Neuro exam 2
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. What would you like to do?
what is a breakdown between concept and performance. Disconnection between the idea of a movement and its motor execution?
what do you call it when the pt. is able to carry out habitual tasks automatically and describe how they are done, but can't imitate gestures or perform on command.?
what is failure in the conceptualization of task. the inability to perform a purposeful motor act; either automatically or on command?
what do you call it when the patient no longer understands the overall concept of the task. Can't retain the idea of or cant formulate motor pattern required?
what is faulty spatial analysis and conceptualization of the the task?
what do you call it when a pt. knows the normal constructional skills, but lacks the capacity to understand the relationship of the parts to a whole? Like they know what you need to make a sandwhich and when they have it in front of them they don't know how to put it together
what do you call inability to dress oneself properly. Often pt. dresses just one side of the body
what do you call it when the pt. fails to respond to stimulus in one part of their visual field? They might walk into things because they don't tend to the R or L side. They keep their head turned in direction they tend to.
visual spatial agnosia
what is lack of recognition?
what is the inability to recognize familiar objects despite normal function of the eyes and optic tracts?
visual object agnosia
a pt. with what may not be able to recognize familar objects, but because their ____________ is still intact they can identify an object once its handled.
- visual object agnosia
what is the inability to recognize forms by handling them; although tactile, proprioception, and thermal sensations may be intact
what is the inability to recognize non-speech sounds or to discriminate between them. Rarely occurs in the absence of other communication disorders? For example the pt. may not know the difference between the dog barking and the phone ringing.
what is a sever condition including denial and lack of awareness of the presence or severity of ones paralysis. Lack of awareness or denial of a paretic extremity as belonging to a person.
T/F: anosognosia is not common, but can resolve on it's own.
what is lack of awareness of the body structures and the relationship of body parts to oneself or to others?
what do you call it when a pt. has difficulty following instructions that require distinguishing bodyparts and may be unable to imitate movements of the therapist?
what is the inability to register and integrate stimuli and perceptions from oneside of the body (body neglect) and the environment (hemispace or spatial neglect) which is NOT due to sensory loss?
what is the inability to identify the right and left side of ones own body or that of the examiner; includes the inability to execute movements in response to verbal commands that include the terms right and left. Pt.'s are often unable to imitate movments.
left/right discrimination deficit
what is the inability to visually distinguish a figure from the background in which it is embedded? Pt. has difficulty ignoring irrelevant visual stimuli and cannont select the appropriate cue to which to respond?
what is the inability to perceive or attend to subtle differenced in from and shape? pt. likely to confuse objects of similar shape or not to recognize an object placed in an unusual position such as a water bottle being knocked over on its side.
form consistency deficit
what is the inability to perceive and interpret spatial concepts such as up, down, under, over, in and out, in front of, behind
position in space deficit
what do you call inaccurate judgement of direction, distance, and depth. spatial disorientation may be a contributing factor in faulty distance perception?
depth and distance perception deficit
what do you call difficulty understanding and remembering the relationship of one location to another?
during the stance phase lateral trunk sidebending/trendelenburg is due to what?
weak glute med
during stance phase, backward lean is due to what?
weak glute max
during stance phase, forward lean is due to what?
weak hip extensors
during stance phase limited hip flexion is due to what?
tight extensors OR weak flexors
what is done during abnormal synergistic activity or "scissoring"
- hip adduction
- knee extension
- ankle plantarflexion
what is an antalgic gait?
- short stance on affected
- short stride length on unaffected
during stance phase, excessive knee flexion is due to what?
weak quads with buckling or weak flexors
during stance phase, hyperextension or "recurvatum" is due to what?
weak quads or extensor spasticity
during stance phase toe first is due to what?
weak dorsiflexors or tight plantarflexors
during stance phase, foot slap is due to what?
decreased conrol of dorsiflexors that is compensated with steppage gait
during stance phase, foot flat is due to what?
- limited ROM
- weak dorsiflexor
during stance phase, exessive DF with uncontrolled tibial advancement is due to what?
weak plantarflexors; may have knee hyperextension
during stance phase, excessive PF/equinis gait is due to what?
spasticity/ contracutre of PF
during stance phase, varus foot is due to what?
spastic anterior tib or weak peroneals
during stance phase, claw toe is due to what?
spastic toe flexors or grasp reflex (UMN)
during stance phase, inadequate toe off is due to what?
