Neuro exam 2

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Neuro exam 2
2015-07-09 21:54:34
perceptual deficits gait treatment theories PNF CVA TBI Concussion seizures

neuro exam 2
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  1. what is a breakdown between concept and performance. Disconnection between the idea of a movement and its motor execution?
    ideomtor apraxia
  2. 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.?
    ideomotor apraxia
  3. what is failure in the conceptualization of task. the inability to perform a purposeful motor act; either automatically or on command?
    ideational apraxia
  4. 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?
    ideational apraxia
  5. what is faulty spatial analysis and conceptualization of the the task?
    constructinal apraxia
  6. 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
    constructional apraxia
  7. what do you call inability to dress oneself properly. Often pt. dresses just one side of the body
    dressing ataxia
  8. 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
  9. what is lack of recognition?
  10. what is the inability to recognize familiar objects despite normal function of the eyes and optic tracts?
    visual object agnosia
  11. 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
    • stereognosis
  12. what is the inability to recognize forms by handling them; although tactile, proprioception, and thermal sensations may be intact
    tactile agnosia
  13. 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.
    auditory agnosia
  14. 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.
  15. T/F: anosognosia is not common, but can resolve on it's own.
  16. what is lack of awareness of the body structures and the relationship of body parts to oneself or to others?
  17. 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?
  18. 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?
    unilateral neglect
  19. 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
  20. 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?
    figure/ground discrimination
  21. 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
  22. 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
  23. 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
  24. what do you call difficulty understanding and remembering the relationship of one location to another?
    topographical disorentation
  25. during the stance phase lateral trunk sidebending/trendelenburg is due to what?
    weak glute med 
  26. during stance phase, backward lean is due to what?
    weak glute max 
  27. during stance phase, forward lean is due to what?
    weak hip extensors 
  28. during stance phase limited hip flexion is due to what?
    tight extensors OR weak flexors 
  29. what is done during abnormal synergistic activity or "scissoring"
    • hip adduction
    • knee extension
    • ankle plantarflexion
  30. what is an antalgic gait?
    • short stance on affected
    • short stride length on unaffected 
  31. during stance phase, excessive knee flexion is due to what?
    weak quads with buckling or weak flexors 
  32. during stance phase, hyperextension or "recurvatum" is due to what?
    weak quads or extensor spasticity 
  33. during stance phase toe first is due to what?
    weak dorsiflexors or tight plantarflexors 
  34. during stance phase, foot slap is due to what?
    decreased conrol of dorsiflexors that is compensated with steppage gait 
  35. during stance phase, foot flat is due to what?
    • limited ROM
    • weak dorsiflexor 
  36. during stance phase, exessive DF with uncontrolled tibial advancement is due to what?
    weak plantarflexors; may have knee hyperextension
  37. during stance phase, excessive PF/equinis gait is due to what?
    spasticity/ contracutre of PF
  38. during stance phase, varus foot is due to what?
    spastic anterior tib or weak peroneals 
  39. during stance phase, claw toe is due to what?
    spastic toe flexors or grasp reflex (UMN)
  40. during stance phase, inadequate toe off is due to what?
    • decreased ROM
    • weak PF 
    • pain in forefoot 
  41. during swing phase pelvic rotation is due to what?
    weak abs and/or weak hip flexors 
  42. during swing phase decreased hip/knee flexion is due to what?
    weak hip and knee flexors or spastic extensors 
  43. during swing phase circumduction is due to what?
    weak hip flexors or limited ROM
  44. during swing phase hip hike is due to what?
    compensate for weak hip and knee flexors or extensor spasticity
  45. during swing phase excessive hip and knee flexion "steppage gait" is due to what?
    compensation for shortened limb or weak DF's 
  46. what is the synergistic pattern during swing phase?
    strong flexion synergy; hip & knee flex with hip adduction 
  47. during swing phase, decreased knee flexion is due to what?
    extensor spasticity, pain, decreased ROM, weak knee flexors 
  48. during swing phase, excessive knee flexion is due to?
    • flexor spasticity
    • flexor withdrawal reflex 
  49. during swing phase foot drop is due to?
    weak or poor recruitment of DF or spastic PF's 
  50. during swing phase verus/inverted foot is due to?
    spastic inverters or weak peroneals or synergistic pattern 
  51. during swing phase equinovarus of the foot/ankle is due to what?
    spastic posterior tib and/or gastroc/soleus or structural deformity
  52. what is based largely on the assumptions drawn from the reflex and hierarchial approaches to motor control?
  53. 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 
  54. what are intervention techniques that increase the patients ability to move in ways judged appropriate by a clinician?
  55. what are intervention techniques used to decrease the patients use of movement patterns considered to be abnormal?
