Michelle Green – Stroke Rehab for Patients who “Push”: Management Strategies for a Unique Patient Population

Outline

ICF MODEL AND ROLE IN ASSESSMENT AND TREATMENT

• ICF Models guide to clinical reasoning
• Levels of ICF definitions and examples
• Correlation with assessment, prognosis and treatment planning

PATHOPHYSIOLOGY OF “PUSHING”

• Role of vestibular system
• Localization of lesions correlating with “pushing”
• Thalamic lesions and “pushing”
• Role of graviceptive systems
• Best support for occurrence of “pushing”

COMMON CHARACTERISTICS OF “PUSHERS”

• Alignment faults (trunk, head, pelvis, femur)
• Movement dysfunction
• Midline deficits
• Other (sensory loss, visual, neglect, cognition)

ASSESSMENT TOOLS

• Tests to confirm presence of “Pushing”
• Outcome measures
• Role of upper and lower trunk assessment

TASK-ANALYSIS, HYPOTHESIS DRIVE APPROACH

• Why use this framework for clinical reasoning
• What is the framework
• How it guides tasks assessment and guides treatment choices
• How to execute a task analysis
• Neuroplasticity and directing treatment choices
• Motor control and motor learning theories on set-up and progression

TREATMENT SET-UP FOR SUCCESS (REDUCE RISK, IMPROVE SAFETY, IMPROVE OUTCOMES)

• Choosing a position for treatment
• Align patient for best results
• Activate muscles in coordinated sequenced fashion to mimic functional demands
• Rehabilitation of function
• Compensation or Recovery?

TREATMENT FOR THE LOW, MID AND HIGH-LEVEL “PUSHER”

• Primary characteristic for each level
• Starting point and progression
• Functional re-education considerations
• Use of objects, adjunct, and equipment in treatment