Arousal impairment
experience different stages of being awake
Orientation impairment
disorientation behavioral or verbal
Attention impairment
inability to focus, keep track of themselves easily distracted, unable to do more than one thing unable to switch back and forth
Retrograde amnesia
impairment of memory cannot recall things before the injury
Anterograde amnesia
impairment of cognition cannot recall things after the injury training is difficult multiple reputations needed, cue cards throughout house
Initiation impairment
inability to start a task needs cueing
Task persistance impairment
inability to stay on task
planning impairment
slow processing smaller steps needed
Generative thinking impairment
compensatory problems cannot think of new ways to complete a task
Wernickes Aphasia
fluent impaired integration and language formation deficit in auditory and reading comprehension Alexic, agraphic
Addressing Wernickes Aphasia
keep it simple keep you language similar check for teach back / understanding
Brochas Aphasia
nonfluent slow effortful speech difficulty reading and writing difficult initiation of speech, use short phrases
Addressing Brochas Aphasia
give them time to speak positive reinforcement encourage use of speech generating device not all communication needs to be verbal dont assume you know what they want
Global aphasia
combination of both types usually caused by occlusion of MCA impaired comprehension, integration, and forming language
4 Phases of swallowing
oral preparatory phase oral phase pharyngeal phase esophageal phase
Swallow treatment and precautions
Chin tilt (NOT a cure) head turn double swallow alternate solids and liquids 24/7 supervision
vision - central lesions
visual field deficits, visual neglect, visual extinction often associated with R stroke
Eye - Head - Hand coordination
cerebellar and visual dysfunction slower tracking of movement inaccurate and more variable hand movements
problems with reach
timing problems difficulty adapting to task
global synkinesis
involuntary movement of hemiplegic limb when other limb moves
right sided cerebral lesions
MCA spatial and perceptual deficits unilateral neglect
Homonymous hemionopsia
lesion of optic tract posterior to optic chiasm
Anosognosia
extensive neglect syndrome fails to recognize limbs as theirs
Praxis
ability to rapidly conceive of and plan motor acts in response to environment
apraxia
inability to carry out purposeful skilled movement disturbance of planning and execution
Ideational apraxia
inability to cognitively understand the demands of a task involving multiple steps
ideomotor apraxia
difficulty with production errors even though the idea and task are understood
Tactile agnosia
inability to attach meaning to somatosensory info
Astereognosis
inability to identify objects by touch only
Stereognosis
testing by occluding vision and using hands to identify objects
visual agnosia
inability to identify or recognize familiar objects or people
Floor reaction AFO
set in plantarflexion anterior shell / band stabilize the knee
who would benefit from a KAFO
spinal cord injury patients NOT stroke patients you need proximal movement to get anywhere
Knee joints in KAFO
Drop Lock (locks in extension) Bail lock (U shape at knee)
Jane is a 78 y.o. s/p L MCA stroke 3 weeks ago R LE strength: Hip 4/5 Quads 4/5, hamstrings 3+/5 TA 2/5, PF 3/5, evertors 1/5 Impaired sensation to light touch and proprioception Type II DM with history of one foot ulcer in the past Currently ambulating with mod A Goals: ambulate in home and community
Custom Plastic, hinged Neutral PF
L LE strength: Hip 4/5 Quads 2+/5, hamstrings 2/5 Ankle muscles 1/5 Impaired sensation Non-ambulatory until recently; currently standing with mod to max A; has taken few steps in parallel bars with max A, plus one to follow w/ w/c Goals: ambulate in home and community
AFO custom plastic fixed slight PF (stabilize the knee)
plastic
interchangeable in shoes
lightweight
LIMIT: hot take up space in shoe
metal
for patients who have a lot of swelling
LIMIT: can only have one shoe
older patients and polio patients
PLS
thin narrow shell allows some movement at ankle
“spring back” for foot clearance
assist dorsiflexion
Hypertonic patients
Articulating AFO
joint at ankle
allow dosriflexion, stops PF
pinching and knee buckleing LIMITS
non articulating AFO
limit motion at ankle
good for pts with ankle and knee weakness
control subtalar joint
Floor reaction AFO
set in PF
Anterior shell / band
prevents knee flexion
for knee stability issues
Tone reducing AFO
typically kids
extended foot plate to control toes
medial and lateral control of ankle