  56. according to neurofacilitation, recovery of function is dependent upon what?
    the higher centers of the CNS regain control over lower centers
  57. neurofacilitation assumes what about normal movement?
    normal movement comes from a chain of reflexes organized hierarchially in the CNS 
  58. another assumption of neurofacilitation is that functional skills will?
    automatically return once abnormal movement patterns are inhibited and normal movement patterns are facilitated 
  59. with neurofacilitation what will transfer into functional tasks?
    repetition of normal movements (1000's of reps) 
  60. what approach is seen the most in regards to movement retraining?
    task oriented approach 
  61. 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
  62. With TOA it is essential to work on what rather than what?
    • identifiable functional tasks 
    • movement for movement sake alone 
  63. 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. 
  64. 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 
  65. what restricts volitional movement, causes "posturing", painful spasms, impairment of automatic postural tone and obligatory synergistic movement?
  66. flaccidity with no movement of the limbs following acute stroke describes what stage of motor recovery?
    stage 1
  67. minimal volitional movement- spasticity begins; occurs as recovery begins describes what stage of motor recovery?
    stage 2
  68. gains voluntary control over the synergy (but not usually full range), spasticiy increasing, and may become severe describes what stage of motor recovery?
    stage 3
  69. some movements out of synergy; spasticity begins declining describes what stage of motor recovery?
    stage 4
  70. synergies lose dominance and more difficult movement combinations are learned describes what stage of motor recovery?
    stage 5
  71. disapperance of spasticity, individual joint movement becomes possible and coordination develops. normal motor function is restored. This describes what stage of motor recovery?
    stage 6
  72. what is the flexion synergy of the UE?
    • scapular retraction/elevation or hyperextension
    • shoulder ab-d, ER
    • elbow flexion
    • forearm supination
    • wrist & finger flexion 
  73. what is the extension synergy of the UE?
    • scapular protraction
    • shoulder ad-d, IR
    • elbow extension
    • forearm pronation
    • wrist & finger extension 
  74. T/F: Patients may progress from one stage to another stage of motor recovery out of order
  75. what is the flexion synergy of the LE?
    • hip flexion, ab-d, ER
    • knee flexion
    • ankle DF & inversion
    • toe DF 
  76. what is the extension of the LE?
    • hip extension, ad-d, IR
    • knee extension
    • ankle PF, inversion
    • toe PF 
  77. how are the reflexes s/p CVA?
    typically start off hypo and then become hyper-reflexive 
  78. what is a physical ambulator?
    walks for exercise only
  79. what is a limited household ambulator?
    relies on walking to some extent for home activities-requires some assistance; furniture walkers 
  80. 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 
  81. 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)
  82. what is the least limited community ambulator?
    indep stairs, stores, and croweded shopping
  83. what is a community ambulator?
    independent with all community and home activites, can manage crowds and uneven terrain 
  84. 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. 
  85. 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 
  86. 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 
  87. T/F: the sooner ambulation occurs after a stroke the better the outcome for ambulation will be. 
  88. 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 
  89. why are there gait changes after a stroke?
    • change in sensory interpretation 
    • loss of motor control 
    • cognitive issues 
  90. what is ther-ex?
    • strengthening, stretching
    • anything you would do at a gym
  91. what is therepeutic activity?
    • something leading towards functional status
    • bed mobility
    • sit -> stand 
  92. what is the typical progression for forward and backward walking?
    • assistance: // bars > AD > unassisted 
    • step length: short > long
    • speed: slow > normal 
    • BOS: wide > narrow 
    • acceleration/deceleration 
  93. what is sidestepping good for?
    glute med in both dynamic and stance limbs 
  94. what are some facilitation techniques? (5)
    • weight bearing
    • tapping
    • light touch
    • quick icing
    • quick stretch
  95. what are some inhibition techniques? (4)
    • neutral warmth
    • deep pressure
    • prolonged stretch
    • prolonged cold 
  96. 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)
  97. what type of movements does PNF use?
    • multi-joint
    • multi-planar
    • diagonal and rotational
  98. 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
  99. 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 
  100. when is using PNF appropriate?
    throughout the entire rehab process
  101. 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 
  102. 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 
  103. 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 
  104. what is the D1 PNF pattern for the LE?
    • D1 flexion: flexion, adduction, external rotation
    • hacky sack 
    • D1 extension: extension, abduction, internal rotation
  105. 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 
  106. what is PNF performed symmetrically?
    D1 flexion of both UE's/LE's 
  107. what is PNF performed asymmetrically?
    D1 flexion of one UE concurrent with D2 flexion of the other UE
  108. what is PNF performed reciprocally?
    D1 flexion of one UE with concurrent D1 extension of the other UE
  109. 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 
  110. 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 
  111. 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 
  112. 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 
  113. 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 
  114. 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 
  115. 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 
  116. 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. 
