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NBCOT > Neurologic Impairments > Flashcards

Neurologic Impairments Flashcards

1
Q

Decorticate Rigidity/Posturing

A
  • Upper extremities are in spastic FLEXED position with internal rotation and adduction.
  • Lower extremities are in spastic EXTENDED position, with internal rotation and addiction.
  • Typical of damage to cerebral hemispheres.
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2
Q

Decerebrate Rigidity/Posturing

A
  • Upper AND lower extremeties are in spastic EXTENSION, with internal rotation and adduction.
  • Wrists and fingers flex, plantar portions of the feet flex and invert, the trunk extends, and the head retracts.
  • Typical of damage to the midbrain and/or brainstem.
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3
Q

Ataxia

A
  • Abnormal movement resulting from cerebellum damage
  • Impaired muscle coordination
  • Interventions focus on compensatory strategies for control, including weighting of body parts or use of weighted utensils or cups
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4
Q

Apraxia

A
  • Inability to plan and perform purposeful movements
  • May be treated with hand-over-hand exercise to repair damaged neural pathways.
  • Client may also compensate by following steps depicted in pictures or written on a card.
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5
Q

Coma

A
  • Severe disorder of consciousness
  • Absence of responses to environmental stimuli
  • No evidence of sleep-wake cycles
  • No intentional movement
  • Eyes do not open to stimuli or spontaneously
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6
Q

Vegetative State

A
  • Onset within 1 month of TBI
  • No awareness or ability to interact with self or environment
  • No sustained, reproducible, voluntary, or behavioral responses to sensory stimuli
  • No apparent receptive language comprehension or verbal expression
  • Sleep-wake cycles of variable length
  • Ability to self-regulate temperature, breathing, and circulation for survival
  • Incontinence of bowel and bladder
  • Variable and unpredictable preserved cranial nerve and spinal reflexes
  • Condition of past and continuing disability with uncertain future
  • Persistent Vegetative State = exceedingly small chance of client regaining consciousness before death
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7
Q

Minimally Conscious State

A
  • Definite behavioral evidence of awareness of self, environment, or both
  • Discernible, reproducible behavior in one or more of the following areas: following commands, gestural or verbal yes/no responses, intelligible verbalizations, purposeful movements.
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8
Q

Glasgow Coma Scale

A
  • Traditional method to assess levels of consciousness
  • Quantifies the severity of TBI and predicts outcome
  • Scores range from 3 to 15:
    Severe = 3 to 8
    Moderate = 9 to 12
    Mild = 13 to 15
  • Assess three behavioral areas (eye opening, verbal responses, & motor responses)
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9
Q

Rancho Los Amigos Scale of Cognitive Functioning

A
  • Descriptive measurement of awareness and cognitive function after traumatic injury
  • Scored from Level I to Level X
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10
Q

RLA - Level I

A
  • No response
  • Is completely unresponsive to any stimuli presented
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11
Q

RLA - Level II

A
  • Generalized response
  • Exhibits inconsistent and non-purposeful reactions to stimuli
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12
Q

RLA - Level III

A
  • Localized response
  • Reacts specifically to stimuli, though inconsistently
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13
Q

RLA - Level IV

A
  • Confused & agitated response
  • Has heightened state of activity with severely decreased ability to process information
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14
Q

RLA - Level V

A
  • Confused, inappropriate & non-agitated response
  • Appears alert with fairly consistent reactions, although increased complexity of commands causes more random responses
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15
Q

RLA - Level VI

A
  • Confused & appropriate response
  • Exhibits goal-directed behavior but is dependent on external input for direction
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16
Q

RLA - Level VII

A
  • Automatic, appropriate responses
  • Behaves appropriately and is oriented to place and routine, but frequently displays shallow recall
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17
Q

RLA - Level VIII to X

A
  • Purposeful and appropriate responses
  • Is alert and oriented
  • Able to recall and integrate past and recent events
  • Each level represents a decreasing need for assistance with routine daily living skills:
    VIII = Stand-by assistance (SBA)
    IX = SBA on request
    X = Modified Independence (Mod I)
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18
Q

Acute Phase of TBI

A
  • Initial interventions for severe disorders of consciousness occur in the intensive care and acute care units of hospitals.
  • Interventions involve both preventive and restorative approaches.
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19
Q

