Acute Neurosurgical Pt - Guidelines for Intervention

Question 1

Whats the aims of an assessment in the acute neurosurgical pt?

Answer 1

1. Describe activity limitations
2. Describe impairments
3. Establish baseline objective measures
4. Likelihood of 2º impairments
5. Extent to which pt can actively participate in therapy
6. Plan for intervention
7. Best way to mobilize/equipment or assistance needed
8. Work with multidisciplinary team

Question 2

What is the process of assessment in this pt?

Answer 2

1. History taking (from pt, family, friends, medical record?)
2. What are the major impairments?
3. What are the ACITIVITY LIMITATIONS?
4. Select a FEW objective measures (should be QUICK+easily replicated) - eg. MAS (used very often in acute wards, GCS)

Question 3

Guidelines for intervention: WEAKNESS

Answer 3

1. elicit mm activity
2. strength training if able
3. E stim
4. Graded mobs (ASAP with med clearance)

Question 4

Guidelines for intervention: Loss of COORDINATION

Answer 4

1. Coordination training (part/whole task)

Question 5

Guidelines for intervention: Spasticity

Answer 5

1. Mild to mod - eliminate inappropriate mm force
2. Mild to mod - train mm for specific actions
3. Serial casting/positioning/meds - to prevent 2º contractures

Question 6

Guidelines for intervention: Prevention of 2º IMPAIRMENTS (contracture, swelling, pain, joint stiffness

Answer 6

1. Passive positioning in neutral positions throughout the day
2. Estim (eg. for shoulder subluxation)
3. Position changes to prevent pressure sores
4. Active stretching

Question 7

What are methods of preventing 2º impairments?

Answer 7

1. Position in neutral throughout the day (esp if strength < grade 3)
2. Be aware of mm’s prone to contracture in UL (flexors pronators, internal rotators) and LL (PFs, add, abds, hip flexors)
3. Target mm’s + joints that MOST impact the pt’s ADLs
4. Use casting/splinting for aggressive spasticity
5. Active training in lengthened positions
6. Monitor ROM
7. Prevent prolonged postures (eg. use of cushoin to prevent looking always to one side eg in a pt with hemispatial neglect; telling family not to support pt’s in a positions that will encourage contracture; chairs that encourage good support)
8. Splinting/casting - if serial casting make sure you monitor for improvement - otherwise its a lot of effort and pain for pt for no improvement!lid
9. Estim, shoulder slings for shoulder disloc
10. Frequent position changes and pressure mats to prevent pressure sores

Question 8

What are some considerations when mobilising?

Answer 8

1. Make sure ICP is stable (remember the signs of ICP?)
2. Make sure BP is stable (too high or low?)
3. No uncontrolled AF
4. PEG/NGF has been ceased