Physiotherapeutic theory for neurological rehabili
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Summary physiotherapeutic theory: upper limb function
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Physiotherapeutic theory for neurological rehabili
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Katholieke Universiteit Leuven (KU Leuven)
Summary of the upper limb lesson given by prof. G. Verheyden of the course physiotherapeutic theory. It is a summary of the powerpoint slides and additional items noted during the lesson. The slides were in English and my own notes are always in Dutch as much as possible. It is therefore a mix of t...
Physiotherapeutic theory for neurological rehabili
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Rehab tech.: trunk rehabilitation after stroke
Vraag: hoe min. Klinisch ≠ weten
- FM&ARAT= geweten
- 10% = veilige marge indien niet geweten
- Varabilietit in patho
1. MEET THE PATIENT
P in een vrij acute fase
Patient is not able to sit upright and to straighten the trunk
Sitting on the edge of the bed is very difficult
Cognition can also limit the outcome
This case is a very severely affected patient -> you don’t see these in studies…
CLINICAL OUTCOME MEASURES
understand theory & application of clinical outcome measures for trunk function in neurorehabilitation
- Trunk impairment scale
- Trunk control test, …
To measure is to know – what can an outcome measure do for me?
- Only when we measure our patient we can know what to do with the patient
- Starting point for rehabilitation
1. WHY SHOULD WE USE OM?
WCPT Core Standards
- WCP= world confederation physiotherapy
- Core standard 6: P problems, published, standardized, valid, reliable & responsive outcome
Standerized = guideline
- measure is used to evaluate the change in the patient’s problem.
Relevant selection
o Focus on what you want to improve for your patient
o Make a relevant selection for your patient
Acceptable to the patient and having the skill and experience to use, administer and interpret
Result is recorded immediately
o Same measure is used at the end episode of care!!
2. OUTCOME MEASURES FOR TRUNK FUNTION
Clinical tools to measure trunk performance after stroke: a systematic
review of the literature
- Red = not available, it doesn’t mean it is not good don’t know…
- Be critical -> is it useful for the patient/function?
- Laatste kolom= spec trunk testen
- Voor 2/3 schalen veel gegevens niet beschikbaar
Zijn wel bruikbaar
.
3. TRUNK CONTROL TEST – TCT
Rolling to paretic/most affected side vanuit supine
Rolling to non-paretic/less affected side vanuit supine
Sitting for 30 sec with pushing (T pushes from different sides)
- Voeten los van de vloer
- Manier niet gestandariseert Zelfde proberen dien bij elke P
From supine to sitting
For each item: enkel deze opties, niets ertussen
- 0: not able to perform
- 12: able with compensations (something that is abnormal)
- 25: normal
Total score: min 0 – max 100 Hogere score is beter
Gross motor movement
4. TRUNK IMPAIRMENT SCALE – TIS
Nala Melis Pagina 1
, Rehab tech.: trunk rehabilitation after stroke
The trunk impairment scale: a new tool to measure motor impairment of the trunk after stroke
- 3 subscales:
Static sitting balance (/7)
Dynamic sitting balance (/10)
Coordination (/6)
- Score between 0 and 23
Higher = better
- Trunk stability as well as selective movements of upper and lower part of the trunk
- KOE! TCT: rolling -> not only using the trunk, so we need a more specific trunk evaluation = TIS
DYNAMIC SITTING BALANCE
- LF romp geintegreerd van
Boven
onder
COORDINATION
- Rotation of shoulder & pelvic girdle -> one girdle
stays stable & other girdle will move
- Rotatie vanuit
BL
OL= Vooruit schuifelen io tafel/stoel met poep
Selectiviteit
- Breaking down different movements
2. TRUNK IMPAIRMENT SCALE – TIS (FUJIWARA ET AL) niet in detail kennen
Development of a new measure to assess trunk impairment after stroke (TIS)
- 7 items
Perception of trunk verticality
Trunk rotation muscle strength on the affected side
Trunk rotation muscle strength on the unaffected side
Righting reflex on the affected side
Righting reflex on the unaffected side
Stroke impairment assessment set verticality
Stroke impairment assessment set abdominal muscle strength
- Min 0 – max 21
Higher = better
- TCT -> Functional items
- TIS -> mixed items (function and strength)
3. OTHER OPINIONS
How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of
measures of balance activity for neurological conditions
- METHODOLOGY
Assessment of psychometric properties – 3 times ‘good’ needed
o Reliability
o Validity
o Sensitivity
Evaluation of clinical utility – 9 or 10 out of 10 → recommended for clinical use
Nala Melis Pagina 2
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