Midterm Flashcards
1
Q
Field cut
A
Knows the other side is there but. cannot see it
2
Q
Neglect
A
Does not know that the other side is there
- mild, moderete, severe
- an attention deficit
3
Q
T or F: visual field loss is a sensory based vision deficit
A
true
4
Q
T or F: neglect is an attention based deficit involving multiple sensory systems
A
true
5
Q
T or F: if patient has neglect the postural alignment of the head, neck, and trunk my bias toward right side
A
true
6
Q
Repeatedly pulls up sleeve
A
premotor preservation
7
Q
Difficulty differentiating front from back of shirt
A
spatial relations
8
Q
Placing left arm into the right armhole
A
spatial relations
9
Q
Not “seeing” shirt located on left side of bed
A
spatial neglect
10
Q
Not pulling down shirt on left side of trunk
A
body neglect
11
Q
Not knowing what to do to get shirt on or not knowing what the shirt is for
A
ideational apraxia
12
Q
Awkward grasp
A
motor apraxia
13
Q
Having trouble donning shirt without watching the performance
A
Astereognosis
14
Q
Unable to brush teeth until touching the toothbrush
A
visual object agnosia
15
Q
Washing face completely, then wash face again
A
Prefrontal perservation
16
Q
Using toothbrush to comb hair
A
Ideational apraxia
16
Q
Cannot find white shirt on white sheet on bed
A
figure ground
17
Q
FUEL: nonfunctional
A
Involved UE is not incorporated into daily activities
- person does not use arm at all
- no AROM
18
Q
FUEL: dependent stabilizer
A
Involved UE incorporated into activities but is placed by the less-involved UE or by caregiver
- some AROM but patient is not able to initiate placement
- increased awareness of involved UE during functional task
19
Q
FUEL: independent stabilizer
A
Some AROM present in involved UE ; able to position independently
- used primarily as weight to stabilize
- no active hand use
20
Q
FUEL: Gross assist
A
involved arm & hand are used actively to assist in accomplishing simple functional tasks
- can grasp but not release
- fine motor coordination is not functional
21
Q
FUEL: semi-functional assist
A
Involved arm and hand are used in activities requiring active motor control for pushing, pulling, and stabilizing
- hand is able to assist with fastening
- some release and stop release on own
- gross grasp and release developed
22
Q
FUEL: Functional assist
A
Involved arm & hand have full AROM
- able to use involved UE for all activities and fine motor tasks, but it remains the assistive UE with mild awkwardness and weakness
- slower movements, needs more time
23
Q
FUEL: fully functional
A
involved UE has returned to complete function
- strength, grasp, pinch, and coordination measurements normal
- uses both hands in task; unable to detect a difference between hands while observing
24
MMT of 0
No contraction palpable
25
MMT of 1
A flicker of movement is seen or felt in muscle
26
MMT of 2
Ability to move through any ROM ONLY with gravity eliminated
27
MMT of 3-
Ability to move through partial ROM against gravity
28
MMT of 3
Ability to move through FULL ROM against gravity
29
MMT of 4-
Ability to move through full ROM and hold against slight pressure; or breaks abruptly with pressure
30
MMT of 4
Ability to move through full ROM and hold against moderate pressure
31
MMT of 4-
Ability to move through full ROM and hold against strong pressure
32
MMT of 5-
uncertain muscle strength
33
MMT of 5
normal strength
34
Concentric movements
Against gravity
35
Eccentric
Going with gravity (bringing elbow back down)
36
Isometric
No change in muscle length; no joint or limb movement
37
reaching forward at forehead level, past arms length
Trunk elongating concentrically as back shortens with a forward weight shift
38
reaching on floor between feet
Core contracts as back is eccentric, the weight shift is forward and down (going slow into gravity hence eccentric back)
Core contracts as back is eccentric, the weight shift is forward and down (going slow into gravity hence eccentric back)
39
Reaching on floor, to the right of patient, below right hip
Lateral flexors on left are eccentric and weight shift to the right
40
reaching behind patients right shoulder, at arms length
Weight shift right, right internal and left internal obliques contract
41
