INDIVIDUAL HEALTH EVAL NEURO

Question 1

What does FAST stand for?

Answer 1

Face - lack of symettry, one side not moving well?
Arm - can the patient hold both hands up, does one drift?
Speech - slurred?
Time - act immediately
When responding to a stroke

Question 2

What are the most common complications for bed ridden patients?

Answer 2

Muscle weakness/atrophy - thinner and weaker muscle due to lack of use
Muscle shortness - some muscles may remain in the short position from where they are always in one position, leading to decreased ROM
Pressure sors (bed ulcerations)
Respiratory problems (lung infection) - low breathing magnitude when in bed so less effieicnet
Blood circulation problems - thrombosis and embolism both caused by blood clot in the blood vessels. (emsolism where the clot travels and stops blood else where). Blood circulation is reduced in bed ridden patients so risk of cots increases. Can have severe impacts.
Bone demineralisation - bones become weaker as they are not stimulated enough.

Question 3

What information would you want to collect for patients’ prior level of function in acute settings?

Answer 3

Durable medical equipment useage
Idependance level for ambulation
Independence level for transfers
Independence level for bed mobility
Independance level for activities of daily living

Assess:
Supine to sit transfer, sit to stand, stand to sit, toilet transfer, bed to chair, abulation ability

Also home information collection:
type of home, number of steps, bed, shower, living with anyone?

Question 4

What is STREAM?

Answer 4

Stroke Rehabilitation Assessment of Movement
A tool used to assess the voluntary movement and mobility of someone who has experienced a stroke. Assesses patient’s coodination, functional mobility and range of motion.
Assesses in different positions eg supine, sitting, standing, (no support and with support), walking.

Question 5

Why is bed mobility important?

Answer 5

Critical to assess for functional indeendence:

Independence in activities of daily living
Preventing complications
Falls prevention
Enhancing recovery
Maintaining muscle strength and function
Comfort and pain management
Assissting caregbers
Enhacning quality of life
Facilitating quality of life
Facilitating rehabilitaion
Safe and efficient transfers

Question 6

How do you get a patient to scoot up in bed?

Answer 6

Bend your knees, and bring your heels close to your bottom
Rise up on both elbows
Push yourself up using your legs and arms

Question 7

What are some assessments that fall under the PASS assessment?

Answer 7

Assessing rolling to the affected and non affected side
Assessing twisting and reaching
Assessing supine to sit at the side of the plinth towards the affected side and non-affected side

Question 8

Explain some methods of family support for stroke patients?

Answer 8

Intensive discharge transition programme eg a therapeutic weekend at home before standard discharge

Group education programmes
Family support Officers
Written information
Integrated care pathways

Providing support can aid the caregiver.

Question 9

Link the ICF to a stroke

Answer 9

Body structure: muscle strength, contorl of voluntary movements, CV fitness, spascitity, sensation
Activities: walking speed, walking endurance, walking on various terrains, walking across obstacles, timed up and go test, daily step counts
Participation: domestic life, interpersonal relationship, major life areas, community integration
Environmental: accessibility, safety
Personal factors: self efficacy, readiness to change

Question 10

What is the sequence you should follow when taking a history from a person with a neurological insult?

Answer 10

History of present condition:
- date of onset of signs and symptoms
progression of the condition
medical management
previous therapy
results of specific investigations

Past Medical History:
- co morbidities
previous neurolgical conditions
special equipment
technology dependency
previous surgery
risk factors

Family history
- risk factors

Occupational History:
- occupation and support structures

Activity History:
Involvement in activities of daily living prior to stroke. Normal daily routine and leisure activities.

Other:
Vision/Hearing/Communication/Cognition/Swallowing/Fatigue/Pain

Question 11

What observations should you make when treating a stroke patient?

Answer 11

Build
Gait
Pattern of movement
Mode of ventilation
Type/Pattern of respiration
Odema
Muscle wasting
Pressure sores
Deformity
Wounds
External Applicances
Involuntary Movement
Tremor
Clonus
Chorea
Associated reactions
Observe any tubes or connection points eg bladder or bowel, feeding tubes, electrodes, tracheotomy.

Question 12

Describe symptoms associated with a frontal lobe stroke

Answer 12

Motor impairments
Problem solving difficulty
Judgement issues
Behavioural changes
Speech difficulty

Question 13

Describe the symptoms associated with a parietal lobe stroke

Answer 13

Difficulty with sensory interpretation, language skills and spatial awareness
Heminegelect and poor body awareness
Difficulty reading, writing and/or speaking

Question 14

Describe some symptoms that can be associated with a temporal lobe stroke

Answer 14

Problems with language comprehension, hearing, and other sensory processes.
May affect hearing, vision, speech comprehenion.

Question 15

Describe some of the symptoms that can be associated with an occipital lobe stroke?

Answer 15

Vision difficulties
Vision loss, cortical blindness, visual hallucinations

Question 16

Describe some symptoms that may be experienced with a brain stem stroke?

Answer 16

Life threating due to housing the pons and the medulla oblongata that control vital functions such as breathing, swallowing.

Question 17

Describe some symptoms that may be experienced with a cerebellar stroke?

Answer 17

Affects the cerebrum so may result in balance difficulties, spatial awareness difficulties, vertigo.

Question 18

Describe some symptoms that may be experienced with a thalamic stroke?

Answer 18

Sensory issues as the thalamus relays 98% of all sensory input.

Question 19

Describe some symptoms that may be experienced with a basal ganglia stroke?