- decreased ROM
- weak PF
- pain in forefoot
during swing phase pelvic rotation is due to what?
weak abs and/or weak hip flexors
during swing phase decreased hip/knee flexion is due to what?
weak hip and knee flexors or spastic extensors
during swing phase circumduction is due to what?
weak hip flexors or limited ROM
during swing phase hip hike is due to what?
compensate for weak hip and knee flexors or extensor spasticity
during swing phase excessive hip and knee flexion "steppage gait" is due to what?
compensation for shortened limb or weak DF's
what is the synergistic pattern during swing phase?
strong flexion synergy; hip & knee flex with hip adduction
during swing phase, decreased knee flexion is due to what?
extensor spasticity, pain, decreased ROM, weak knee flexors
during swing phase, excessive knee flexion is due to?
- flexor spasticity
- flexor withdrawal reflex
during swing phase foot drop is due to?
weak or poor recruitment of DF or spastic PF's
during swing phase verus/inverted foot is due to?
spastic inverters or weak peroneals or synergistic pattern
during swing phase equinovarus of the foot/ankle is due to what?
spastic posterior tib and/or gastroc/soleus or structural deformity
what is based largely on the assumptions drawn from the reflex and hierarchial approaches to motor control?
neurofacilitation has emphasis on ______________________ and the techniques are designed to either _______ or _________ movement patterns
- modification of the CNS vs. the mm involved
- inhibit or faciliate
what are intervention techniques that increase the patients ability to move in ways judged appropriate by a clinician?
what are intervention techniques used to decrease the patients use of movement patterns considered to be abnormal?
according to neurofacilitation, recovery of function is dependent upon what?
the higher centers of the CNS regain control over lower centers
neurofacilitation assumes what about normal movement?
normal movement comes from a chain of reflexes organized hierarchially in the CNS
another assumption of neurofacilitation is that functional skills will?
automatically return once abnormal movement patterns are inhibited and normal movement patterns are facilitated
with neurofacilitation what will transfer into functional tasks?
repetition of normal movements (1000's of reps)
what approach is seen the most in regards to movement retraining?
task oriented approach
TOA is organized with what in mind?
behavioral goal that is set up in a way that the patient is successful the first go around
With TOA it is essential to work on what rather than what?
- identifiable functional tasks
- movement for movement sake alone
TOA assumes what regarding movement?
patients learn actively attempting to solve problems inherent in a functional task rather than by repetively practicing normal patterns of movement.
What is CIT and how is it accomplished?
- constraint induced movement theory
- restraining of a non-involved limb to force use of an involved limb
what restricts volitional movement, causes "posturing", painful spasms, impairment of automatic postural tone and obligatory synergistic movement?
flaccidity with no movement of the limbs following acute stroke describes what stage of motor recovery?
minimal volitional movement- spasticity begins; occurs as recovery begins describes what stage of motor recovery?
gains voluntary control over the synergy (but not usually full range), spasticiy increasing, and may become severe describes what stage of motor recovery?
some movements out of synergy; spasticity begins declining describes what stage of motor recovery?
synergies lose dominance and more difficult movement combinations are learned describes what stage of motor recovery?
disapperance of spasticity, individual joint movement becomes possible and coordination develops. normal motor function is restored. This describes what stage of motor recovery?
what is the flexion synergy of the UE?
- scapular retraction/elevation or hyperextension
- shoulder ab-d, ER
- elbow flexion
- forearm supination
- wrist & finger flexion
what is the extension synergy of the UE?
- scapular protraction
- shoulder ad-d, IR
- elbow extension
- forearm pronation
- wrist & finger extension
T/F: Patients may progress from one stage to another stage of motor recovery out of order
what is the flexion synergy of the LE?
- hip flexion, ab-d, ER
- knee flexion
- ankle DF & inversion
- toe DF
what is the extension of the LE?
- hip extension, ad-d, IR
- knee extension
- ankle PF, inversion
- toe PF
how are the reflexes s/p CVA?
typically start off hypo and then become hyper-reflexive
what is a physical ambulator?
walks for exercise only
what is a limited household ambulator?
relies on walking to some extent for home activities-requires some assistance; furniture walkers
what is a unlimited household ambulator?
able to walk in home independently, difficulty with stairs and uneven surfaces. may not be able to leave the home independely
what is the most limited community ambulator?
can come and go independently from the house, can manage curbs, and some degree of stairs, independent with low level activity (church)
what is the least limited community ambulator?
indep stairs, stores, and croweded shopping
what is a community ambulator?
independent with all community and home activites, can manage crowds and uneven terrain
what is apraxia?