reaching at shoulder level, to the left of left shoulder
Weight shift to the left, right external obliques elongate and the left internal oblique contracts
42
reaching on the floor to the left of patent’s left foot
Left internal oblique contracts, right external oblique elongates, weight shift left, with eccentric back extensors
43
reaching above head and posterior
Posterior weight shift, eccentric abdominals to control going back (elongating)
44
motor control
how our neuromuscular system functions to activate & coordinate the muscles to perform a skill
(1) reciprocal innervation
(2) postural malalignment & normal muscle length
(3) dissociation
(4) voluntary vs. automatic
45
External perturbations:
When surface moves (ex: sitting on therapy ball) or outside something makes us to move (ex: being pushed by OT to test sitting balance, windy day)
46
Trunk flexors
- Leaning backwards the main muscle contributor are ABs eccentrics while leaning back
- Going from backward lean to forward ABs are concentric as going against gravity
- Going from slouched to sitting up right there is control going in, concentric of ABs because of controlled movement
- Going from forward to back with legs going back as well while seated are eccentric ABs, hip flexors are concentric during upper/lower body dressing
47
Trunk extensors
- Going forward from leaning back → from posterior to anterior tilt, from lengthened to shortened, concentric of back extensors
- Leaning forward → eccentric of back, concentric of ABs as you fall
- Going back to sitting up from forward → concentric of back to go back from leaning forward
48
Static sitting balance
can you sit statically and not fall over and no arm for balance is fair
- fair to normal has resistance
- fair to poor the lower you go is how much assistance needed from someone else
49
Dynamic sitting balance
Fair to normal → can reach further or to side, more weight shift the higher you get from fair to normal
Poor + to poor → need assistance with reaching and weigh shifting
- ability to weight shift
50
Trunk impairment scale (TIS)
More comprehensive → static, dynamic, coordination
The TIS is more used for research unless insurance requires
Measures static and dynamic seated trunk control
51
Trunk control test
Ideal for hemiplegia patients
Can be used to assess the motor impairment in a patient who has had a stroke, it correlates with eventual walking ability
52
Trunk control and ADL: LE dressing
Trunk flexion to reach down toward feet
Trunk flexion & rotation to reach to one side of body (ex: right)
Trunk extension to realign to sitting position
Lateral flexion required when using a cross-leg method (ex: right leg over left leg)
53
T or F: People with postural control while standing issues may furniture walk
True
54
T or F: quads and hamstrings isometrically hold in standing
true
55
Force of gravity
pulls us down and need isometric muscle contraction to stand
Head control, trunk stability, hip flexors
56
Center of gravity (COG) or center of mass
points where the weight is evenly distributed to balance self
57
Line of gravity
moves as you move and need balance reaction, from the center to surface
58
Balance
ability to control center of gravity over base of support, strategies to work on balance
59
Posture
maintain alignment in any position or task
60
Balance: actual stability limits
Actually better balance than thought
May have fears
Lack of confidence in balance
61
Balance: Perceived limit stability m
Thinks balance is better than real
Safety issues
Impulsive
Overly confident
Be very careful with this patient!
62
Postural set
prepared positon before doing an activity
-No slouching!
- Stand erect
- Feet shoulder width apart for good alignment with head up
63
Cerebellum
balance, movement coordination, timing, muscle groups
- Dysfunction of cerebellum leads to drunken gait
- Delayed postural response for uncoordinated muscles
64
Basal ganglia
postural control and adjustments → typically Parkinson’s → trouble initiate movement, shuffle gait, shaky, bradykinetic
65
Brainstem
vestibular info and initiate eye movements
66
Flexor synergy
muscle “drawing” or “pulling in”, in turn making the muscle in a limb feel stiff, tight, or immovable.