  117. 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 
  118. what are the developmental stages of motor control?
    • initial mobility
    • stability 
    • controlled mobility
    • skill 
  119. 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 
  120. what is the initial mobility stage?
    postural and antigravity control is typically lacking, functional patterns are not well controlled.
  121. what is the stability stage?
    the ability to maintain a steady position in weight bearing, antigravity posture; maintaining COM within the limits of stability 
  122. what PNF techniques would you use during the stability stage?
    • alternating isometrics
    • rhythmic stabilization
    • slow reversals
    • positioning and holding 
  123. what is the controlled mobility stage?
    dynamic postural control; ability to change position or move in weight bearing while maintaining postural stability
  124. 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 
  125. what is the skill acquisition stage?
    highly coordinated movement that allows for  adaptability
  126. 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
  127. what is a MTBI?
    • mild traumatic brain injury
    • a complex pathophysiological process affecting the brain, induced by traumatic forces
    • new term for concussion
  128. 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.
  129. what are the combat sports associated with MTBI's?
    professional boxing
  130. what are the collision sports associated with MTBI's?
    • hockey
    • football
    • rugby
  131. what are the contact sports associated with MTBI's?
    • soccer
    • lacrosse
    • basketball
    • softball/baseball
    • volleyball
    • cheerleading
    • playground/recess
  132. what percent of people recover from a concussion within 1 week with or without treatment?
  133. what percent of people recover from a concussion within 2 weeks with or without treatment?
  134. what percent of people recover from a concussion within 3 weeks with or without treatment?
  135. Headache
    loss of consciousness
    difficulty remembering new info
    double vision/blurry vision
    sensitivity to light/noise

    These are s/s of what?
  136. LOC >1 min
    severe persistent neck pain
    weakness/numbness/tingling in arms or legs
    severe loss of balance
    persistent vomiting
    worsening of s/s

    These are s/s of what?
    medical emergency related head injury
  137. which s/s is indicative of prolonged recovery associated with a concussion and what does it mean?
    • dizziness
    • means you have vestibular involvement and it takes longer for that system to recover
  138. 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
  139. With brain rest how do you return to prior level of functioning?
    gradually introduce mental activity 15-30 min at a time
  140. T/F: noise, light, crowded environment, driving/riding in a car might increase the s/s of a concussion?
  141. 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
  142. 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
  143. T/F: the affects of concussions are cumlitive, even if they are 10 years apart.
  144. what is the worse case scenario after a concussion?
    second impact syndrome: another impact before recovery causes severe brain swelling and death
  145. what is persistence of concussion symptoms for greater than 3-4 weeks?
    post concussion syndrome
  146. 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
  147. how does primary damage from a TBI occur?
    • result of the forces acting on the brain at the time of injury
    • acceleration, deceleration, rotational
  148. 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
  149. localized damage; may be due to hematoma, edema, contusion, laceration or a combination is known as what?
    focal injury
  150. what are the two types of focal injuries?
    • closed: brain tissue contacts the skull forcefully
    • open: skull is penetrated and brain is exposed
  151. 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)
  152. 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
  153. what creates shearing forces that disrupts the integrity of the axons and has lots of deficits with this type of injury?
    diffuse axonal injury
  154. what areas of the brain are typically injured with a diffuse axonal injury?
    brainstem, cerebellar tracts, basal ganglia, corpus collosum
  155. how does a DAI affect nerves?
    wallerian degeneration: everything distal to the injury dies
  156. are increased level of neurotransmitters toxic to nerves? If so what can happen?
    • yes
    • causes cells to shut down causing further damage
  157. Can trauma cause the brain to shift? What else could cause the brain to shift?
    • yes
    • swelling
  158. 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
    • choking
  159. What is normal ICP?
    4-15 mmHG
  160. 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
  161. T/F: even mild increases of ICP are associated with increased mortality.
  162. __________ are more indicative of recovery than _____________.
    • cognitive deficits
    • physical dysfunction
  163.  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
  164. 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)
  165. 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
  166. What are the impairments that are a sequelae of a TBI?
    • neuromuscular
    • cognitive
    • behavorial
    • communication
    • visual-perceptual
    • swallowing
    • indirect (contractures, OA, bedsores...)
  167. 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)
    • ataxia
    • heterotopic ossification: bone developement in muscle
  168. 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
    • perseveration
    • executive functioning: budgeting and family meal planning
  169. what are the long term behavioral impairments associated with a TBI?
    • emotional dis-inhibition: inappropriate emotional reactions
    • impulsiveness
    • physical or verbal aggression
    • apathy/lack of concern
    • sexual inappropriateness
    • irritability, low frustration tolerance
    • egocentrincity
  170. 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?