- inability to plan and execute coordinated movements.
- results from lesions of the pre-motor cortex of either hemisphere as well as the left parietal and corpus callosum.
what are the two types of apraxia?
- ideational: inability to move on their own or on command
- ideamotor: can move automatically but not on command
how is gait an autonomic postural activity?
neural control from subcortical and spinal centers. the role of the cortex is to intervene for adaptation purposes and to correct movement patterns based upon info from the cerebellum
T/F: the sooner ambulation occurs after a stroke the better the outcome for ambulation will be.
what is the typical gait presentation with a stroke?
- decreased speed
- assymetrical gait
- affected limb with longer step whereas unaffected side with shortened step length
- decreased efficiency and endurance
why are there gait changes after a stroke?
- change in sensory interpretation
- loss of motor control
- cognitive issues
what is ther-ex?
- strengthening, stretching
- anything you would do at a gym
what is therepeutic activity?
- something leading towards functional status
- bed mobility
- sit -> stand
what is the typical progression for forward and backward walking?
- assistance: // bars > AD > unassisted
- step length: short > long
- speed: slow > normal
- BOS: wide > narrow
what is sidestepping good for?
glute med in both dynamic and stance limbs
what are some facilitation techniques? (5)
- weight bearing
- light touch
- quick icing
- quick stretch
what are some inhibition techniques? (4)
- neutral warmth
- deep pressure
- prolonged stretch
- prolonged cold
what is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor response and improve neuromuscular control and function?
proprioceptive neuromuscular facilitation (PNF)
what type of movements does PNF use?
- diagonal and rotational
what type of sensory cues do you use for PNF?
- proprioceptive: hands on boney prominences
- cutaneous: tapping on muscle belly
- visceral: watch and move head in the direction you are moving the limb
- Auditory: Tone and speed of your voice and reptition of the word
what are the 7 potential uses for PNF?
- facilitate neuromuscular control
- develop myscular endurance
- facilitate stability
- facilitate mobility
- coordinated movements
- utilized to increase flexibility
- lay a foundation for the restoration of function
when is using PNF appropriate?
throughout the entire rehab process
what are the 9 important concepts to performing PNF?
- manual contacts: change when the goal changes
- maximal resistance: greatest amount that still allows to move smoothly
- position and movement of the therapist: shoulder and trunk in the direction of the moving limb
- stretch: quick stretch just past the point of tension; distal -> proximal
- normal timing: muscles fire in appropriate sequence distal -> proximal
- traction: slight separation of jt. surfaces to inhibit pain and faciliate movement
- approximation: compression of jt. surfaces to stimulate co-contraction
- verbal commands: vary tone and volume based upon response
- visual cues: instruct and remind the pt. to watch and concentrate on the movement
what is the D1 PNF pattern of the UE?
- D1 flexion: flexion, adduction, external rotation
- DeLaHoya punch
- D1 extension: (reverse flexion) extension, abduction, internal rotation
what is the D2 PNF pattern of the UE?
- D2 flexion: flexion, abduction, external rotation
- draw your light-saber
- D2 extension: (reverse flexion) extension, adduction, internal rotation
what is the D1 PNF pattern for the LE?
- D1 flexion: flexion, adduction, external rotation
- hacky sack
- D1 extension: extension, abduction, internal rotation
what is the D2 PNF pattern for the LE?
- D2 flexion: flexion, abduction, internal rotation
- puppy at fire hydrant
- D2 extension: extension, adduction, external rotation
what is PNF performed symmetrically?
D1 flexion of both UE's/LE's
what is PNF performed asymmetrically?
D1 flexion of one UE concurrent with D2 flexion of the other UE
what is PNF performed reciprocally?
D1 flexion of one UE with concurrent D1 extension of the other UE
what is the purpose of alternating isometrics and what is the procedure?
- purpose: improve isometric recruitment; strength and promote stability
- procedure: isometric holding against alternating resistance from one direction to the opposite but in the same plane; no joint movement should occur
what is the purpose of agonist reversals and what is the procedure?