67
3 strategies for postural reaction
(1) ankle - first response is ankle sway
(2) hip - little push & hips
(3) stepping - change in base of support to increase it
68
Objective: Balance Grading Review -- Static standing
Fair - uses UE for balance, ½ arm, contact guard usage
poor +/poor - requires Max A and UE support to maintain standing balance without loss
69
Objective: Balance Grading Review -- Dynamic Standing
Good and G-/F+ → further reach, more weight shift for good dynamic standing ability
poor+/poor → needs support for dynamic, hemiplegia
70
Balance Assessments
Berg balance scale
Berg balance test
TUG
Functional Reach Test (FRT)
Tinetti Performance Oriented Mobility Assessment (POMA)
Tinetti Mobility (TMT)
Task Analysis
71
diagnosis for Berg Balance Scale (BBS)
vestibular disorder, stroke, SC, pulmonary disorders (PD), PD, osteoarthritis, OA, AD, limb loss/amputation, brain injury
72
diagnosis for TUG test
vestibular disorders, stroke, SC, PD, OA, osteoarthritis, AD, progressive dementia, brain injury
- Balance most iffy at turn part of the test
73
Diagnosis for the Tinetti Performance Oriented Mobility Assessment (POMA) or TMT (Tinetti Mobility)
Stroke, OAs, ALS
74
Diagnosis for Functional reach test (FRT)
vestibular disorders, stroke, SC, PD, OA
75
Aspects of task analysis for balace
Simple to complex
Meal prep (small to large),
Combination & weighting of physical & cognitive skills
More complex meals, talk and walk, count and walk
Environmental factors
(Quiet then louder, different surfaces and lights, obstacles)
Fatigue
76
Anticipatory postural control
Necessary for stability to have UE control
77
Common malaligment post-stroke: pelvis
Asymmetrical weight bearing
Posterior pelvic tilt
Unilateral retraction
78
Common malaligment post-stroke: vertebral colum
Scoliosis
- Loss of lumbar curve; increased thoracic kyphosis
- Shortening on one side; elongation on opposite side
79
Common malaligment post-stroke: rib cage
Lateral tilt
- Flaring on one side
- Unilateral retraction
80
Common malaligment post-stroke: shoulders
Asymmetrical height
Unilateral retraction
81
Common malaligment post-stroke: head/neck
Protraction
Flexion to weak side
Rotation away from weak side
82
Anterior subluxation
Pushed up, humerus extended and elbow flexed
- long heads of biceps overstretched
83
Inferior subluxatio
Humeral head out of socket
- right below acromion
- most common
84
Superior subluxatio
Head of humerus moves up
- due to movement the humerus moves into acromion
85
Factors associated with Hemiplegic Shoulder Pain (HSP)
Lack of G-H joint external rotation
Correlation – hemiplegic shoulder pain and decreased UE motor function
Correlation – hemiplegic shoulder pain and shoulder weakness
Orthopedic involvement (correlation)
- HSP & tendinitis of long head of biceps and supraspinatus
- SHS (shoulder hand syndrome) in hemiplegia is initiated by peripheral lesions
- Hemiplegic shoulder pain and adhesive capsulitis, rotator cuff tear, and shoulder hand syndrome
But NOT subluxation
- For hemiplegic shoulder pain, but the symptoms can cause pain
Correlation – poor handling of the UE and pain
Choosing wisely → DO NOT USE PULLEYS FOR PEOPLE WITH A HEMIPLEGIC SHOULDER!
86
87
Implemented prevention protocol: DECREEASED SHS
Education to family, patient, staff at admission to prevent peripheral injury
Modified bed & w/c positioning to prevent pain in arm (prevent impingement!)