Answer 19

Associated with emotion, voluntary muscle control, cognitive function and memory. Can therefore result in emotional blunting, and post stroke depression.

Question 20

Dizziness and strokes?

Answer 20

No hard lines in regards to which area of the brain is damaged if there is dizziness.
Can be linked with blood pressure, medications, and vision changes.
The vestibular system (in your ear) can play a big role in balance and equillibrium. Vestibular dysfunction is more prevalent following a stroke that affects the cerebellum.

Can lead to increase fall risk

Question 21

What is the get up and go test?

Answer 21

Requires the patient to to from a chair and return to a seated position in the chair after walking 3 metres and turning around. Scored on a scale from 1 (normal) to 5 (severe)

Question 22

What is the tinetti balance and gait test?

Answer 22

Standardised evaluation of mobility and stability. Balance and gait are scored individually in a 16 item test.
Balance is assessed first and is assessed sitting, arising, standing (immediate and prolonged), and turning. Maintainance of balance is tested using nudges, and with the eyes closed.
In gait testing, the right and left feet are evaluated seperately.
A score is calculated per section and this aids determining the likliness of risks of falls.
Functional mobility, whereby balance issues, risk of falls and overall well being can be assessed and managed.

Question 23

What is spasticity?

Answer 23

An abnormal increase in muscle tone or stiffness of muscles. Increase in muscle tone with exaggerated tendon jerks, that results from hyperexciteability of the stretch reflex. It is usually caused by damage to nerve pathways within the brain or spinal cord that control muscle movement. Interuption of the nerve impulses that control muscle movement.

May be associated with\;
spinal cord injury, multiple scelorisis, cerebral palsy, stroke, brain or head trauma (to name a few)

Symptoms may include:
hypertonicity (increased muscle tone)
clonus (rapid muscle contractions)
exaggerated deep tendon reflexes
muscle spasms
scissoring (involuntary crossing of the legs)
fixed joints (contractures)

Question 24

What is muscle tone?

Answer 24

the resistance of muscles to passive stretch or elongation, the amount of tension a muscle has at rest.

Question 25

How might spasticity present itself?

Answer 25

Arms pressed against the chest
Tight fists
Stiffness in arms, fingers and legs
Bent elbow
Stiff knee
Pointed foot (or curled toes)

Question 26

What is a contracture?

Answer 26

When your muscles, tendons, joints or other tissues tighten causing a deformity.

A result of stiffness or constriction in the connective tissues of your body.

Question 27

What is hypertonia?

Answer 27

High muscle tone
Resistance to passive movement
Stiff

Question 28

What is hypotonia?

Answer 28

Low muscle tone
Flaccidity, resistance to passive muscle stretch is lost and the limbs become flail like
A typical feature of lower motor neuron damage, as the lower motor neuron lesions reduce muscle tone.
Floppy

Can also be seen in cerebral or spinal shock, and in peripheral nerve or root lesions.

Question 29

What are the deep tendon relfexes for the upper extremities?

Answer 29

Biceps C5/6
Brachioradialis C6
Triceps C7
Distal finger flexors C8

Question 30

What are the deep tendon reflexes for the lower extremities?

Answer 30

Patellar L4
Achilis S1

Question 31

What clinical scale is used to assess muscle strength?

Answer 31

The Medical Research Council (MRC) Scale for Muscle Strength

0 - no contraction
1 - flicker or trace of contraction
2 - active movement, with gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and resistance
5 - normal power

Question 32

How should you test/examine perception?

Answer 32

Test in this order:
Superficial (exteroceptive) sensation
Proprioceptive (deep) sensation
Combined cortical sensations

If the superficial sensation is impaired then some impoairment is also seen in deep and combined sensations.

Superficial sensation:
- pain perception, temp awareness, touch awareness, pressure perception

Deep sensation:
- kinesthesia awareness, vibration perception

Combined cortical sensation:
- 2 point discrimination, texture, barognosis, double simultaneous stimulation, tactile localisation, graphesthesia.

Question 33

What are the somatosensory perceptions?

Answer 33

Thermoception - temperature
Nocioception - pain
Equilibrioception - balance
Mechanoreception - vibration, touch or pressure
Proprioception - position and movement

Proprioception - position: joint position sense, kinesthesia (movement), sense of force, sense of change in velocity, balance.

Question 34

How can you test for proprioception?

Answer 34

Joint position sense - ability of a person to percieve a joint angle, and after the limb has been moved to reproduce the same angle.

Kinaesthesia - awareness of motion of the human body, eg duration, direction, amplitude, speed, acceleration, timing of joint movement.

Sense of force - ability to match a desired level of force one or more times.

Sense of change in velocity - ability to detect vibration, from oscillating objects placed against the skin.

Question 35

Describe the postural assessment scale for Stroke

Answer 35

PASS
12 item activity measure
1 - sitting without support
2 - standing with support
3 - standing without support
4 - standing on each leg (affected and non-affected)
Supine to affected side
Supine to non affected side
Supine to sitting
Sitting to supine
Sitting to standing up
Standing up to sitting down
Standing, picking up a pencil from the floor

Score are generated accordingly

Question 36

What is the timed up and go test?

Answer 36

Patient stands up, walks 3 meters, turns and sits back down
Important to stay by the patient the whole time.

Question 37

What is the Tardieu scale?

Answer 37

Differentiates contractures from spasticity. Considers the angle of muscle resistance to passive stretch at various velocities.