- purpose: work on both concentric (raise) and eccentric (lower) motor control of a specific movement or muscle
- procedure: first apply resistance to the agonist in one direction during a concentric contraction immediately followed by the controlled eccentric contraction of the same muscle while moving in the opposite direction; resistance stays the same, don't switch hand contacts
what is the purpose of slow reversals and what is the procedure?
- purpose: promotes rapid reciprocal action of agonists and antagonists
- procedure: slow, isotonic contractions of the agonists through the ROM followed without a rest by slow, isotonic contraction of the antagonist; hand contacts change
what is the purpose of repeated contractions and what is the procedure?
- purpose: strengthen an agonist at any point of the ROM where it may be weak
- procedure: repeated, dynamic contractions, initiated with quick stretches at any point in the ROM where recruitment or strength is limited
what is the purpose of rhythmic initiation and what is the procedure?
- purpose: promote the ability to initiate a movement pattern
- procedure: passively move patients through the desired movement several times to familiarize them with the movement and rate, then practice assisted or active movement through the motion
what is the purpose of rhythmic rotation and what is the procedure?
- purpose: to treat hypertonia with limitations in function
- procedure: voluntary relxation combined with slow, passive, rhythmic rotation of the body part around a longitudinal axis, followed by movement into the limited range
what is purpose of rhythmic stabilzation and what is the procedure?
- purpose: used to treat instability in WB, poor static postural control and weakness
- procedure: typically performed in a WB position, is alternating isometric contraction of the agonists followed by isometric contraction of the antagonist pattern. Resistance is applied in multiple directions rather than unidirectionally
what is the purpose of contract relax and what is the procedure?
- purpose: increase flexibility
- procedure: place range limiting muscle in a stretched position then the pt. performs an isometric contraction of the limiting muscle for 5-10 second, then relaxes while the extremity is further taken into a stretched position.
what is contract-relax-active contraction (CRAC)?
same as CR but after the isometric contraction the pt. contracts the agonist moving the segment into the new range during the stretch that follows
what are the developmental stages of motor control?
- initial mobility
- controlled mobility
what PNF techniques would you use during the initial mobility stage?
- rhythmic initiation & rotation
- CR & CRAC
- hold-relax active movement
- repeated contractions using resistance and stretch as tol
- active assistive & guided movement
what is the initial mobility stage?
postural and antigravity control is typically lacking, functional patterns are not well controlled.
what is the stability stage?
the ability to maintain a steady position in weight bearing, antigravity posture; maintaining COM within the limits of stability
what PNF techniques would you use during the stability stage?
- alternating isometrics
- rhythmic stabilization
- slow reversals
- positioning and holding
what is the controlled mobility stage?
dynamic postural control; ability to change position or move in weight bearing while maintaining postural stability
what PNF techniques would you use during the controlled mobility stage?
- agonist reversal
- slow reversal
- D1/D2 tracking resistance
- diagnal pattern
- active-assitive to active movements to movement transitions
what is the skill acquisition stage?
highly coordinated movement that allows for adaptability
what are the 8 things that emphasis is placed on during the skill acquistion stage?
- coordination tasks
- refinement of swquential and temporal organization
- control of multiple body segements
- dual tasks
- reactive and proactive balance activites
- agility tasks
- practice in variety of environmental contexts (from closed to open)
- balanced contributions of agonists and antagonists and smooth timing
what is a MTBI?
- mild traumatic brain injury
- a complex pathophysiological process affecting the brain, induced by traumatic forces
- new term for concussion
T/F: the number of concussions among contact sports is likely a lot higher due to people not reporting them because of the return to sport protocol for concussions.
what are the combat sports associated with MTBI's?
what are the collision sports associated with MTBI's?
what are the contact sports associated with MTBI's?
what percent of people recover from a concussion within 1 week with or without treatment?
what percent of people recover from a concussion within 2 weeks with or without treatment?
what percent of people recover from a concussion within 3 weeks with or without treatment?
loss of consciousness
difficulty remembering new info
double vision/blurry vision
sensitivity to light/noise
These are s/s of what?
LOC >1 min
severe persistent neck pain
weakness/numbness/tingling in arms or legs
severe loss of balance
worsening of s/s
These are s/s of what?
medical emergency related head injury
which s/s is indicative of prolonged recovery associated with a concussion and what does it mean?