No PROM before scapular mobilization
No pain during exercise/activity/positioning
No infusions into affected hands (NO IV THERE)
88
UE standardized assessments
Fugl-Meyer
Stroke Upper Limb Capacity Scale
Wolf Motor Function test
Action Research Arm test (ARAT)
MAL (motor activity log)
Abilhand
FUEL (functional UE levels)
Jebsen-taylor hand function test
89
Abilhand
Valid & reliable interview → based tool that measures participants' perceived difficulty with use of their arm and hands in bimanual tasks
Score: impossible, difficulty, easy
Enter data into website for results
Usage of both hands (bimanual) during tasks
90
Motor Activity Log (MAL)
Structured interview to examine how much & how well the stroke survivor uses their affected arm
Standardized questions:
- Amount of use of their affected arm
- Quality of their movement
91
Action Research Arm Test (ARAT)
Standardized objective assessment to measure arm and hand function for individuals post stroke
Mostly used in research
4 subtests → Grasp, grip, pinch, and gross movements
92
Wolf Motor Function Test
Standardized assessment to quantify UE motor ability through timed and functional tasks for stroke patient
Standardized template so items can be placed in specific areas
93
Stroke Upper Limb Capacity Scale
10 tasks from simple to complex → ex: reach forward across body, leaning on affected forearm
Performed standing or sitting
All tasks are unaided
Examines performance of task not the quality
94
Fugl Meyer Assessment UE
Measures recovery in stroke survivors (UE & LE)
GOLD STANDARD for assessing recovery post-stroke
Used for both clinical & research settings
Motor: UE, wrist, hand, coordination
Sensation
PROM
Pain
95
UE Interventions
- treatment to decrease excessive spasticity
- soft tissue elongation (PROM)
- shoulder support
- minimal sling usage
- taping shoulder
- wheelchair adaptions
- electrical stimulation
- task choice to regain UE control
- weight bearing activities
- open vs. closed chain
96
Adjunctive UE intervnetions
Mirror therapy
Mental Practice
Action observation
Robotics
NMES & Bioness
VR
Saeboflex
Constraint Induced Movement Therapy (CIMT)
Modified Constraint Induced Movement Therapy (mCIMT)
97
Mirror therapy
Designed to improve limb & ADL function post-stroke through visual feedback
- the visual feedback "tricks our brains" into thinking the involved arm is moving
- affected arm is hidden
98
Why does mirror therapy work?
(1) increased attention to affected side
(2) motor neuron system activated via action observation
(3) motor system
99
Bimanual mirror therapy
both hands do the task
100
Unimanual mirror therapy
Only 1 had does task, the unaffected arm
101
Mirror therapy ideal candidate
- acute, subacute, chronic stroke
- cognitively able to follow directions and attend to tasks
- no severe visual or perceptual deficits
- no motor requirements
- patient can do this at home
102
Mental practice
A training method of mental rehearsal with goal of improved performance in absence of physical practice
- MP can be practiced before or after traditional OT
- usually administered via CD recording of therapist voice
103
Mental practice candidate
Cognitively intact, no motor requiremens
104
Action observation
Intervention where a person observes a "typical" person perform a functional task either by video or through a live performance in stroke population (watch someone)
105
Action observation candidate
cognitively intact, no motor requirements, however, some movement to perform task after Action observation
106
107
Robotics intervention candidate
No severe tone, minimal hand and arm requirements
108
Do robots work?
Many studies have shown too improve motor function and does not appear to improve hand function, ADL, and muscle tone
109
Neuromuscular Electrical Stimulation (NMES) & Bioness
NMES is a method to facilitate limb movements by using electrical current to paretic limbs (neuro rehab)
- bioness not the best and meant for specific body parts
110
NMES & Bioness candidate
No contraindication (ex: pacemaker), need a MMT of 1/5, able to tolerate
111
VR candidate for interventions
Requires some movement, can cause virtual sickness, no severe tone
112
Saeboflex/reach
Dynamic orthosis developed for stroke survivors to improve UE function
113
Candidate for Saeboflex/reach
Recovering from stroke, TBI, SCI, radial nerve palsy
- hand and arm weakness, wrist drop or unable to open hand
- minimum 15° ROM
- minimal to moderate spasticity
- need certification for SAEBO
114
Constraint Induced Movement Therapy
Intervention developed to reverse effects of learned non-use
- constrain good hand to only use affected hand
115
Components of CIMT
- repetitive task-oriented training (key to CIMT)
- adherence enhancing behavioral strategy (transfer package)
- constraining use of more-affected UE
116
Adherence enhancing behavioral strategies -- transfer package
Behavioral contract
home diary
home skill assignment
home practiced
motor activity log
- most important part of CIMT
117
Traditional CIMT
Wear a protective safety mitt on unaffected hand for 90° of their waking hours over a 2-week period, including 2 weekends, for a total of 14 days
On each weekday, participants received shaping (adaptive task practice) and standard task training of the paretic limb for up to 6 hours per day
118
Modified CIMT (MCIMT)
Over a 10-week period, subjects’ less affected arms were restrained every weekday for 5 hours
Half-hour, one-on-one sessions of more affected arm therapy occurring during 3 days per week during the 10-week period. This component includes shaping.
