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NEUROMUSCULAR II (Potter) > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Explain the exiting of nerve roots at vertebrae

A

at C8 the nerve roots exit below
at C1-C7 they exit above
in T spine they exit below corresponding vertebrae

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2
Q

end of the SC is at

A

conus medullarus (L2)

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3
Q

below L2 is the

A

cauda equina

peripherial nerves = potential for regeneration

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4
Q

injury to the spinothalmic tract would result in (contra or ipsi sx)

A

contra

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5
Q

injury to post columns (dorsal columns) would result in (contra or ipsi sx)

A

ipsi

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6
Q

injury to lateral corticospinal tract would result in (contra or ipsi)

A

ipsi

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7
Q

injury to medial corticospinal tract would result in (contra or ipsi sx)

A

ipsi

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8
Q

the spinothalmic tract is aka

A

anterolateral system

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9
Q

the anterolateral system (aka spinothalmic tract) has what functions

A

pain
temp
crude touch

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10
Q

the spinothalmic tract crosses where

A

in SC

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11
Q

the dorsal column functions

A

disc (fine) touch
vibration
proprioception

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12
Q

the dorsal column (aka post column) crosses in the

A

BS

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13
Q

the lateral corticospinal tract functions

A

motor to extremities

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14
Q

the medial corticospinal tract functions

A

motor to trunk

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15
Q

damage to the SC on one side would yield motor damage to the (contra or ipsi side of damage)

A

ipsi side from that level and down

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16
Q

overall, the corticospinal tracts are the ___ pathways

A

motor

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17
Q

overall, the dorsal columns and ant/lateral system are the ___ pathways

A

sensory

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18
Q

C5 motor level

A

elbow flexors

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19
Q

C6 motor level

A

wrist extensors

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20
Q

C7 motor level

A

elbow ext

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21
Q

C8 motor level

A

long finger flexors (FDP)