- means you have vestibular involvement and it takes longer for that system to recover
how do you treat a concussion?
- imaging as needed: at least neck x-ray b/c concussions don't show up on imaging
- computer based neuropsychological testing: imPACT; memory, responsiveness, etc..
- cognitive and physical examination: mini-mental, balance and vestibular testing
- REST: complete brain rest; no work, school, TV, music, reading, facebook, texting, video games
With brain rest how do you return to prior level of functioning?
gradually introduce mental activity 15-30 min at a time
T/F: noise, light, crowded environment, driving/riding in a car might increase the s/s of a concussion?
T/F: with a return to sport protocol after a concussion the patient must stay in a phase until ALL s/s of each phase have fully resolved
what are the 6 phases of the return to sport protocol after a concussion?
- 1. rest
- 2. light aerobic exercise
- 3. sport specific exercise
- 4. non-contact drills
- 5. full contact after medical clearance from MD
- 6. game day
T/F: the affects of concussions are cumlitive, even if they are 10 years apart.
what is the worse case scenario after a concussion?
second impact syndrome: another impact before recovery causes severe brain swelling and death
what is persistence of concussion symptoms for greater than 3-4 weeks?
post concussion syndrome
What is the cure for TBI's?
- no cure just prevention
- decrease drinking and driving
- use seat belts and wear helmets
- proper training and equipment for athletes
how does primary damage from a TBI occur?
- result of the forces acting on the brain at the time of injury
- acceleration, deceleration, rotational
how does the secondary damage from a TBI occur?
occurs due to brain swelling or impaired blood flow to the site of injury (hypoxia, ischemia, ICP, post traumatic epilepsy
localized damage; may be due to hematoma, edema, contusion, laceration or a combination is known as what?
what are the two types of focal injuries?
- closed: brain tissue contacts the skull forcefully
- open: skull is penetrated and brain is exposed
what is coup? and what is contracoup?
- coup: direct lesion of the brain under the point of contact
- contracoup: injury to the opposite side from impact (rebound effect after impact)
what is caused by acceleration, deceleration and rotational forces and what type of accident does it typically occur with?
- diffuse axonal injury
- roll over accident
what creates shearing forces that disrupts the integrity of the axons and has lots of deficits with this type of injury?
diffuse axonal injury
what areas of the brain are typically injured with a diffuse axonal injury?
brainstem, cerebellar tracts, basal ganglia, corpus collosum
how does a DAI affect nerves?
wallerian degeneration: everything distal to the injury dies
are increased level of neurotransmitters toxic to nerves? If so what can happen?
- causes cells to shut down causing further damage
Can trauma cause the brain to shift? What else could cause the brain to shift?
what can occur from systemic hypotension, anoxia, damage to vascular territories and can lead to global damage and poorer outcomes? What can it be caused by?
- hypoxic-ischemic injury
What is normal ICP?
What are the 3 classifications for hematomas?
- according to their site
- epidural: above the dura, below the skull
- subdural: under the dura, above the arachoid
- intracerebral: blood vessel bleeding into the brain tissue
T/F: even mild increases of ICP are associated with increased mortality.
__________ are more indicative of recovery than _____________.
- cognitive deficits
- physical dysfunction
what are the three predictors of disability??
- 1: severity of injury; measured by the glasgow coma scale
- 2: length of coma:
- >2 weeks: severe disability 1 year post injury
- <1 week: mild to moderate disability
- 3: length of post-traumatic amnesia; common to forget the accident but able to remember right up until and right after the accident
- >12 weeks: moderate to severe disability
- <4 weeks: moderate disability or good recovery at one year
what is persistent vegetative state?
in a coma but have a sleep wake cycle and have primitive reflex's return (grasp, babinski) They have no higher cortical function, just brain stem function (basic life sustaining)
Is delirium reversible? What is it caused by?
- Yes it is reversible, but if left alone for a long time it can become debilitating
- Caused from cytotoxic blood build up in the brain
What are the impairments that are a sequelae of a TBI?
- indirect (contractures, OA, bedsores...)
what are the neuromuscular impairments that can be associated with a TBI?
- monoplegia: one extremity
- hemiplegia: one side
- flaccidity initally, followed by increased tone, spasticity, or rigidity
- abnormal balance reactions (ankle, hip stratigies, protective extension)
- heterotopic ossification: bone developement in muscle
what are the cognitive and behavorial impairments associtated with a TBI?
