Neurological System Disorders

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Author:
chalford23
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227413
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Neurological System Disorders
Updated:
2013-08-03 21:38:26
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ALS
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ALS, neuropathies
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  1. Amyotrophic Lateral Sclerosis (ALS)
    • Onset-57, Death 2-5 yrs
    • Symptoms: 1) muscle weakness
    • 2) atrophy
    • 3) begins distally and asymmetrically
    • 4) cramps & fasciculations precede weakness
    • 5) lower motor signs are soon accompanied by spasticity, hyperactive deep tendon reflexes, corticospinal tract involvement
    • 6) dysarthria & dysphagia
    • Sensory system, eye movements, & urinary sphincters are spared.
    • Treatment: aimed at treating secondary complications 1) spasticity, 2) prevent aspirations
  2. Guillain-Barre Syndrome
    • Symptoms: 1) acute rapid progressive form of polyneuropathy characterized by symmetric muscular weakness & mild distal sensory loss/paresthesias
    • 2) weakness more apparent than sensory findings and more prominent distally
    • 3) stocking/glove distribution
    • 4) deep tendon reflexes are lost
    • 5) sphincters spared
    • 6) respiratory failure & dyphagia in some cases
    • TX: 2-4 wks after symptoms
  3. Myasthenia Gravis
    • progressive, disabling
    • Symptoms: 1) ptosis 2) diplopia 3) muscle fatigue after ex. 4) dysarthria 5) dyspahgia 6) proximal limb weakness
    • 7) sensation & deep tendon reflexes are intact
    • 8) symptoms fluctuate over course of day
    • 9) relapsing-quadriparesis may develop
    • 10) respiratory mus.-life threatening
  4. When a client with a progressive condition has a change in function, it is important to _____________ so that appropriate ___________ can be planned/implemented
    • re-evaluate
    • interventions can be planned
  5. Used to test vibration
    a. tuning fork
    b. nylon filament
    c. a disk-criminator
    d. ninhydrin test
    a
  6. Used to test the ability to sweat
    a. tuning fork
    b. nylon filament
    c. a disk-criminator
    d. ninhydrin test
    d
  7. Used to test cutaneous pressure thresholds
    a. tuning fork
    b. nylon filament
    c. a disk-criminator
    d. ninhydrin test
    b
  8. Used to test for 2-point discrimination
    a. tuning fork
    b. nylon filament
    c. a disk-criminator or caliper
    d. ninhydrin test
    c
  9. What type of evaluation is used for evaluating one's capabilities for the physical demands of a specific job or for a group of occupations.
    Functional Capacity Evaluation (FCE)
  10. Stages of motor learning (3)
    • 1. Skill acquisition (cognitive stage)
    • 2. Skill retention (associated stage)
    • 3. Skill transfer (autonomous stage)
  11. What stage occurs during initial instruction & practice of skills
    Skill acquisition, cognitive stage
  12. What stage involves "carry over", as ind. are asked to demonstrate their newly acquired skills after initial practice
    Skill retention, associated stage
  13. What stage involves the ind. demonstrating the skill in a new context
    Skill transfer, autonomous stage
  14. Practice of several tasks in random order encouraging reformulation of the solution to the presented motor problem
    Random or variable
  15. Repeated perf. of the same motor skill
    blocked practice
  16. practice of skills in various contexts to improve transfer of learning & retention of skills
    variable conditions
  17. T/F generalization is a tx technique
    F
  18. Child with C-7 lesion is able to complete what act I.
    • UE dressing
    • Personal grooming
    • Tabletop act.
  19. T/F Child with c-7 injury would need to focus intervention on LE dressing
    T
  20. Light joint compression throughout the trunk & LE during a reaching act. is consistent with what approach
    Rood
  21. Therapeutic handling to affect the CNS is what approach
    neurodevelopmental theory approach
  22. Providing a stool to sit on during reaching act. can  be used for safety is what type of approach
    compensatory
  23. Verbal & visual feedback while practicing reaching is what type of approach
    Motor-re-Learning Program (MRP)
  24. What practice is used when a client moves numerous one pound cans of veggies from the counter to the cabinet
    blocked-invloved repeated perf. of the same motor skill.