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22
Q

T1 motor level

A

small finger abd

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23
Q

L2 motor level

A

hip flexors

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24
Q

L3 motor level

A

knee ext

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25
L4 motor level
ankle DF
26
L5 motor level
long toe ext (EHL)
27
S1 motor level
PF
28
C2 sensory location
behind ear
29
C3 sensory location
above clavicle
30
C4 sensory location
AC jt
31
C5 sensory location
lateral elbow
32
C6 sensory location
dorsal thumb (at proximal phalanx)
33
C7 sensory location
dorsal middle finger (at proximal phalanx)
34
C8 sensory location
dorsal pinky finger (at proximal phalanx)
35
T1 sensory location
medial elbow
36
T2 sensory location
axilla
37
T3 sensory location
3rd intercostal space (midline of clavicle)
38
T4 sensory location
nipple line | 4th intercostal space (midline of clavicle)
39
T5 sensory location
5th intercostal space
40
T6 sensory location
xiphoid process (in midline with clavicle)
41
T7 sensory location
1/4 way btwn xiphoid and umbilicus (higher up)
42
T8 sensory location
1/2 btwn xiphoid and umbilicus
43
T9 sensory location
3/4 way btwn xiphoid and umbilicus
44
From T3-T12, use what anatomical location as marker
all are at midline of clavicle
45
T10 sensory location
at level of umbilicus
46
T11 sensory location
1/2 way btwn umbilicus and ing. lig
47
T12 sensory location
at ing. lig
48
L1 sensory location
btwn T12 and L2's location | upper middle ant thigh
49
L2 sensory location
middle ant thigh
50
L3 sensory location
medial epicondyle of knee
51
L4 sensory location
medial malleolus
52
L5 sensory location
3rd MCP of toe
53
S1 sensory location
lateral calcaneous
54
S2 sensory location
middle of popliteal fossa
55
S3 sensory location
ischial tub
56
S4/5 sensory location
peri area
57
which type of SCI is more common
traumatic
58
what vert levels of traumatic SCI are more common and why
C5/C6 T12-L1 bc energy takes path of least resistance and these segments are very mobile
59
explain very basically what occurs with traumatic SCI
hemorrhaging necrosis of gray matter primary and secondary injury
60
what spinal level controls the diaphragm
C4
61
what levels (not specific segments but general level) of spine are more and least likely to have SCI, and describe which are more likely to be complete vs incomplete
Cervical and Lumbar are more common and are usually incomplete Thoracic is less common but is often complete (less common bc it lacks mobility and is protected by ribs)
62
what is the determining factor regarding extent of injury to L spine
cauda equina involvement
63
what injury often accompanies a SCI
TBI
64
4 movement patterns that lead to SCI (MOI)
flexion compression flexion with rotation hyperext
65
flexion SCI cause damage where
ant vertebral
66
2 types of flexion SCI (most common)
wedge | ant cord
67
diving head first on a hard surface would yield in what type of SCI
compressive (it's a straight vertical force)
68
2 types of compressive SCI
burst | teardrop
69
explain where damage occurs with a flexion with rotation SCI
Post to ant forces cause damage to lamina, peduncle, facets fx
70
this type of SCI is typically seen in older pts. who fall. they can result in complete SCI, but most often result in central Cord syndrome
hyperextension
71
reasons for non traumatic SCI
``` Tumor Transverse myelitis Syringomyelia Vertebral subluxation Infection Vascular malformations ```
72
what is transverse myelitis
a non traumatic SCI, typically sudden onset, involves a specific spinal cord level, and inflammatory process
73
what is synringomyelia
a non traumatic SCI, a condition that causes an opening somewhere in the spinal cord – effects multiple levels –fills up with fluid
74
RA at what vert levels can cause a non traumatic SCI
C1/C2 – these pts can be subject to vertebral subluxation
75
explain complete vs incomplete SCI
complete: Both motor and sensory function absent below level of injury, including lowest sacral segments incomplete: Some motor and sensory function preserved below level of injury, including lowest sacral segments
76
what are the lowest sacral segments, and why are they significant
S4 and S5 – control BB Complete SCI – are incontinent of BandB In order to be classified as incomplete: S4 and S5 have to be preserved in order to be classified as incomplete S4/S5 preservation can often be predictors of prognosis
77
explain zone of partial preservation
Term used for patients with COMPLETE SCI who have partial preservation (i.e., sparing) of motor and/or sensory function below level of injury. Example: Patient with complete C5 tetraplegia who can perform partial DF of his ankle. However, keep in mind that they are still complete, so S4/5 are still not preserved
78
paraplegia vs tetraplegia
tetra is loss at trunk and all 4 limbs | para is B leg loss
79
what is ant cord syndrome