- altered level of consciousness
- altered orientation
- memory loss:(anterograde (new memory) retrograde (before injury) post traumatic (between injury and now) declaritive (remembering facts and knowing events)
- attention span
- safety awareness due to lack of accepting impairment
- executive functioning: budgeting and family meal planning
what are the long term behavioral impairments associated with a TBI?
- emotional dis-inhibition: inappropriate emotional reactions
- physical or verbal aggression
- apathy/lack of concern
- sexual inappropriateness
- irritability, low frustration tolerance
what are the factors to consider with behavioral impairments after a TBI?
- pre-morbid personalty: they wern't a dick before the accident and now they are
- physical, cognitive and emotional affects: depression, anxiety...
- nature of the social environment: supportive family, do they have insurance?
what are the communication impairments associated with a TBI?
- receptive aphasia (wernickes)
- expressive aphasia (brocas)
- dysarthria (trouble speaking not related to wernickes or brocas)
- auditory deficits
- impaired reading comprehension
- impaired written expression
what are the visual/perceptual impairments associated with a TBI?
- damage to cranial nerves or occipital region
- visual: heminanopsia (loss of visual field) Cortical blindness (damage to occipital lobe)
- perceptual: spatial neglect, apraxia, somatagnosia, left-right discrimination
contractures, skin breakdown, DVT's, hetertopic ossification, muscle atrophy, decreased bone density, decreased endurance, infection, pneumonia, post-traumatic seizures, cardiovascular issues, and GI & GU issues are all what?
secondary impairments to TBI
what is considered severe on the glasgow coma scale?
what is considered moderate on the glasgow coma scale?
what is considered mild on the glasgow coma scale?
when someone in a coma:
1) randomly opens eyes
2) opens eyes to verbal cues
3) opens eyes to pain
4) doesnt open eyes at all
what would you rate them?
- random: 4
- verbal cues: 3
- pain: 2
- doesnt open eyes: 4
when someone in a coma:
1) follows motor commands
2) localizes motor response
3) withdrawals due to stimulus
4) abnormal flexion due to stimulus
5) extensor response due to stimulus
6) no response to stimulus
What would you rate them?
- follows: 6
- localizes: 5
- withdrawals: 4
- flexion: 3
- extensor: 2
- no response: 1
when someone in a coma is:
1) oriented with a verbal response
2) has a confused conversation
3) uses inappropriate words
4) incoprehensible sounds
5) no verbal response
What would you rate them?
- oriented: 5
- confused: 4
- inappropriate: 3
- incomprehensible: 2
- no response: 1
Why is the ranchos los amigos scale for levels of cognitive function important to us?
helps us identify progress and plan treatment
T/F: a pt. can skip phases or get stuck within a phase on the RLA scale for levels of cognitive fucntion
What is typical medical treatment for someone with a TBI?
- immediate medical attention
- prevention of secondary damage
- manage secondary injuries
- control seizures
Would you want to lay a person with increased ICP flat on their back?
when are issues with increased ICP most prevelant?
within the first week s/p injury
changes in vitals= increased BP and decreased HR
These are s/s that sound familar to what?
increased intercrainial pressure
What does it mean if the ICP drops after you stand a pt. up?
they have a CSF leak
what are the activities that can increase ICP?
- cervical flexion
- head down position
- precussion & vibration
what are the general intervention guidelines for someone with a TBI?
- emphasis on motivation and promoting independence
- focus on orientation of the patient and behavior modification
- repetition and structure are very important
- compensatory stratigies and family education
- avoid over stimulation and use calm tones
Therapy for TBI pt.'s should be focused on?
What do want to focus on with a pt. who is ranchos I-III?
- improve arousal through sensory stimulation (light, sound, and smell)
- managing effects of abnormal tone and spasticity
- early transition to sitting postures (upright is best)
increase level of alertness and physical function
reduce risk of secondary impairents
motor control is imporved
manage the effects of tone
improve postural tone
increase tolerance of activities and postions
joint integrity and mobility maintence (PROM and AROM)
educate family and caregivers
coordinate care are general goals for what ranchos phase?