Interventions for Acute Phase of TBI

A
  • Wheelchair positioning
  • Bed positioning
  • PROM (to prevent development of secondary impairments)
  • Splinting and casting (if spasticity interferes with functional movement AND/OR soft-tissue contractures are possible)
  • Sensory stimulation
  • Management of agitation (e.g., behavior management strategies to avoid reinforcing inappropriate behaviors while allowing medically necessary treatments to occur)
  • Family and caregiver education (so can assist with sensory regulation, positioning, & ROM needs)
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21
Q

Inpatient Rehabilitation Phase of TBI

A
  • Inpatient rehabilitation settings for TBI provide intensive rehabilitation for clients who are able to demonstrate stimulus-specific responses.
  • Clients in inpatient rehabilitation are generally at Rancho Level V or higher.
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21
Q

Interventions for Inpatient Rehabilitation Phase of TBI

A
  • Optimize motor function (with focus on motor learning, skill acquisition& exercise, through occupation-based activities)
  • Optimize visual abilities (e.g., through environmental adaptation, vision correction, & intro of compensatory strategies such as contrasting colors)
  • Optimize visual-perceptual function including compensatory and rehabilitative strategies (e.g., Neglect may be treated by encouraging use of neglected side during functional activities, and environmental modifications)
  • Optimize cognitive function (emphasis is on self-awareness of deficits, attention, memory and executive function through functional activities)
  • Optimize voice and speech function (e.g., conversation exercises for aphasia and compensation with communication devices or pictures if gains not made)
  • Restore competence in self-maintenance tasks including: dysphagia & feeding, bed mobility, wheelchair management, functional ambulation, community mobility, transfers, home management, & community reintegration
  • Contribute to behavioral & emotional adaptation (focus on decreasing or mediating problem behaviors utilizing both environmental & interactive interventions)
  • Support family caregivers
22
Q

Post-acute Rehabilitation Phase of TBI

A
  • As clients prepare to reenter the community, rehabilitation transitions from an inpatient setting to one of a variety of post-acute rehabilitation settings
  • Possibilities include: home-based therapy, a residential program, a day treatment program, or an outpatient community reentry program
  • Client’s family often need to provide long-term assistance depending on the severity of the TBI
23
Q

Interventions for Post-acute Rehabilitation Phase of TBI

A
  • Optimize cognitive function (focus on residual cognitive deficits such as memory problems & executive function deficits)
  • Optimize visual and visual-perceptual function (focus on environmental adaptations & compensatory strategies)
  • Restore competence in self-maintenance roles (continued focus on skills not fully acquire in inpatient rehab; emphasis on behavioral intervention with repetitive practice through errorless leaning, fading cues, and positive encouragement; homemaking tasks addressed first, then money management, shopping skills, & community mobility)
  • Restore competence in leisure and social participation (e.g., social skills groups using behavior contracts, role-playing, self-reflection thru video-feedback, and role modeling)
  • Restore competence in work once client is competent in self-maintenance (includes skill development for work-appropriate behaviors, and vocational rehabilitation)
  • Contribute to behavioral and emotional adaptation (focus on increasing self-awareness and coping skills)
24
Q

Spinal Shock

A
  • Initial stages of SCI
  • May last between 24 hours and 6 weeks
  • Can result in the absence of reflexes below the level of injury
  • If the injury results in paralysis and reflex activity ceases, spasticity can result
25
Q

Functional ability in SCI - Level C1 to C4

A
  • Respiratory assistance REQUIRED
  • Total assistance for personal and domestic care
  • Limited head and neck movement; tetraplegia
  • SNS compromised (autonomic dysreflexia possible)
  • No bowel or bladder control
  • Mobility with power wheelchair with sip and puff possible
26
Q

Functional ability in SCI - Level C5

A
  • Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
  • Total assistance for personal and domestic care
  • Full head and neck movement; able to raise arms and flex elbows (** Arms should be positioned with elbows extended and forearms in supination to prevent contractures **)
  • SNS compromised (autonomic dysreflexia possible)
  • No bowel or bladder control
  • Mobility with power wheelchair with hand controls possible
27
Q

Functional ability in SCI - Level C6

A
  • Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
  • Moderate assistance for personal care
  • Total assistance for domestic care
  • Full head and neck movement; able to raise arms and flex elbows; some wrist extension (tenodesis)
  • SNS compromised (autonomic dysreflexia possible)
  • Little bowel or bladder control
  • Mobility with power wheelchair with hand controls; manual wheelchair for short distances; may drive a vehicle with hand controls
28
Q