an Incomplete injury Loss of motor function, and pain, temperature, and crude touch sensation below level of injury So the corticospinal tracts and the spinothalmic tracts are damaged but the post column functions are preserved bc post SC is intact
80
cause of ant cord syndrome
often an ant spinal A stroke
81
what is central cord syndrome
an Incomplete injury= UE motor only effected Typically involves cervical spine from a fall = hyperextension injury results in UE weakness with sparing of LE Sparing of sacral motor and sensory function central cord =falls = hyper ext
82
Pts with central cord syndrome would have more trouble with WB/walking or dressing themselves/daily ADL's
more trouble with daily ADL's dt UE weakness
83
one main cause of Brown Sequard syndrome
a hemi sectioning like a stabbing
84
What is Brown Sequard Syndrome
an incomplete SCI Ipsilateral loss of proprioception, deep and discriminatory touch, vibration, & motor function Contralateral loss of pain, temp, and crude touch contra loss of spinothalmic tract ipsi loss of dorsal column and corticospinal tracts
85
what is post cord syndrome
loss of post/dorsal column function below level of injury | often d/t stroke of post spinal A
86
what % of SCI occur after the original accident d/t improper mvmt/care
About 25% of SCIs occur after original insult
87
within the first 24 hours of a SCI, what is critical to watch for
Hypotension & neurogenic shock – disruption in sympathetic NS hypotension and brady cardia More common in higher level SCI
88
pts with SCI should be treated at what type of facility
level 1 trauma center
89
main med used after a SCI
Methelprednisone (steroid to decrease inflammation) is main med for SCI immediately
90
primary vs secondary injury of SC
Primary- Due to the insult, local deformation of cord Irreversable Secondary-Shortly after initial trauma, first few hours Ischemia, axonal degeneration, inflammation May be reversable
91
traumatic vs non traumatic SCI, what title of health care provider is most important for each
traumatic- orthopedist | non traumatic - neurologist
92
soft tissue image type
MRI
93
Multi-slice or spiral/helical image type
CT
94
what is ASIA
American Spinal Cord Association (ASIA index).
95
Mainstay of stabalization devices for C spine cord injury bc it provides the best stabilization
halo
96
how long do pts have to wear halo, what is main con
12 wks | very top heavy
97
when is cspine traction used over a halo, what is a con
Used when medical problems don’t allow use of other devices they are on bedrest
98
when are cervical spine orthosis used (ex: a menerva brace)
Often used for cervical spine injuries that do not result in neuro deficits
99
cons of cspine orthosis
Often used for cervical spine injuries that do not result in neuro deficits
100
thoracolumbar braces are worn how long
up to 3 months
101
thoracolumbar surgical Rods that attach to lamina above and below injury level, these limit motion and are very stable Avoid high torque forces
Harrington rods
102
special considerations of cspine pre-stabalization (precautions) special considerations for thoracolumbar spine
Cervical: No neck ROM shoulder flex and abd to 90 degrees only ER may be limited Thoracolumbar: No hip flex past 90degrees, SLR may be limited to 30
103
why is full elbow ext so important for pts with SCI
bc they spend a lot of time in long seated position and they need elbow ext to keep them from falling over
104
what is needed to be able to sit in long seated
Full shoulder extension and ER Full elbow extension Hamstrings to 110
105
during transfers for pts with SCI, what motion is needed to occur when knee is flexed
DF
106
what motions are required for SCI pts with ADLS
tight long finger flexors (especially for pts who have lost motor function to hands/wrists) full hip ER
107
explain muscle tone for pts with a SCI
``` Initially flaccid (spinal shock= edema); gradual increase in tone (like stroke) ```
108
what are the 10 main complications (listed in the ppt) for pts with SCI
``` px decub ulcers ectopic bone postural hypotension autonomic dysreflexia mental health resp issues DVTs contractures osteoperosis ```
109
what is autonomic dysreflexia
Pathology of autonomic N.S. at injury levels above T6 Trigger: noxious stimulus below level of injury Results in HTN, HA, profuse sweating Can cause stroke, blindness, death
110
what is neurological level
Lowest segment where there is normal sensation (2) and | antigravity motor function (≥ 3)
111
why is 3/5 against gravity important for asia scoring
functional is against gravity
112
what is sensory level for asia
lowest level that is a 2
113
explain scoring options for asia sensory
``` Scoring 0 = absent 1 = altered 2 = normal (1 can be too much or too little) ```
114
which classification of asia is complete injury (no sensory or motor below a certain level, and lack of S4/S5)
Asia a
115
explain Asia B classification