  25. What practice is used for a client who lifts cans of different sizes, shapes, and/or weights from the counter to the cabinet
    Random-invloves the perf. of several tasks in random order to encourage re-formulation of the solution to the presented motor problem.
  26. Direct therapy for oral motor intervention utilizes a __________________________
    bolus
  27. Indirect therapy for oral motor intervention does not include the use of a _______________
    bolus
  28. What is aura
    Brief warning including numbness, taste, smell, or other sensation before tonic phase of seizure.
  29. First aid steps for seizure
    • 1. Remain calm
    • 2. remove dangerous objects & protect ind. from harm w/out interfering with ind. movements
    • 3. If upright, gently guide to floor, loosen clothing
    • 4. turn ind. on side to prevent choking
    • 5. Don't put stuff between teeth
    • 6. don't be alarmed if they seem to stop breathing momentarily
    • 7. if breathing stops, use standard rescue breathing.
  30. Post-seizure care
    • 1. Let rest/sleep
    • 2. call dr. if 1) 1st seizure, 2) followed by another seizure, 3) lasts more than 5min.
    • 3. notify parent/caregiver/guardians or emergency person that seizure occurred
    • 4. observe safety precautions if ind. seems groggy, confused, weak
  31. Landau-Kleffer Syndrome
    • 1. Acquired epileptic aphasia
    • 2. Progressive encephalopathy (disease affecting tissues of the brain)
    • 3. loss language skills
    • 4. auditory agnosia (inability to distinguish different sounds)
    • 5. Behavioral disturbances, inattention,
  32. Lennax-Gastaut syndrome
    • 1. Children w severe seizures, mental retardation, specific EEG pattern
    • 2. Begin 1st 3yrs life, diff. to control
    • 3. associated w diff. brain disorders-structural abnormalities to birth asphyxia (lack oxygen)
    • 4. regression of dev. status can occur
  33. D1 PNF pattern
    • reach down on same side
    • reach up and across to opp. side
    • L-side impairment
    • dishwasher on L side cabinet on R
    • reach and grab dishes with L hand & cross to put in r-sided cabinet
  34. D2 PNF pattern
    • reach down on opposite side
    • reach up on same side
    • R-side impairment
    • dishwasher on L-side & cabinet on R-side
    • reach down and across with right hand
    • put up in cabinet on r side.
  35. A client recovering from CVA demonstrates increased flexor tone in the dominant right UE while trying to re-learn to right with L hand. What is he exhibiting?
    An associated reaction
  36. Normalization of tone & muscular responses are achieved via controlled sensory stimulation
    Rood
  37. Rood's facilitation techniques
    • 1. Fast brushing
    • 2. Stretch/tendon tapping-quick manual tapping to apply quick stretch to desired muscle.
    • 3. High frequency vibration
    • 4. Quick icing
    • 5. Heavy joint compression-manually & longitudinally in WB position
    • 6. Resistance-utilizing gravity or OTs hand stimulates muscle recruitment.
  38. Rood's Inhibition Techniques
    • 1. gentle rocking
    • 2. slow stroking over post. rami of spine
    • 3. slow rocking from supine to side-lying and back in rhythmical pattern
    • 4. Tendinous pressure over muscle insertion
    • 5. maintained stretch-inhibit spastic muscle
    • 6. neutral warmth
    • 7. prolonged icing
  39. Fast brushing over the muscle belly is considered a ________ approach and is used to __________ movement.
    • Rood
    • facilitate
  40. Slow brushing & firm pressure over a muscle belly are a _______ approach and are used to _________ movement.
    • Rood
    • inhibit
  41. Slow responses, hesitancy, fearfulness, cautious behavior; can appear slow due to cautious behavior are indicators of what side CVA
    Left CVA
  42. Impulsive behaviors, poor judgement & disregard for safety are indicators or what side CVA?
    Right CVA
  43. Bilateral motor praxis, bilateral auditory reception, speech, verbal memory, processing verbal auditory info, visual verbal processing.
