Adult Neurology Flashcards
(28 cards)
Strategies to “Improve awareness of hemineglected side”.
- Awareness training: use meaningful and motivational tasks chosen by the pt. - provide verbal and visual feedback (mirror) - make patient aware of their neglect of hemiplegic side.
- Limb activation / spatiomotor cueing: encourage pt. to move neglected limb using motor intervention (SCOM) / provide sensory stimulation to neglected limb.
- Mental imagery: e.g. bend arm at elbow
When is CIMT contraindicated?
- Severe cognitive impairment (can’t give informed consent)
- Patients LOWER THAN STAGE 3 SCOM
- Patients with poor balance
- Severe spasticity or contracture
- No active movement in affected limb
- Lack of motivation
- Psychological barriers
Criteria for use of CIMT?
(on affected side)
* Need at least 20 degrees of active wrist extension and 10 degrees of active finger extension
* Minimal sensory and cognitive deficits (needs to be able to understand and consent)
* Able to communicate at least with gestures
* Can cope without the OT being present e.g. able to feed themselves (SCOM stage 3)
Factors AGAINST splinting.
- If the pt. has + diminished sensation - splinting increases risk of skin breakdown.
- Costly / requires follow up for maintenance of splint
- Increases care-giver burden to put on / take off splint + cleaning of splint
- Immobilisation goes against the neuroplasticity principle of “use it or lose it”
- Alternatives - Inhibitory techniques = prolonged stretch, warmth, weight bearing
Factors FOR splinting.
- Maintains current PROM - prevents contracture
- Provides long stretch and/or warmth which is inhibitory to hyperreflexia
- Immobilises - can reduce pain
- In line with the chronic phase and adapt/modify approach
What does each letter in “BEFAST” stand for?
(Warning signs of Stroke)
B: Balance loss
E: Eyesight changes
F: Face drooping
A: Arm weakness
S: Speech difficulty
T: Time to call 911
Function of each brain lobe?
(NB for focal TBI)
- Frontal lobe = speech, cognitive functioning, personality
- Parietal lobe = sensation
- Temporal lobe = processing auditory information, memory
- Occipital lobe = visual processing
- Cerebellum = balance, fine coordination
Define spasticity (hyperreflexia).
Motor disorder characterised by velocity dependent INCREASE in tonic stretch reflexes with exaggerated tendon jerks resulting from hyper excitability of the stretch reflex (hyperreflexia) - CONSTANT STRETCH REFLEX because there is no inhibitor reflex from the brain.
How does spasticity/hyperreflexia contribute to hypertonicity?
Hypertonicity includes all factors which will provide resistance to movement: Spasticity/hyperreflexia AND secondary impairments (such as stiffness, pain, shortening, myofascial tension, neural tension).
** Only spasticity in extremes affect movement
** Mild to moderate spasticity does NOT affect movement
What is the difference between hypertonicity and spasticity?
Hypertonicity is due to bio-mechanical changes in muscles due to immobility, and can also be caused by spasticity. Increase in resistance during PASSIVE movement.
Spasticity is due to neurological changes causing dysfunction in the regulation of the stretch reflex. VELOCITY DEPENDENT.
Why does a patient who has a stroke become weak?
- Loss of SCOM - seen as weakness due to loss of descending motor units or decreased number of units activated.
- Loss of inhibition to reflexes - seen as spasticity / increased reflexes
- Weakness is due to brain innervation to muscles being lost - as opposed to MSK where the muscle itself is weak
What are synergistic movements?
- Movements that are evoked volitionally or reflexively and are primitive, autonomic and reflect the loss of inhibitory control exerted from higher levels of CNS integration.
- CNS damage results in regression to phylogenetically older patterns of movements.
- When movements initiated at one joint - all muscles linked in synergy with that movements automatically contract.
Which synergy develops first in the upper limb, and which movements are seen in relation to it?
Flexor synergy:
* Scapular elevation and retraction
* Shoulder abduction
* Elbow flexion
* Wrist and finger flexion
Which synergy develops first in the lower limb, and which movements are seen in relation to it?
Extensor synergy:
* Hip adduction and internal rotation
* Knee extension
* Ankle plantar flexion and inversion
What are the 6 Brunnstrom stages of recovery (SCOM recovery)?
- Flaccidity (no voluntary movement)
- Synergies can be elicited reflexively (flexion develops before extension)(spasticity developing)
- Beginning of voluntary movement, but only in synergy, increased spasticity
- Some movements deviating from synergy
- Independence from basic synergies
- Isolated joint movements
F (frequent)
S (socialising)
B (but)
S (sleep)
I (in)
I (isolation)
What does SCOM trunk dysfunction lead to?
- Dysfunctional limb control
- Increased risk of falls
- Contractures and deformities
- Decreased sitting and standing endurance
- Decreased visual feedback from the environment
- Poor interaction with the environment
- Poor swallowing ability
Sensory re-eduction vs Sensory education
Sensory re-education = improving sensation detection post stroke e.g. ability to discriminate between temperatures
Sensory education = informing someone of a strategy to prevent injury e.g. “you can’t feel your legs anymore so make Sur you always wear shoes because you could get hurt on the bottom of your feet and not feel it”
Which client factors (CFs) are affected due to STROKE?
- Sensation and pain
- Muscular endurance (+ muscle strength)
- Coordination
What is the definition of “penumbra”?
Penumbra = the area around a brain lesion (necrotic part)
What is the definition of neuroplasticity?
Neuroplasticity = Functional improvement due to changes in spared / non-lesioned parts of the brain
Intact cortical areas adjacent and remote undergo functional/cortical reorganisation around the penumbra.
What are the three mechanisms of neuroplasticity?
- Unmasking = strengthening existing neuronal connections
- (axonal) Sprouting = bridge damaged areas by growing new part
- Transplantation = emergence of new connections
What is the ideal timeframe post stroke for neuroplasticity?
3 months
Name 3 sensorimotor / reflex based neurofacilitation approaches.
- Brunnstrom
- Rood
- PNF
- Sensory integration
Principles of which FoR to use in adult neurology.
- Must not focus on tone alone
- Must consider WEAKNESS AS A PRIMARY DYSFUNCTION and be focused on neuroplasticity
- Must include treatment of secondary impairments