sensory incomplete Sensory preserved below neurological level and includes AND no motor preserved below levels below motor level on either side (essentially means they have some sensation but no motor below the level)
116
explain asia C
motor incomplete Motor preserved below neurological level > half of muscles ≤ 3/5
117
explain asia D
ASIA D = motor incomplete Motor preserved below neurological level > half of muscles ≥ 3/5
118
what is asia E
normal
119
what asia classifications have poorer prognosis
A and B bc lack of motor
120
what is different about Tspine levels for asia
you cannot classify motor like C spine, whatever sensory level is..is what your motor level is if sensory level is a Tspine, motor is automatically that level
121
complete vs incomplete SCI (how to tx differently)
complete - aim for compensation | incomplete - aim for remediation
122
which asias will we almost always tx with compensatory txs
A and B
123
why strengthen muscles that are 5/5 for SCI pts
bc we need to work on strength for the new compensatory movements they will be doing
124
prerequisites for function
``` strength ROM balance endurance psycho abilitys ```
125
how might spacticity be a good thing
typically only in incomplete pts | it can help tighten a limb for function (WB, transfers)
126
___ practice is good for teaching new transfers for SCI pts
part
127
what is a CV precaution of SCI pts
ortho HTN (long seated is good for them )
128
3 main strategies used by pts with SCI for function
Muscle substitution Momentum Head-hips relationship
129
explain muscle substitution
Used when a muscle normally producing the movement is weak or absent Patient learns to use an alternate muscle to perform the movement by having the alternate muscle pull in a different way
130
if triceps are weak, how could you muscle substitute
ER shoulder and supinate
131
why would we not want to overstretch the long finger flexors
they need tenodesis
132
serratus level is
C6
133
which muscle is important to stretch for pts who cannot stand
soleus
134
what levels are more likely to have resp issues with a SCI
C4 and above
135
what is dysthesia and where is it seen
``` SCI pts abnormal sensations (often a burning type of px) ```
136
% of SCI pts with chronic px
70
137
atrophy of muscles = loss of circulation and tissue preservation = skinny bony areas is an issue bc of
decubs forming for SCI pts
138
biophosphonate drugs tx
``` heterotopic ossifications (ectopic bone) vigerous ROM and trauma causes bone where it shouldn't be (occurs in bigger jts mainly) ```
139
sx of ectopic bone are
similar to infection/inflammation | hot, red, lack of ROM
140
what 2 issues are causes for postural hypoTN in SCI pts
Venous pooling and lack of SNS function
141
autonomic dysreflexia is a(n)
medical emergency | extreme HA and HTN
142
explain autonomic dysreflexia sx and outcomes if not handled properly
Results in extreme HTN and head ache, profuse sweating Can cause stroke, blindness, coma, and death
143
how to avoid autonomic dysreflexia
monitor BP, sit up (45 degrees), remove noxious stimulus, inform nurse/MD
144
why do pts with KAFOs still require a wc
they typically use wcs for community transport bc KAFO’s are not really functional and they also require hands to be on crutches (so its really not functional)
145
which asia classification has more potential for motor return
ASIA D
146
PT focus for SCI pts should be
mobility/transfer training
147
Asia C pts best ambulatory training would be
BWS
148
KAFOs are for which Asia classifications
A | B
149
why do we use BWS
it allows us to trial and error in a safe way | keeps us and pts safe
150
summary of articles about amb training for SCI pts
overground was best conventional over treadmill robotics not so great bc pt isn't having to correct self
151
what muscles would help a SCI pt to stand/pivot transfer if the muscle was spastic
quads (min to mod spasticity)
152
type of transfer for asia b
sensory incomplete (motor is complete) these pts will do scoot bc they don’t have the motor to stand
153
type of transfers for asia c
motor incomplete (half the muscles are less than 3/5) these pts will do scoot pivot bc they wouldn’t be strong enough for stand (especially early)
154
type of transfers for asia d
motor incomplete (muscle grade of 3 or more in half the muscles below the level) these pts. Could use both – but can do stand.
155
a pt with C6 tetra, how would they lock their wc brakes or handle arm rests
tenodesis
156
when thinking prognosis of future function, if the neuro level is L2 or below what is significant to remember
L2 and below is peripheral = can possibly regenerate
157
trunk control segment (approx)
T6
158
what time frame is typically the predictor of future function of a SCI pt
at 6 months | what that have at that time is typically what they will have
159
time frame for incomplete injuries, when does MOSTrecovery occur
½ - ⅔ of the 1-year motor recovery occurs in first 2 months (like cortical lesions) biggest recoveries are first 2 months 6 months is usually prognostic marker