  171. 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
  172. 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
  173. 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
  174. what is considered severe on the glasgow coma scale?
    <= 8
  175. what is considered moderate on the glasgow coma scale?
  176. what is considered mild on the glasgow coma scale?
  177. 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
  178. 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
  179. 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
  180. Why is the ranchos los amigos scale for levels of cognitive function important to us?
    helps us identify progress and plan treatment
  181. T/F: a pt. can skip phases or get stuck within a phase on the RLA scale for levels of cognitive fucntion
  182. What is typical medical treatment for someone with a TBI?
    • immediate medical attention
    • prevention of secondary damage
    • manage secondary injuries
    • control seizures
  183. Would you want to lay a person with increased ICP flat on their back?
    HELL NO!!!
  184. when are issues with increased ICP most prevelant?
    within the first week s/p injury
  185. decreased responsivness
    impaired consciousness
    severe HA
    changes in vitals= increased BP and decreased HR

    These are s/s that sound familar to what?
    increased intercrainial pressure
  186. What does it mean if the ICP drops after you stand a pt. up?
    they have a CSF leak
  187. what are the activities that can increase ICP?
    • cervical flexion
    • head down position
    • coughing
    • precussion & vibration
  188. 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
  189. Therapy for TBI pt.'s should be focused on?
    • goals
    • functional
    • recreational
  190. 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)
  191. 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?
  192. What is the key for ranchos phase I-III?
    choose activites that address several goals at once
  193. what is level IV of ranchos?
  194. 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?
  195. 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
  196. with ranchos level IV what should you expect?
    no carryover, egoccentricity, limited attention span
  197. 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
  198. 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)
  199. 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
  200. What type of feedback is better for level V and VI ranchos?
    explicit typically most beneficial but don't overwhelm the patient with info
  201. What type of approach would you use with level V and VI?
    compensatory, restorative, TOA
  202. At what ranchos level is the pt. typically discharged from the impatient setting?
    VII & VIII
  203. What is emphasis placed on during levels VII & VIII?
    intergrating the cognitive, physical, and emotional skills necessary to function in the community
  204. 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
  205. what do you call level VII & VIII of ranchos?
    • VII: automatic appropriate
    • VIII: purposeful appropriate
  206. what may precipate a seizure?
    • hypoglycemia
    • fatigue
    • stress (emotional or physical)
    • fever
    • constipation
    • stimulant drugs
    • withdrawal of depressant drugs (including alcohol)
    • respiratory distress
    • blinking lights and loud noises
  207. what are the 2 ways a seizure can end?
    • fatigue of synapses
    • inhibition by other parts of brain
  208. what are seizures produced by?
    overexcite-ability (hyperactivity of some part of the CNS)
  209. What can seizures due to secondary causes lead to?
    epilepsy if they cause long term brain damage
  210. In essence what can cause seizures?
    any type of insult to the brain
  211. what are the two classifications of seizures?
    • partial: begin locally; one hemisphere is involved
    • generalized: both hemisphere involved; consciousness is always impaired or lost
  212. what are the two types of partial seizures?
    • simple partial: no loss of consciousness
    • complex partial: consciousness impaired
  213. 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
  214. what is a partial seizure with secondary generalization?
    complex partial that become tonic clonic as the seizure progresses
  215. 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
  216. what is a aura?
    partial seizure experienced as percular sensation preceding onset of generalized seizure (smell, sound..)
  217. 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
  218. what is the tonic phase of a seizure?
    state of muscle contraction in which there is excessive muscle tone
  219. what is clonic phase of a seizure?
    state of alternating contraction and relxation of muscles
  220. 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
  221. What do you do if your patient has a seizure?
    • time it: even if they have a known seizure disorder
    • clear environment
    • make comfortable
  222. If your patient is having a seizure, do you want to put something in their mouth to keep them from biting their tongue?
  223. if someone starts vomiting of foaming at the mouth during a seizure what do you wan to do?
    get them on their side
  224. When is a seizure an emergency?
    • >5 minutes (neurons not fatiguing, brain damage can occur)
    • 1st known seizure
    • status eplipeticus
  225. What three things must be preserved with a partial seizure?
    awareness, memory, consciousness
  226. if awareness, memory or consciousness isnt preserved during a seizure, what type of seizure is that/
    complex parital
  227. What are the s/s of a temporal lobe seizure?
    • unusual feelings
    • abnormal sensations
    • forced thinking
  228. what are the physical sensations of a aura?
    • dizziness
    • HA
    • lightheadedness
    • numbness
    • upset stomach
    • tingleing up the body
    • fear/panic
  229. what two types of feelings are common with a complex seizure?
    • deja vu: familiar feelings
    • sha ma vu: unfamiliar feelings