What is the key for ranchos phase I-III?
choose activites that address several goals at once
what is level IV of ranchos?
improve patients endurance
maintain integrity and mobility
reduce secondary impairments
increase tolerance to activities
prevent agitated outburst and assist patient in controlling their behavior
What level of ranchos is this?
with ranchos level IV what do you not want to focus on and what do you want to focus on?
- dont: focus on new learning
- do: behavorial modification program
with ranchos level IV what should you expect?
no carryover, egoccentricity, limited attention span
with a pt. who is level IV ranchos, what is it important to inform the family on?
the behavior is a result of the injury, not of the family
increase performance of functional mobility and ADL skills
improve gait, mobility, and balance
increase motor control and postural control
increase strength and endurance
improve safety with functional mobility
These are the goals of what level of ranchos?
level V & VI: confused-inappropriate (V) and confused appropriate (VI)
What type of practice is better suited for level V & VI of ranchos?
distributed practice: spending time practicing one thing, moving to something else, then back to the first thing
What type of feedback is better for level V and VI ranchos?
explicit typically most beneficial but don't overwhelm the patient with info
What type of approach would you use with level V and VI?
compensatory, restorative, TOA
At what ranchos level is the pt. typically discharged from the impatient setting?
VII & VIII
What is emphasis placed on during levels VII & VIII?
intergrating the cognitive, physical, and emotional skills necessary to function in the community
further education of patient and family
safety is improved
functional mobility and ADL's improved
return to leisure and work activities
motor control, balance and postural control improved
improved self management and level of supervison decreases
These are general goals for what level of ranchos?
VII & VIII
what do you call level VII & VIII of ranchos?
- VII: automatic appropriate
- VIII: purposeful appropriate
what may precipate a seizure?
- stress (emotional or physical)
- stimulant drugs
- withdrawal of depressant drugs (including alcohol)
- respiratory distress
- blinking lights and loud noises
what are the 2 ways a seizure can end?
- fatigue of synapses
- inhibition by other parts of brain
what are seizures produced by?
overexcite-ability (hyperactivity of some part of the CNS)
What can seizures due to secondary causes lead to?
epilepsy if they cause long term brain damage
In essence what can cause seizures?
any type of insult to the brain
what are the two classifications of seizures?
- partial: begin locally; one hemisphere is involved
- generalized: both hemisphere involved; consciousness is always impaired or lost
what are the two types of partial seizures?
- simple partial: no loss of consciousness
- complex partial: consciousness impaired
what are the two types of generalized seizures?
- petit mal (absence): most common form of epilepsy in children; "drift off into space" for a few seconds, often have no clue they zoned out
- grand mal (tonic clonic): most common form of epilepsy in adults
what is a partial seizure with secondary generalization?
complex partial that become tonic clonic as the seizure progresses
what is status epilepticus?
- medical emergency in which there are repeated seizures with no recovery from postictal state (no return to full consciousness) between periods of seizure activity.
- typically seizures occur every 10-30 minutes
what is a aura?
partial seizure experienced as percular sensation preceding onset of generalized seizure (smell, sound..)
what is prodroma?
early clinical manifestations such as malasie, HA, or sense of depression, that may occur hours to few days before onset of seizure
what is the tonic phase of a seizure?
state of muscle contraction in which there is excessive muscle tone
what is clonic phase of a seizure?
state of alternating contraction and relxation of muscles
what is the postictal state? And, what must happen before this state is over
- time period immediately following cessation of seizure activity
- regain consciouness, feel good, moving around
What do you do if your patient has a seizure?
- time it: even if they have a known seizure disorder
- clear environment
- make comfortable
If your patient is having a seizure, do you want to put something in their mouth to keep them from biting their tongue?
if someone starts vomiting of foaming at the mouth during a seizure what do you wan to do?
get them on their side
When is a seizure an emergency?
- >5 minutes (neurons not fatiguing, brain damage can occur)
- 1st known seizure
- status eplipeticus
What three things must be preserved with a partial seizure?
awareness, memory, consciousness
if awareness, memory or consciousness isnt preserved during a seizure, what type of seizure is that/
What are the s/s of a temporal lobe seizure?
- unusual feelings
- abnormal sensations
- forced thinking
what are the physical sensations of a aura?
- upset stomach
- tingleing up the body
what two types of feelings are common with a complex seizure?
- deja vu: familiar feelings
- sha ma vu: unfamiliar feelings
What would you like to do?
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