160
most significant functional and motor predictor of prognosis for a SCI
severity
161
5 main predictors for prognosis for SCI
``` severity age level of injury complete/incomplete MOI- lower energy = better outcome ```
162
explain how level of injury differs for SCI pts (cspine vs tspine)
Cervical SCI: more incapacitating (overall) than thoracic Thoracic SCI: less potential for recovery than cervical (T spine have less chance to transition to incomplete from complete) 1 level in tspine isn't as significant as 1 in cspine
163
time frame LTG for SCI
1-2 yrs
164
tetra or high tspine injuries stay in rehab how long
5-8 wks rehab
165
paras stay in rehab how long
3-4 wks
166
functional goals for SCI C1-3
``` Respirator dependent will need full-time attendant Can talk, chew, swallow Can sip, blow Can use sip-and-puff w/c ```
167
what is still intact with a C1-C3 injury
face/neck muscles | cranial nerves
168
functionality of C4
power wc dependent bed mobility and transfers are dependent pt will be able to verbalize and direct the care giver to perform transfers May not be able to breath on own all time They can power a WC They can shoulder shrug
169
muscles innervated by C4
Upper trapezius, Diaphragm Cspine paraspinal muscles Neck flexion, extension, rotation; scapular elevation; inspiration
170
muscles innervated by C5
Elbow flexors, supinators (Deltoid, biceps, RC, brachialis, brachioradialis, rhomboids)
171
functionality C5 level
``` grooming with adaptive equp. manual wc propulsion for house only Bed mobility with some asst. Cannot grasp reg spoon or fork Part time care attendant Low endurance ```
172
other than the wrist extensors, what muscles are innervated by C6
Lat. dorsi Serratus Pecs (clavicular)
173
functionality C6
``` Eat w/ adapted utensils Dress almost Ind–big benchmark I bed mob/transfer w/ sliding board I pressure relief- benchmark Good cough – still impaired Drive w/ hand controls- benchmark I manual w/c (friction rim) May use power w/c Assist w/ self-ROM ```
174
what muscle is key for bed mobility
serratus - C6
175
functionality of C8-T1
all UE functional can pop wheely can drive with hand controls can eat without adaptive devices
176
T4-T6 muscles
MOST intercostals upper back mid trunk resp is better but still no forced cough
177
level to bend and pick something up off the floor (trunk control)
T4-T6
178
what level is FULL intercostal function
T9-T12 best resp function good core
179
level of first potential for ambulation (with KAFO) SCI
T9-T12
180
L2-L4 functionality
can amb with KAFO | quads, hip flexors, adductors (all some function)
181
muscle needed to hip hike with KAFOs on
quadratus
182
muscles innervated L4-L5
``` Low back Quads Medial hams Tib ant and post Toe ext ```
183
our main goals for an acute pt in ICU with GBS
positioning for prevention, PROM, (education to staff and family for both), assist in pulmonary hygiene
184
PT dx for GBS
force production deficit with expectation of recovery down the road
185
possible PT dx for SCI
Monitored Mobility, Sensory Detection Deficit, LE Paresis with Flaccidity
186
biggest diff btwn GBS and MS
with GBS there is a chance of remyelination bc its a PNS issue not CNS
187
most GBS pts have good prognosis for recovery with residual weakness where
distal extremeties
188
GBS pts have absent
DTRs
189
Most common cause of acute, flaccid paralysis in developed countries ___ Most common motor neuron disease___
flaccid paralysis- GBS motor neuron disease - ALS
190
does GBS have geographic distribution like MS
no
191
who has GBS more, men or women
men
192
why is there a slight peak in incidence of GBS at certain times in life....and when are they
Slight peak in late adolescence & early adulthood, and elderly = decreased immune sx causes some form of infections (at these age ranges we are more prone to infections)
193
trigger for GBS
Triggered by a preceding bacterial OR viral infection in 60-70% of patients (resp or GI) 1-3 weeks prior Bacterial = C jejuni Gastroenteritis is most common
194
explain pathophysiology of what occurs with GBS (why does body attack itself)
When pple get c jenuni, the body’s immune sx kicks in and attack the ganglioside thinking that the gangliosides on peripheral axons are bad and an autoimmune response occurs
195
bugs that cause GBS
cytomegalovirus haemophilis influenza c jejuni
196
after the GBS pt has had a virus/bacterial inf, what occurs next
Gradual symmetrical ascending paralysis over days - 4 weeks with paresthesias and numbness (starts with involving feet and hands and travels to trunk)
197
once the ascending paralysis occurs and travels to trunk (with GBS), what happens next
a plateau of about 2 weeks
198
what happens after the plataeu with GBS
Gradual resolution of paralysis (weeks to months) (onset paralysis is distal to proximal, resolution is proximal to distal)
199
GBS is predominantly (motor or sensory)
motor sx
200
dx of GBS is done how