119
Cognition
a conscious though process that refers to awareness of knowledge f objects, perceptions, thoughts, and memories
120
Perception
ability to meaningfully interpret sensory information
121
Neurobehavioral dysfunction
a functional impairment of an individual manifested in defective skill performance due to a neurological processing deficit that effects any of the following components:
affect, body scheme, cognition emotion, gnosis, language, memory, personality, praxis, spatial relations, and visuospatial skills
122
functional cognition
Ability to integrate cognition and performance skills to complete any task
123
Different assessment types for cognition
Interview
Performance based
Patient self-reported outcome measures (subjective)
Cognitive skills out of context
124
Initiation
Patient may have difficulty starting a new task or slowing to respond
- may be able to plan and organize but needs cues to begin
- often misinterpreted as lack of motivatiion
- typically Parkinson's diagnosis
125
Planning, Organization, Sequencing
Required to achieve any goal!
126
Components of planning
ability to look ahead, anticipate consequences, make choices, develop alternative
127
Clinical considerations: Planning, organization, sequencing
Unrealistic goals
Underestimates time required for tasks (can they foresee problems ahead?)
Omits steps in sequence
Lack of organization and structure of task (not efficient)
Unable to foresee consequences
Proceeds by trial & error
128
encoding
taking in the info, mental operations at time of study
129
Storage
holding on to info over time
130
Retrieval
searching for, finding and getting it out
131
What is the hardest type of recall?
free recall
132
working memory
holding on to info and manipulating while doing a task
133
Short term memory
holding onto memory for short periods of time (minutes)
134
Long term memory
store and bring back type
135
Declarative
(explicit, conscious, deliberate)
semantic memory
episodic
136
Semantic memory
facts, vocabulary
137
episodic memory
memory of everday events (long term and short term)
138
Non-declarative
(implicit, automatic)
How to do something
- procedural
- habits
139
Prospective memory
Remembering to do something in the future
140
Intellectual awareness: Pyramidal model of awareness
ability to understand at some level that a function is impaired. At the lowest level, one must be aware that one is having difficulty performing certain activities. Refers to you knowing you have a problem
- need intellectual awareness before getting to emergent awareness
141
Emergent awareness: Pyramidal model of awareness
ability to recognize a problem when it is actually happening. Intellectual awareness is considered a prerequisite
142
Anticipatory awareness: Pyramidal model of awareness
ability to anticipate that a problem will occur as the result of a particular impairment in advance of actions
- Highest level
- Intellectual and emergent awareness are considered prerequisites to anticipatory awareness
143
Dynamic comprehensive model of awareness
Has 2 components
(1) general awareness (offline)
(2) online awareness
144
General awareness: Dynamic comprehensive model of awareness
(offline): self-knowledge and beliefs that exists before a task or situation
- Similar to emergent and anticipatory
- Awareness of own function, health condition
145
Online awareness: Dynamic comprehensive model of awareness
awareness during a task (ie; knowing when things are going well or not)
- During task
146
Ways to assess awareness
Standardized assessments/questionnaires
Interviews
Rating scales
Functional observations
Comparisons of self-rating
147
Self-Awareness of Deficits Interview
An interviewer rated tool to obtain both quantitative and qualitative data on self-awareness after brain injury
Specifically assess intellectual awareness
Prompts → physical abilities,
memory/confusion, concentration, problem solving, communication, gets along with others, personality change
148
Self-regulation skilled interview for awareness
Semi-structured clinician rated interview
6 questions to assess metacognitive or self-regulation skills that are applied to main area of difficulty related to everyday living (ex: memory loss, poor attention or concentration) as identified by client:
- Emergent awareness
- Anticipatory awareness
- Motivation to change
- Strategy generation
- Strategy selection
- Strategy effectiveness
149
The patient competency rating scale
Evaluates self-awareness post-TBI
- subjective
150
Mini mental state exam
An objective cognitive test to measure cognitive performance
Short, strong psychometric properties
Well researched
151