Functional ability in SCI - Level C7

A
  • Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
  • Limited assistance for personal care
  • Partial assistance for heavy-duty domestic care
  • Full head and neck movement; able to raise arms; flex and EXTEND elbows; wrist flexion and extension; partial finger movement
  • SNS compromised (autonomic dysreflexia possible)
  • Little bowel or bladder control
  • Independent transfers
  • Mobility with power wheelchair with hand controls; manual wheelchair for short distances; may drive a vehicle with hand controls
29
Q

Functional ability in SCI - Level C8

A
  • Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
  • Primarily independent in personal care
  • Partial assistance for heavy-duty domestic care
  • Full head and neck movement; able to raise arms; flex and extend elbows; wrist flexion and extension; finger flexion
  • SNS compromised (autonomic dysreflexia possible)
  • Little bowel or bladder control
  • Independent transfers
  • Mobility with power wheelchair with hand controls; manual wheelchair for short distances; may drive a vehicle with hand controls
30
Q

Functional ability in SCI - Level T1 to T5

A
  • Respiratory capacity and endurance may be compromised
  • Independent in personal care
  • Partial assistance for heavy-duty domestic care
  • SNS compromised (autonomic dysreflexia possible)
  • Normal upper-extremity ROM and strength
  • Little bowel or bladder control
  • Independent transfers
  • Mobility with manual wheelchair; may drive a vehicle with hand controls
31
Q

Functional ability in SCI - Level T6 to T12

A
  • Respiratory capacity and endurance may be compromised
  • Independent in personal care
  • Partial assistance for heavy-duty domestic care
  • NOT at risk for autonomic dysreflexia below T6
  • Normal upper-extremity ROM and strength
  • Little bowel or bladder control
  • Independent transfers
  • Mobility may be with manual wheelchair or may stand in standing frame or walk with braces; may drive a vehicle with hand controls
32
Q

Functional ability in SCI - Level L1 to L5

A
  • Normal respiratory system
  • Independent in personal care
  • Partial assistance for heavy-duty domestic care
  • NOT at risk for autonomic dysreflexia below T6
  • Normal upper-extremity ROM and strength; only partial paralysis in hips and legs
  • Little bowel or bladder control
  • Independent transfers
  • Mobility may be with manual wheelchair or walk with braces; may drive a vehicle with hand controls
33
Q

Functional ability in SCI - Level S1 to S5

A
  • Normal respiratory system
  • Independent in personal care
  • Partial assistance for heavy-duty domestic care
  • NOT at risk for autonomic dysreflexia below T6
  • Normal upper-extremity ROM and strength; only some loss of function in hips and legs
  • Little bowel or bladder control
  • Independent transfers
  • Likely able to walk with assistance or aids, though slowly and with difficulty; may drive a vehicle with hand controls and load wheelchair into car independently
34
Q

Impairments in SCI

A
  • Sensory loss (also leads to high risk of skin breakdown and decubitus ulcers)
  • Decreased vital capacity (breathing difficulty)
  • Risk of orthostatic hypotension
  • Risk of autonomic dysreflexia (for SCI at T6 level and higher)
  • Spasticity (can also lead to contractures without proper positioning)
  • Risk of heterotopic ossification (can also be controlled through proper positioning and monitoring/maintaining ROM)
  • Risk of deep vein thrombosis (warning signs include asymmetrical lower-extremity color, size and/or temperature)
  • Bowel and bladder dysfunction (affected at all levels at and above S2-S5)
  • Difficulties with temperature regulation
  • Pain (Nociceptive = due to damage to body tissues, such as with muscle overuse; Neuropathic = nerve pain/damage)
  • Fatigue
  • Sexual function (SCI does NOT alter a person’s sex drive or need for intimacy; however, problems may arise from mobility and impact of functional dependence, altered body image, and other medical conditions/complications)
35
Q

SCI - Acute Recovery Phase (or Acute Phase)

A

Involves short OT sessions limited to 15 minutes and often in the ICU. Focus of intervention is on:
- Client & family support & education
- Allowing environmental control for client (e.g., call button, bed controls)
- Maintaining normal UE ROM and positioning (including splinting if needed)
- Facilitating tenodesis grasp, if appropriate
- Ongoing evaluation of ability to sit upright and begin ADL training
- Evaluation of client’s swallowing ability if needed depending on level of injury