nerve conduction study (EMG) lumbar puncture (protein build up bc myelin is made of protein) Antigangioside antibodies
201
most common form of GBS
Acute inflammatory demyelinating polyneuropathy
202
cells that get demylenated with GBS (type)
schwann cells on myelin
203
sx of acute inflammatory demyeliating polyneuropathy
LEs involved before UEs Will involve distal and proximal muscles (inc. Cr. N) Can involve sensory nerves (esp. deep sensation) DTRs typically absent Proximal pain/aching Variable autonomic involvement (abnormal cardiac/resp response to exercise) Can end up on a vent
204
mortality rate is high in what phase of GBS
acute, infl, demy. poly
205
CV issues with GBS (acute setting)
Autonomic dysfunction Hypotension occurs in 10% of severely affected patients; treated by IV fluids Hypertension: short-acting hypotensive agents DVT prevention
206
O2 sat of ___ is goal for GBS
88 | under 88 there is potential for issues
207
other than O2 sats, what are the parameters for other vitals to know whether or not to terminate PT with GBS pt
HR 40-130 bpm RR 5-40 breaths / min Systolic BP > 200 mm Hg
208
2 main medical ways GBS is tx
``` plasmaphoresis immunoglobulins (preferred) ```
209
effects wear off after ____ weeks for immunoglobulin tx of GBS
6 | pts usually are improved at this time though
210
bc of fatigue, what must we do during tx for GBS pts
modify and alter our plan always | prioritize
211
what are key tests to perform on a GBS pt day 1
mobility balance strength VS
212
bc overdoing it can cause further weakness in neuro pts, how to monitor overuse with therex
Px, stiffness, prolonged weakness are signs of them over doing it If you wake up tomorrow morn and are still tired, we over did the ex Its a good idea to educate pts that these side effects might occur Its not unusual for pts with GBS to have mild cramping aches and pxs but then it goes away
213
GBS and ALS guidelines for resistance training
≥ 3/5: against gravity with resistance as tolerated | ≤ 3-/5: gravity neutral or into gravity, with assistance prn
214
PT focus for GBS should be on
LE and trunk strengthening
215
most strength gains for GBS happen when
first 6 months
216
(-) correlations between strength recovery slope and;: - Plateau stage duration - Acute stage duration GBS, what does this mean
The longer the pt is in the plateue or acute stage, the slower their progress goes
217
its common for tingling in distal ext to occur up to ___ months with GBS
6
218
what do a good % of GBS pts need at 1 year for amb
B AFOs - feet are distal so the return last
219
substitutions for C5
shoulder elevation
220
substitutions for C6
supination
221
substitutions for C8
wrist ext
222
PT dx for ALS
force production deficit
223
length pts with ALS are in an in pt rehab setting is typically
2-3 wks
224
most common motor disease
ALS
225
incidence of ALS
Incidence more common in males
226
3 variants of ALS
Classical sporadic- insidious onset for no reason Pacific- occurs in Guam Familial
227
etiology of ALS is
unknown | there are theories about possible triggers though
228
theories about triggers for ALS
Environmental trigger-Likely role in the pacific variant May be diet-related Trauma- athletics Physical and emotional stress
229
ave age at onset for ALS
60
230
3 ways ALS begins at onset (which is most common)
Upper limb Lower limb- usually 1 first*** Bulbar- impairments with bulbar involvement effect cranial nerves (speech and swallowing issues)
231
which of the types of ALS onsets has poorest outcome
bulbar - resp issues (CN and swallow)
232
2 factors that have shown to be associated with less rapid onset of ALS
Younger age at onset | Males w/ hand involvement at onset
233
drug that extends survival by at least 3 mos for ALS
Riluzole
234
life expectancy ALS
3-5 yrs post dx
235
only ___% of pts dx with ALS live more than 3 yrs post dx
50
236
GBS is an issue with ____ neurons, while ALS is an issue with
GBS is lower motor neurons (peripherial) | ALS is a mix of upper and lower
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in summary, explain progression of ALS
if there is deg of neurons LMN then LMN sx will occur, as disease progresses (legs first then travels up) towards brain then they can get involvement at higher levels, so the sx will later reflect UMN signs Eventually it can reach fronto-temporal cortex effecting memory, cognition behavior (prob solving issues)
238
what are the sx related to the UMN issues with ALS
Spasticity Hyperreflexia Loss of dexterity & speed Pathological reflexes
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what are the sx related to LMN issues with ALS
Weakness & atrophy Hyporeflexia Fasciculations- abnormal oversensitive axons that depolarizes = twitching Muscle cramps
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bulbar sx with ALS
suck/gag reflexes resp issues speech
241
a general psychological prob with ALS
pts don't always have time to grieve one loss before disease continues to progress