    What sided CVA?
    Left CVA
  44. visual spatial, nonverbal memory, nonverbal auditory, attention, emotion, interpret abstract info & tonal inflections.  
    What sided CVA?
    Right CVA
  45. Lobe?
    voluntary muscle control
    plan movements
    emotions/judgement
    Broca's
    Frontal Lobe
  46. Lobe?
    receives/processes auditory info
    wernicke's, comprehension
    Temporal
  47. Lobe? 
    integration of sensory 
    touch, proprioception, temp on opposite side of body
    Sensory cortex
    parietal lobe
  48. Lobe? 
    receives & interprets visual
    occipital
  49. Lobe?
    Connects with vestibular system; equillibrium & regulation of muscle tone
    receives input from propriocpetive pathways; modifies tone & synergistic actions of muscles
    maintenance of posture, voluntary movement control
    smooth coordination of voluntary movements; accurate force, direction, degree of movement.
    cerebellum
  50. What would you screen for in ind. who had tumor removed on cerebellum
    proprioception & coordination
  51. What would you screen for in ind. who had tumor removed on parietal lobe
    sensory & tactile integration
  52. What would you screen for in ind. who had tumor removed on occipital
    vision & visual perceptual
  53. What would you screen for in ind. who had tumor removed on temporal
    audition & communication
  54. What would you screen for in ind. who had tumor removed on frontal lobe
    expressive language, emotions & judgement, planned movements
  55. An adult incurred an injury to the anterior spinal artery at T12.  What sensory eval should be preformed on the client.
    proprioception
  56. An adult incurred injury to dorsal (posterior) columns, which sensory should be tested.
    pain, light touch, temperature
  57. What level can ind. use joystick control?
    C-8
  58. What level can ind. use tendonesis splint?
    C-6 & C-7
  59. What level can ind. use chin switch?
    C-3 & C-4
  60. What level can ind. use dorsal splint with universal cuff?
    C-5
  61. Symptoms of CVA
    • 1.numb, weak (face, arm leg) usually unilateral
    • 2. confusion
    • 3. diff. talking, seeing 1 or both eyes, walking, dizziness, loss balance & coordination
  62. Glasgow Coma Eye responses
    • spontaneous eye opening 4
    • eyes open to speech 3
    • open to pain 2
    • no opening 1
  63. Glasgow Verbal Responses
    • Oriented, coherent, appropriate answers 5
    • confused coherent to questions with some disorientation/confusion 4
    • inappropriate words, random, no conversation 3
    • incomprehensible sounds, moaning, no words 2
    • none 1
  64. Glasgow Motor Repponse
    • obeys commands, simple tasks 6
    • localizes pain, purposeful movement towards changing painful stimuli 5
    • withdraws from pain 4
    • flexion (decorticate) to pain 3
    • extension (decebrate to pain) 2
    • no motor response 1
  65. Decorticate rigidity
    abnormal flexion
  66. Decerebrate rigidity
    extension posturing
  67. Rancho Levels
    Total Assistance
    • I. no response
    • II. Generalized Response: reflex, responds to repeated auditory stimuli 
    • III. Localized Response: withdraw/vocalize to pain, turns toward/way auditory stimuli, blinks at light, follows moving object in field, pulls tubes, respond to family
    • Interventions: positioning, PROM, splints, sensory stimuli, promote functional mobility skills by upright posture for arousal & body alignment.
