Stroke Part 2: Synergies and Spasticity

Stroke Part 2: Synergies and Spasticity

Not everything is weakness! In the second of a multi-part series on stroke, Dr. Michael Powers highlights the role of abnormal synergies and spasticity on movement and functional difficulties after stroke. Along the way, you'll learn about stereotypical synergy and spasticity patterns, motor recovery expectations, tools to examine synergies and spasticity, and how to consider synergies and spasticity within an evidence-based plan of care for stroke rehabilitation. Key Takeaways * Acute stroke response and flaccidity * Abnormal synergies and impact on movement * Stages of motor recovery following stroke * Outcome measures for synergies: STREAM and Fugl-Myer * Spasticity as part of the upper motor neuron (UMN) syndrome * Strongest spasticity components for the upper and lower extremity * Examining spasticity: Modified Ashworth Scale and Tardieu Scale * Moving Forward: contextualizing synergies and spasticity within best current evidence References * O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed. [https://www.fadavis.com/product/physical-rehabilitation-fulk-8] * Stroke Rehabilitation Assessment of Movement [https://www.sralab.org/rehabilitation-measures/stroke-rehabilitation-assessment-movement] * Fugl-Meyer Assessment of Motor Recovery after Stroke [https://www.sralab.org/rehabilitation-measures/fugl-meyer-assessment-motor-recovery-after-stroke] * Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity [https://pmc.ncbi.nlm.nih.gov/articles/PMC10892074/] * Moving Forward: State of Evidence in Neurologic Physical Therapy [https://journals.lww.com/jnpt/fulltext/2021/01000/moving_forward.10.aspx] All music courtesy of Free Music Archive and used via attribution 4.0 international license. * Intro and Outro: Stylin' by JMHBM * Transitional: Our Reality by Ketsa Connect * email: neuropowerhour@drmichaelpowers.com * LinkedIn [https://www.linkedin.com/in/michael-powers-pt-dpt-edd/]

Stroke: Part 1

Time to talk stroke! In the first episode of a multi-part series on stroke, Dr. Michael Powers discusses stroke risk factors, the importance of early detection including the value of BEFAST and HINTS, and presentations of common vascular syndromes. Along the way, you'll learn about the differences between ischemic and hemorrhagic strokes, and how despite these differences the functional outcomes between these types of strokes is fairly similar. As 1 in 4 adults over the age of 25 will sustain a stroke in their lifetime, this is a vital topic for all physical therapists regardless of practice area! Key Takeaways * Prevalence/incidence of stroke * Stroke risk factors * PT role in educating patients on modifiable risk factors * Time is brain * Early detection: FAST, BEFAST, and HINTS * Ischemic vs hemorrhagic stroke - differences in medical management, similarities in functional outcomes * Vascular syndromes: ACA, MCA, PCA, which is most common? * Hemispheric differences References * O'Sullivan & Schmitz's Physical Rehabilitation, 8th ed. [https://www.fadavis.com/product/physical-rehabilitation-fulk-8] * WHO Global Stroke Fact Sheet 2025 [https://pmc.ncbi.nlm.nih.gov/articles/PMC11786524/] * Stroke Symptoms [https://www.stroke.org/en/about-stroke/stroke-symptoms] * Systematic Review Comparing FAST and BEFAST [https://pmc.ncbi.nlm.nih.gov/articles/PMC8837419/] * HINTS Exam More Sensitive Than Early MRI [https://pmc.ncbi.nlm.nih.gov/articles/PMC4593511/] * TPA vs TNK in Acute Ischemic Stroke Within 4.5 Hours [https://pubmed.ncbi.nlm.nih.gov/39413337/] * Hemorrhagic Stroke Overview [https://www.ncbi.nlm.nih.gov/books/NBK559173/] * Hemorrhagic Transformation of Ischemic Stroke [https://radiopaedia.org/articles/hemorrhagic-transformation-of-ischemic-stroke] * Ischemic vs Hemorrhagic Stroke Functional Outcomes [https://pubmed.ncbi.nlm.nih.gov/33379391/] All music courtesy of Free Music Archive and used via attribution 4.0 international license. * Intro and Outro: Stylin' by JMHBM * Transitional: Our Reality by Ketsa Connect * email: neuropowerhour@drmichaelpowers.com * LinkedIn [https://www.linkedin.com/in/michael-powers-pt-dpt-edd/]

