Mid Semester VIVA Flashcards
(36 cards)
Diffuse axonal injury, affected areas, pathophysiology, signs/symptoms
Shearing of axons and the myeline sheath due to acceleration, deceleration and rotation of the brain tissues during a traumatic event caused by a blunt force to the brain
Commonly affect corpus callosum and the brain stem
Dysfunction of neural connections in the brain affecting functional areas
Headache, dizziness, vomiting, fatigue, loss of consciousness. The results can be mild, moderate, or severe and lead to disconnection or malfunction of neuron’s synapses, affecting numerous functional areas of the brain.
Presentation of damage to the right frontal lobe (motor, behaviour/personality and higher executive function)
Frontal:
Motor function of the left side of the body is affected: voluntary movement, loss of coordination, initiating and coordinating eye movement, difficulty with postural adjustments, difficulty with motor control of speech (N/A - FROM LEFT HEMISPHERE DAMAGE)
Personality/behaviour: changes in personality, behavioural changes, deciding on a goal and executing a plan, inhibition of behaviours (socially inappropriate behaviour), emotionally labile
Higher executive function: loss of sequencing and planning, difficulty carrying out goal directed behaviour and habits, difficulty making decisions and problem solving, difficulty with motivation, inability to focus on a task (attention), persistence of a single thought
Presentation of damage to the right parietal lobe (sensation, motor, executive function)
Right parietal lobe: Viso-spacial deficits eg. difficulty understanding spatial orientation and navigation - proprioception, navigating environments
Sensation: Difficulty locating stimuli and discriminating shape, texture and/or size of objects (stereognosis), difficulty with proprioception, inability to focus visual attention
Motor: difficulties with hand eye coordination (due to reduced sensation), difficulty discriminating left and right
Executive functions: difficulty attending to multiple things (dividing attention), inability to name objects (anomia), inability to locate words to write (agraphia), difficulty reading (alexia), difficulty drawing objects, difficulty with maths (dyscalculia)
How is Johnsons environment affecting function post injury (PHYSICAL eg. stairs, space, showering, meal prep, SOCIAL eg. support, COGNITIVE eg. fatigue, attention)
PHYSICAL: left sided hemiplegia and sensory loss, able to walk short distances with standby assist on the left and verbal prompts to attend to the left side.
Stairs: difficulty with motor planning and sequencing may affect his ability to get up the stairs, difficulty with problem solving may affect his ability to climb the stairs if an obstacle is in his path (communal stair of of his apartment floor), difficulty with hand eye coordination and proprioception affecting his ability to lift and place his leg in the correct position on the stair)
Small apartment space: reduced ability to coordinate movements therefore may misjudge the apartment space eg. Walks into walls or apartment objects eg. Knocking lamps etc.
Clutter may reduce his ability to focus on a task due to having difficulty focusing on one task
Showering: may have difficulty coordinating the arms to wash his body, less stimuli eg. Shampoo, conditioner, soap that are colour coded to support him
Meal prep: ability to plan, prepare and cook meals may be affected due to proprioception, planning, sequencing movements, fatigue, left sided hemiplegia (affecting bilateral tasks)
SOCIAL SUPPORT: lives with his partner therefore she can assist him to complete physically or cognitively challenging activities, large supportive network of family and friends, highly active (played soccer and windsurfed)
COGNITIVE: fatigues quickly, difficulty attending to tasks during group therapy (multiple stimuli) however can follow 1:1 instructions, requires verbal prompts to complete all grooming, showering & dressing
How work is affected (plumber) - plumber roles, worker roles, travel
- Requires bilateral hand coordination to manipulate tools and align/clean pipes
- Required to bend, lie down and work with arms outstretched
- Required to read documents and complete correct tasks for clients (eg. Not be distracted by other tasks that clients haven’t been quoted for)
- Must manage time effectively to reach KPIs
- Must calculate quotes for job orders
- Must be able to effectively communicate with clients and the apprentice plumber
- Must be able to drive to different job sites requiring visual attention, cognition and hand motor function
Leisure occupation requirements for participation (soccer, windsurfing)
- Balance
- Coordination
- Ability to track ball and kick/head butt/chest bump ball
- Hand eye coordination
- Ability to run and endure neuromuscular fatigue
- Ability to focus eg. On the ball or the demands involved in kite surfing such as holding onto the rope and looking forward without getting distracted
5 questions to ask prior to beginning assessment (vision)
- “Do you wear glasses or use any other visual aids?”
- “When was your last review/eye test?”
- “I am just making sure the information I have is correct, is your right hand your dominant hand?”
- “Do you know why you’re in the hospital?” (insight)
- “Have you noticed any differences in your vision since your accident/traumatic brain injury?”