  68. Rancho Confused Stages/Mid-Level Recovery
    • IV (agitated) & V (inappropriate): MAX A
    • VI (appropriate): MOD A
    • Interventions: Provide structure, preventing overstimulation for confused, agitated patient- Providing a closed, reduced stimulus environment- daily schedules, memory logs, relaxation techniques, providing consistency: use team-determined behavioral modification techniques- give clear feedback, writen contracts, engage the patient in task-specific training- limit activities to familiar well-liked ones- offer options; break down complex task into component parts- provide verbal or physical assistance, Control the rate instruction; - Provide frequent orientation to time,place, your name and task- Emphazie safety, behavioral management techniques- Model calm, focused behavior
  69. Rancho Appropriate stages
    • VII (auto-Min A)
    • VIII (purposeful, Stand by A
    • IX (purposeful, Stand by on request)
    • X Purposeful, MI
    • Interventions: Allow for increasing independence: wean patient from structure (from closed to open environments); involve patient in decision making, Assist patient in behavioral, cognitive, emotional reintegration: provide honest feedback, prepare for community re-entry, Promote independence in functional tasks: Functional Mobility Skills, ADLs, in real-life environment, Improve postural control, symmetry and balance- encourage active lifestyle, improve cardiovascular endurance, Provide emotional support, encourage socialization, behavioral control, and motivation- re-orient and reassure- provide patient and family education
  70. ASAI scale for degree of severity
    • A. complete, no sensory or motor function  is preserved in sacral segments
    • B. incomplete, sensory but no motor is preserved below neurological level to sacral
    • C. incomplete, motor preserved below neurological level, key muscles below level muscle grade less than 3/5
    • D. incomplete, motor preserved below neurological level, key muscles greater or equal to 3/5
    • E. Normal
  71. Brown-Sequard Sumdrome
    • Ipsilateral: spastic paralysis, loss position sense, loss discriminate touch
    • Contralateral: loss pain, temp
  72. Anterior Cord Syndrome
    Loss motor, pain, temp bilaterally below level of lesion
  73. Conus Medullaris Syndrome
    • Injury of sacral cord & lumbar nerve roots
    • LE motor & sensory loss
    • Reflexive bowel, bladder
  74. Cauda Equina Syndrome
    • injury L1 & below
    • Lower motor lesion
    • flaccid paralysis-no spinal reflex activity
  75. Automatic Dysreflexia Signs
    • rise in BP
    • pounding headache
    • profuse sweating
    • medical emergency, if not reversed by removing irritating stimullus
  76. Deep Vein Thrombosis Signs
    • swelling
    • pain/tenderness
    • warm
    • red/discolored
  77. Parkinson's signs
    • Resting: pill rolling tremor in 1 hand
    • Cardinal Signs: tremors, rigidity, akinesia, postural instability, festinating gait, retropulsion, propulsion, mask face, micrographia, resistance to passive motion (cogwheel or lead pipe)
  78. Stage _____ Parkinsons
    unilateral tremor, rigidity or akinesia
    Min to no fun. impairement
    I
  79. Stage _____  Parkinsons
    Bilateral tremor, rigidity, akinesia with or without axial signs
    I ADLs
    no balance impairment
    II
  80. ______ Stage of Parkinsons
    Impaired righting reflexes, onset of disability in ADL perf., can lead I life.
    III
  81. Stage _____ Parkinsons
    Needs helps with some or all ADLS
    unable to live alone
    can stand, walk unaided
    IV
  82. Stage ______ Parkinsons
    Confined to W/C or bed
    MAX A
    V
  83. Spina Bifida with Myelomeningocele
    • Sensory & motor deficits below level of lesion
    • LE paralysis &/or deformities
    • bowel/bladder incontinence
    • Shunts may be needed due to intracranial pressure
  84. Signs of blocked shunts
    1st year
    2nd year
    Signs infected shunts
    What to do?