Carpal Tunnel Syndrome

Time to talk about good ol' carpal tunnel syndrome! In this episode, Dr. Michael Powers discusses key considerations of managing carpal tunnel syndrome, including the importance of patient history and the use of evidence-based practice in clinical-decision making. He also highlights the importance of knowing your anatomy, including knowing the unforgiving structure of the carpal tunnel (how many flexor tendons are squeezed in there?) and recalling peripheral nerves are complex structures composed of multiple neurons functionally grouped together in fascicles. This episode is a must-listen if you're wanting to improve your confidence in applying the evidence toward the diagnosis, prognosis, and management of carpal tunnel syndrome! References * Global and Regional Prevalence of Carpal Tunnel Syndrome [https://pmc.ncbi.nlm.nih.gov/articles/PMC11645257/?shem=rimspwouoe] * Carpal Tunnel Syndrome [https://www.ncbi.nlm.nih.gov/books/NBK448179/] * Teach Me Anatomy: The Carpal Tunnel [https://teachmeanatomy.info/upper-limb/areas/carpal-tunnel/] * A Self-administered Hand Diagram for the Diagnosis of Carpal Tunnel Syndrome [https://www.jhandsurg.org/article/0363-5023(90)90124-A/abstract] * A Handy Review of Carpal Tunnel Syndrome [https://pmc.ncbi.nlm.nih.gov/articles/PMC4072815/] * Median Nerve Injury [https://www.ncbi.nlm.nih.gov/books/NBK553109/] * CPR for Carpal Tunnel Syndrome [https://www.physio-pedia.com/CPR_for_Carpal_Tunnel_Syndrome] * Carpal Tunnel Syndrome: A Summary of Clinical Practice Guideline Recommendations - Using the Evidence of Guide Physical Therapy Practice [https://www.jospt.org/doi/10.2519/jospt.2019.0501?shem=rimspwouoe] * Electrodiagnostic Evaluation of Carpal Tunnel Syndrome [https://www.ncbi.nlm.nih.gov/books/NBK562235/] * Recent Advances in Ultrasound Diagnosis of Carpal Tunnel Syndrome [https://pmc.ncbi.nlm.nih.gov/articles/PMC7460039/] * Surgical vs. Non-surgical Treatment for Carpal Tunnel Syndrome [https://www.cochrane.org/evidence/CD001552_surgical-versus-non-surgical-treatment-carpal-tunnel-syndrome] All music courtesy of Free Music Archive and used via attribution 4.0 international license. * Intro and Outro: Stylin' by JMHBM * Transitional: Our Reality by Ketsa Connect * Email: neuropowerhour@drmichaelpowers.com * LinkedIn [https://www.linkedin.com/in/michael-powers-pt-dpt-edd/]

Cerebral Cortex

Let's learn about the brain! In this episode, Dr. Michael Powers introduces the cerebral cortex including the four main lobes (and wait, is there maybe a 5th lobe?), differences between the left and right hemispheres, and the importance of the limbic system. If you've ever wondered where in the brain language is processed, memories are stored, commands for movement are generated, where incoming sensation is interpreted, or the role of emotions in memory consolidation then this episode is for you! References * Clinical Neuroanatomy, 30th Edition [https://www.amazon.com/Clinical-Neuroanatomy-30th-Stephen-Waxman/dp/1264583621] * Brain Anatomy and How the Brain Works [https://www.hopkinsmedicine.org/health/conditions-and-diseases/anatomy-of-the-brain] * Neuronatomy, Cerebral Cortex [https://www.ncbi.nlm.nih.gov/books/NBK537247/] * Insular Cortex [https://www.ncbi.nlm.nih.gov/books/NBK570606/] * Neuroanatomy, Limbic System [https://www.ncbi.nlm.nih.gov/books/NBK538491/] * Amygdala Activity [https://pmc.ncbi.nlm.nih.gov/articles/PMC2882379/] * My Stroke of Insight: A Brain Scientist's Personal Journey [https://www.amazon.com/My-Stroke-Insight-Scientists-Personal/dp/0452295548] All music courtesy of Free Music Archive and used via attribution 4.0 international license. * Intro and Outro: Stylin' by JMHBM * Transitional: Our Reality by Ketsa

Balance

In this episode, Dr. Michael Powers outlines key considerations for assessing and treating balance. He discusses the importance of considering contributions to balance from the individual, the environment, and the balance task including differences between various dimensions of balance. He differentiates normal age-related changes from balance dysfunction, and encourages clinicians to NOT accept balance dysfunction as part of the normal aging process. Your ability to effectively assess and treat balance will be enhanced after listening to this episode! Show References * Motor Control, 6th edition [https://www.amazon.com/Motor-Control-Translating-Research-Lippincott/dp/1975209567/ref=pd_lpo_d_sccl_1/136-7580794-0461133?pd_rd_w=uyw4R&content-id=amzn1.sym.4c8c52db-06f8-4e42-8e56-912796f2ea6c&pf_rd_p=4c8c52db-06f8-4e42-8e56-912796f2ea6c&pf_rd_r=QQ9MZM6YWGWA29MMP3V0&pd_rd_wg=O9SGL&pd_rd_r=bf8bd89d-5a1a-4669-a831-fd4fa24be697&pd_rd_i=1975209567&psc=1] * Changes in Sensory Organization Test Scores with Age [https://pubmed.ncbi.nlm.nih.gov/8670527/] * Motor Unit Number Estimates in Masters Runners: Use it or Lose it? [https://journals.lww.com/acsm-msse/fulltext/2010/09000/motor_unit_number_estimates_in_masters_runners_.5.aspx] * Muscle Changes in Aging [https://pmc.ncbi.nlm.nih.gov/articles/PMC3874224/] * Heavy Strength Training in Older Adults [https://pmc.ncbi.nlm.nih.gov/articles/PMC12003923/] * Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association [https://journals.lww.com/nsca-jscr/fulltext/2019/08000/resistance_training_for_older_adults__position.1.aspx] All music courtesy of Free Music Archive and used via attribution 4.0 international license. * Intro and Outro: Stylin' by JMHBM * Transitional: Our Reality by Ketsa