3 things to check or observe before the test
- Your language
- Positioning of patient (comfortable, resting, no pain)
- Ensure they cannot see (if necessary)
After the test
- Discuss what you found from the test
- Describe the implications of this (how will this affect their daily life?)
- Discuss where this will be going eg. The intervention
- Discuss when you would be back eg. tomorrow to complete a few other visual tests to see how they may support or pose as a barrier for daily life to target interventions towards your needs
Convergence equipment and set up
Pen/pencil
Round coloured sticker
Sit face to face with patient
Convergence discussion and instructions
Ask preliminary vision questions
Instructions:
1. “Today I want to see how your eye muscles are working.
2. Watch the tip of the pencil and I will move it towards the tip of your nose.
3. Focus on the pencil.”
Convergence difficulty implications
Difficulty for the eyes to see objects close to the face eg. Difficulty reading documents and increased fatigue due to strenuous eye movements when reading documents
Difficulty with depth perception eg. Catching balls, misjudging steps, knocking objects
Poor posture during activities requiring near vision
Visual pursuit/tracking equipment and set up
Pen/pencil
Round coloured sticker
Sit facing each other
Visual pursuit/tracking instructions
Ask preliminary vision questions
Instructions:
1.”What I am looking for is how your eyes move across your middle, up and down, and diagonally - so in all directions.
- I have a pencil here with a sticker on it for you to focus on.
3.Keep your head still (moving only your eyes) and follow the pencil with your eyes as it moves.
- I will start with the pencil in the centre of your face and I would like you to watch as I move it across, back to the centre, up and down, and on the diagonal and back to the centre
Visual pursuit/tracking difficulty implications
- Client may lose track of objects leading to difficulty with reading (following lines and starting a new line when reading documents)
- Difficulty shifting from near sightedness to far sightedness eg. From reading, to focusing looking up at street signs on a train or reading maps to looking at the note while driving, difficulty reading fine print/searching for tools to focusing on pipes at work
Visual hemianopia (visual fields) - Equipment and set up
Pen/pencil
Round coloured sticker
Sit facing each other
Visual hemianopia (visual fields) - instructions
Ask preliminary vision questions
Instructions:
1. “I want to look at your visual fields - that is how far out to the sides you can see with each eye.
- In a moment I am going to ask you to cover your right eye and I will use this pencil with a dot on the end
- Please cover you right eye
- I will start with the pencil over here on your right side and I am going to move it
- Tell me when you can see it by saying now
- Keep looking forward at me as i move it
“Can you see my pencil?” - I am going to do the same but from higher up
“Can you see my pencil?” - I am going to start moving it, look forwards and say now when you can see it
- Last one on this side - I am going to move it from down lower
“Can you see my pencil?” - Repeat covering the left eye still coming from the right side. The covering right eye coming from the left, then the right.
Visual hemianopia (visual fields) - difficulty implications
Bumping into objects on the affected side
Difficulty driving due to have limited peripheral vision of the affected side
Difficulty reading
Visual inattention - equipment and set up
Sit facing each other
No equipment needed, just fingers
Visual inattention - instructions
“I am looking at how your eyes are seeing - specifically at how they see things out to both sides.
I am using my fingers and I will place them on both sides of you - like this
I will either move 1 on left/right or both at the same time
I am going to ask you to tell me or show me (by pointing) which side is moving, or both
If both are moving you can say both
Can you see both of my fingers?”
Move fingers in random order for ~20 reps
Sensation - test on which side first and which area of the body?
TEST ON UNAFFECTED SIDE FIRST
TEST PROXIMAL TO DISTAL
Preliminary questions (sensation)
“Is there a difference in how the affected arm feels after the accident?”
“How did you notice that?”
“How does your left side compare to your right side?”
“Can you describe how it feels?”
“When you are lying in bed at night and it’s dark, do you know where your arm is?”
“Do you notice any difference in sense of touch when you are dressing?”
Explanation of sensation test
“I am going to test how some things feel and I am looking for differences between both your arms”
Sharp and dull - equipment, instructions and after the test questions
Equipment:
Comfortable chair
Pencil with eraser on the end
Instructions:
“I want to see if you can feel any differences between when I touch you with something a little bit pointy and something that is blunt
I will touch your arm like this…
I want you to tell me whether it felt sharp or dull
I want you to close your eyes now and tell me how it felt
Now you can open your eyes. I will now test on the other arm
Close your eyes again
Open your eyes - I am now going to test on the other side of arm so turn your hands around. Please close your eyes again”
After test:
“Was there a difference between the 2 sides for you?”
Provide client with feedback from findings