Assessments for: Identify and rating underlying skills or processes: rating underlying impairments (ex: neglect & apraxia) & processes skills through observation
A-One and General Task analysis, Kessler Foundation Neglect Assessment Process (KF-NAP), Comb/Razor test
152
Assessment for: Screening or independence level: accuracy of each step or task, can they do it or not (yes or no), quick scream, useful in acute
kettle test, performance assessment of self care skills (PASS), executive function performance task (EFPT), general task analysis
153
Assessment for: Error analysis: analyze error patterns and strategies during observation
Multiple errands task (MET), weekly calendar planning activity (WCPA)
154
A-ONE (ADL-Focused Occupation-Based Neurobehavioral Evaluation)
An OT instrument based on a conceptual framework where a direct link is made between ADL performance and neurobehavior
Used to detect neurobehavioral impairments in adults with CNS dysfunction by observation of ADL performance
A-ONE used to assist OT in analyzing the cause of problem thus to help with goal writing, treatment planning and discharge
155
General task analysis adapted from A-ONE
Relevant occupations, in many cases client chosen, are the foundation for assessment (ex: occupations that a client wants to do, needs to do, and/or has to do)
Use personal items and appropriate time of day
Position materials to elicit a scanning response
“Fly on wall”: skilled observation, allow safe errors, minimal cues, allow for extra time
156
parts of praxis
Ideation (know what something is/ what to do)
Motor planning 9plan movement for usage)
Execution
157
inability to carryout purposeful movement with intact sensation, movement & coordination (rule out sensory and motor components)
apraxia
158
Ideational apraxia
breakdown in knowing what is to be done, lack of idea
159
Motor (ideomotor) apraxia
breakdown of planning even though idea is present
160
Left CVA
Possibly bilateral
- both sides motor planning issues
161
Right CVA
Disruption on left side
- if there is a right CVA the deficits will appear on left side
- motor delay issue
162
Spatial relations syndrome (right inferior parietal lobe)
- Foreground from background differentiation
- Position in space (position of object to pearson)
depth/distance perception (curb)
- Topographical disorientation (lost in space, can’t navigate)
- Spatial relations dysfunction (difficulty up and down, left and right → can’t put shirt on head put head through arm hole)
- Object orientation best tested via dressing
- Difficulty find things on a cluttered counter, can’t find white bar soap on white counter
163
Unilateral spatial neglect (right inferior parietal lobe, right prefrontal cortex, right cingulate gyrus, thalamic nuclei)
- lateralized attention deficit
- usually left neglect
-Hypo-attentive to left and hyper-attentive to right (attends to right but ignores left)
- Near extrapersonal (peripersonal) vs. far extra personal (knock into things on left, safety issue)
- Representation neglect (can’t mentally imagine)
- Poor awareness (severe)
- Multi-sensory: auditory, tactile
- With or without field cut
164
Preservation (prefrontal or premotor cortex)
Difficulty shifting from one pattern of response to another
Premotor
Prefrontal
Speech
165
Body scheme disorders
unilateral body neglect
somatoagnosia
166
Unilateral body scheme disordeer
inattention or neglect of personal space, contralateral to lesion
167
Somatoagnosia
failure to recognize one's body parts and their relationships to each other
- confusion of body parts
- mirror image confusion
168
Agnosia
Hall mark is inability to "recognize" incoming sensory stimulus
- impaired ability to recognize the sensory stimuli (primary sense is intact)
- tactile agnosia
- visual object agnosia
- prosopagnosia
- color agnosia
- auditory agnosia
169
KF-NAP (Kessler Foundation Neglect Assessment Process) (objective)
Analysis of occupational performance
Cognitive processes that support
- lateralized attention deficit
- awareness
- topographical disorientatioon
Longer assessment that can be used for body neglect
170
Comb and Razor/Compact Test
Objectively evaluates personal grooming behavior
Highly reliable
Person asked to comb their hair during a 30-sec period
171
Cognitive Screening or independent level Assessments
Menu task
Erlangen Test for ADLs (E-ADLs)
Erlagen Test for ADL with mild dementia or mild cognitive impairment (ETAM)
172
Menu task assessment
Performance based screening measure for functional cognition
Can be administered by any health care discipline
Used as a screening tool to refer to OT
173
Erlangen test for ADL (E-ADL test)
Good for acute care
Performance based with objective scoring