36
Q

SCI - Acute Rehabilitation Phase (or Active Phase of Intervention)

A

Includes providing education and support, and helping the client find meaningful activities that restore a sense of self-efficacy and self-esteem. Focus of interventions is on:
- Continuous education throughout intervention sessions (e.g., on SCI impairments, & pressure ulcer awareness/reduction)
- Caregiver training in ROM, positioning, pressure relief, ADL assistance, equipment use, and SCI impairments (essential for successful discharge)
- Occupational performance interventions to train basic ADLs to level of desired functional independence
- Selection of and training in use of necessary equipment for ADL & IADL performance
- Physical interventions as needed depending on level of injury (i.e., mobile arm supports for C5; tenodesis splint for C6 & C7, etc.)
- Psychosocial adaptation also most prominent in this stage, with focus on developing positive coping skills, problem-solving, making care decisions, being involved in meaningful activities, and group learning.

37
Q

SCI - Transition Rehabilitation Phase

A
  • May involve outpatient OT services if the client has been unable to achieve optimal outcomes in acute rehab phase
  • Focus of interventions is to maximize strength gains in the first year post-injury, as well as continued training in the use of adaptative devices and equipment, as needed
  • Access to support groups and interventions that enhance community integration should also be a focus
38
Q

Ideational Apraxia

A
  • Characterized by the loss of ability to conceptualize and plan a SEQUENCE of motor actions
  • Breakdown in the knowledge (IDEA) of what is to be done and how to perform specific activities.
  • Also, sometimes used interchangeably with term “conceptual apraxia” which describes the loss of the ability to perceive an object’s intended purpose, so client uses tool incorrectly
39
Q

Ideomotor Apraxia

A
  • Inability to execute a MOTOR action on demand/request or imitation
  • Can conceptualize the action cognitively, so can often execute spontaneous actions such as gestures and one-step tasks (i.e., waving goodbye, brushing hair)
  • Intervention focuses on breaking down tasks into separate components to teach and master each individually; requires repetition
40
Q

Dressing Apraxia

A
  • Inability to motor plan how to dress UE and/or LE
41
Q

Constructional Disorder/Apraxia

A
  • Inability to recognize or assemble parts into a whole
42
Q

Aphasia

A

Neurological language disorder

43
Q

Global Aphasia

A

Loss of all language ability

44
Q

Broca’s Aphasia

A
  • Broken speech
  • Slow, labored speech with frequent mispronunciations
  • Broca’s Area is located in the FRONTAL LOBE of the dominant hemisphere (usually the LEFT) and controls speech production
45
Q

Wernicke’s Aphasia

A
  • Aka receptive aphasia
  • Impaired auditory reception
  • Speech may be be fluent but is often meaningless or nonsensical
  • Wernicke’s Area is located in the TEMPORAL lobe of the dominant hemisphere (usually the LEFT) and controls receptive language and language comprehension.
46
Q

Anomic Aphasia

A

Difficulty finding words

47
Q

Dysarthria

A

Articulation disorder resulting from paralysis of the organs of speech

48
Q

Visual Agnosia

A

Difficulty recognizing objects

49
Q

CVA Impairments & Functional Limitations

A
  • Motor dysfunction (contralateral hemiplegia or hemiparesis)
  • Impairment in trunk & postural control
  • Impairment in standing activity that affects weight bearing & weight shifting, etc.
  • Possible communication impairment (may include speech production or reception or both)
  • Cognitive and perceptual impairment
  • Upper-extremity impairment (Note: Subluxation in the glenohumeral joint is a particular concern!)
  • Visual impairments possible depending on site of lesion (including visual field deficits such as homonymous heminopsia and hemi-inattention or neglect)
  • Risk of depression and other psychological issues (including anxiety, mania, emotional lability, and personality changes)
50
Q

Learning new skills - Transfer

A
  • The ability to take a strategy used with one task and apply that strategy to a new task.
  • Example: A client with a CVA is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg first. The client is demonstrating transfer, by using the strategy for donning a shirt and transferring it to donning pants.
51
Q

Learning new skills - Generalization

A
  • Generalization occurs when clients transfer a skill learned in one context to another context.
  • Example: A client dresses themselves at home in the same way they did in their hospital room.
52
Q
A

NBCOT (28 decks)

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