    • 1st-head growth, ten soft spot forehead
    • 2nd-severe headache, vomiting, irritability
    • infected-seizures, deterioration of physical/cognitive function
    • Might see changes in behavior, school perf., fever, pallor, visual perceptual difficulties
    • Call neurosurgeon immediately
  85. What syndrome?
    Hairy patch, hemangioma, dimple lower spine
    difficulty with bowel/bladder, gait disturbances, deformities of feet
    Tethered Cord
  86. Recovery of _______ & _________ precede recovery of _____________ &  _______ ________.
    • pain and temperature (small unmylenated fibers, recover faster) 
    • Part of protective primary sensory system, received simple info
    • proprioception & light touch (larger mylenated fibers)
    • also include vibration & tactile localization
    • discrimitative or epecritic system, carry complex info
  87. Wrist-driven flexor hinge splint used with what population
    • C-6 injury
    • extensor tone of muscles in conjunction with the splint will operate the power for prehension force
  88. When sensation begins to return, it is important to provide ___________ activities for sensory retraining.
    • Remedial
    • Stimulate the involved extremity by rubbing or stroking (tactile input) or through WB (proprioceptive input)
    • Compensatory strategies such as teaching how to feel water with uninvloved UE would be part of original treatment.
  89. T/F When working with an ind. with diabetes on a macrame project for increasing standing tolerance, it's MOST relevant to take into consideration
    A. length of cord
    B. thickness of cord
    C. texture of cord
    D. type of surface
    • C-coarse materials may shred or cause splinters or injure skin.  For ind. with poor circulation & sensation, skin damage must be avoided, as healing is compromised.  
    • Length-Limited ROM
    • Thicknesss-limited hand functions
    • Surface-back pain
  90. T/F When working with a client with apraxia it is best to have the ind. visualize the task first and then provide general statements such as "Let's get ready".
    • T-visualizing a task & its movement sequences helps the ind. by giving visual model to refer to during the act.  
    • Using general statements rather than step-by-step is more effecitve as ind. with motor apraxia have diff. imitating or initiating motor tasks on commands.  
    • They understand the concept of the task.
  91. persistent rednessskin intact with nonblanchable redness over localized area.  warm or cool, pain, itchy
    partial thickness ulcer
    stage I ulcer
  92. can present as a blister that is intact or open/ruptured.  
    wound bed is pink without slough or bruising
    partial thickness ulcer
    Stage II
  93. Involves full thickness loss with subcutaneous fat possible visible
    depth of tissue loss is not obscured if sloth (dead matter/necrotic tissue) is present.  
    Bone, tendon, muscle not exposed or palable
    Stage III
  94. Extend to muscles, tendon, fascia, and/or joint capsule
    Osteomyelitis is a concern
    Stage IV Ulcer
  95. Compensatory strategy for homonymous hemianopsia
    teach client to turn head to the affected side.
  96. 1. T/F An ind. with complete C6 can not set a goal to dress independently.  

    2. T/F Same ind. would need MAX A to don socks & shoes
    1. F- an ind can I don underwear & pants while laying in bed.  

    2. F- need MIN A to don shoes & socks
  97. When using a deficit-specific approach for an ind. with residual body neglect due to CVA, what is the best approach to use
    Bilateral activities using both UE.  During these act. the OT can guide the affected extremity through the activity.
  98. T/F The most severe spinal cord injury level that an ind. can have to perform I bowel & bladder training including skin inspections is C6
    F- C7-C8, C6 and above don't have fine motor control to perform skills needed for I in bowel & bladder
  99. What is the best PNF pattern to use with ind. with stiffness recovering from CVA
    D1 and D2 flexion with traction
  100. T/F A person returning to work with C5 injury will be working on a keyboard.  What is the best splint and device to use
    A wrist splint in functional position with a slot to hold a typing stick
  101. T/F Slow stroking is a PNF approach to help with relaxation when restriction is felt during ROM.
    • F- Rood approach
    • PNF approach is rythmic rotation
    • OT repeats rotation all the components of PNF pattern at the point of restriction slowly and gently.  As relaxation response occurs, movement is continued through larger range.
  102. Transfer of training approach is remedial/restorative that focuses on restoration of components to increase skill.  It is deficit specific & utilizes _________ and _________ activities as treatment modalities
    tabletop and computer

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