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leading cause of death for ALS
resp failure
243
what is predictor of mortality for ALS
pulmonary function FVC
244
sx of resp muscle weakness (ALS)
``` May or may not include dyspnea (bc no exercise) Orthopnea Sleep disturbance Daytime hypersomnolence Morning headaches Abnormal breathing patterns ```
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what is typically spared with ALS pts
BB are continent, but ability to transfer and hygiene care are often dependent
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OM for ALS
AFRS ALS function rating scale (self reported) 0-4 scale (4 normal) (takes into acct multiple aspects: ADLs, motor, speech)
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what are unrealistic goals for ALS
prevent strength loss | increase strength
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why is stretching and positioning so important for ALS
bc spacticity causes px and these txs can help better than the meds can (meds cause more weakness)
249
strengthening guidlines ALS
don't do res ex for muscles less than 3/5 | only do res/strengtening for pts early dx
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Emotional impact of the diagnosis Denial and other emotional responses Uncertain future: inevitable loss What stages of ALS
Early | 1 and 2
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Multiple losses experienced Great need to make decisions May be reluctant to use compensatory strategies what stages of ALS
mid | 3-4
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Confronted w/ terminal aspects of disease Worries about family and loved ones Decisions regarding life-saving measures what stages of ALS
late | 5-6
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total exercise time for ALS should be
``` Total = 30 -45 min 10-15 min at a time do 2-3 bouts throughout the day mod only-no max only in early stages ```
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why is exercise so beneficial early in ALS
decreases spacticity and increases QOL
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what are measures to take before the step of a ventilator for pts with ALS
Non-invasive positive pressure (mask or canula) Can prolong survival time without ventilation Helps maintain FVC values Improves respiratory symptoms, QOL, and cognition Shown to improve exercise capacity
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only method to provide indefinite life prolonging support to ALS pts
trach
257
type of care team appropriate for ALS pts
palliative
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4 aspects of palliative care
Communication Symptom control Rehabilitation Terminal care
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3 aspects of tx for ALS pts
remediation, prevention, compensation
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what stages of ALS should we focus on remediation
1 and 2
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what stage of ALS should we focus on prevention
all
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what stages of ALS should we focus on compensation
2 on
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what are examples of remediation in regards to tx of ALS
conditioning maintaining strength maintaining leisure activities
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examples of prevention in regards to tx of ALS
decub prevention | airway clearance
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beginning to show signs of weakness is usually what ALS stage
2
266
mod to max weakness in some areas | ambulation beginning to be impaired is what ALS stage
3
267
Severe leg weakness; mild arm weakness Use of wheelchair for locomotion; may be able to use arms for ADLs describes what stage of ALS
4
268
max assist with most ADLs Progressive weakness; decreased endurance Wheelchair use; lift may be necessary; need for assistance w/ ADLs and mobility what stage of ALS
5
269
what is the focus of stage 6 of ALS | they are total dependent
comfort | peace
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specific group of muscles min. weak independent in ADLs what stage of ALS
1
271
why is Tspine the least likely area in spine for a SCI
it lacks mobility and is protected by ribs
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of the pathologies, which pts will have absent DTRs
GBS
273
what level is upper traps
C4- they can shoulder shrug
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ALS is a ____ disease while GBS is a ___ disease
ALS- Upper and lower motor neuron | GBS - demylinating paralysis of LMN
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level pt can pop a wc wheely
C8-T1
276
Type of SCI MOI that causes ant cord syndrome
Flexion
277
bulbar has to do with what disease
ALS

NEUROMUSCULAR II (Potter) (3 decks)

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