

Some spasticity may be useful to the patient, particularly for standing and walking. Factors that are well known for enhancing spasticity include:

Presence of contractures, anxiety, extremes of heat or cold, any ordinary painful condition (ingrown toe nail, infection, decubitus ulcer, fecal impaction, bladder dysfunction)

Surgical management of spasticity in the stroke patient consists of tendon releases/transfers

2) Incoordination

² May be associated with spasticity or may be due to involvement of the cerebellum or cerbellar tracts

3) Apraxia

² Is a disorder of voluntary movement wherein the individual can not initiate a willed or planned purposeful movement or activity despite the presence of adequate strength, sensation, coordination, and comprehension

² The motor (kinetic) dyspraxia is the most commonly encountered in stroke patient. The rehabilitation training gives the patient assistance for starting a complex performance that the patient completes successfully. The prognosis is good for recovering most types of dyspraxia if consistent training is required

Дата добавления: 2015-10-30