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Misc Neuro Dx Flashcards

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1
Q

What are triggers for a seizure? (7)

A
  1. Photosensitivity
  2. Loud noises
  3. Stress
  4. Hormonal changes
  5. Alcohol/drug use
  6. Sleep disturbance
  7. Not taking meds correctly
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2
Q

General OT Tx for epilepsy (5)

A
  1. Safety
  2. Enviro modification
  3. Adaptive equipment
  4. Activity analysis
  5. Coping skills
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3
Q

OT Tx Examples for Epilepsy: Bathing/Toileting (6)

A
  1. Water temps in house not over 120 degrees
  2. Non-skid surfaces
  3. Pad all corners
  4. Use plastic containers, no glass
  5. Don’t shower when home alone
  6. Shower seats, grab bars, etc.
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4
Q

OT Tx Examples for Epilepsy: Hygiene/grooming (5)

A
  1. Shatter-proof mirrors
  2. No curling iron alone
  3. Mirror at correct height to avoid climbing to see
  4. Electric razors only
  5. Use vanity & sit while applying makeup
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5
Q

OT Tx Examples for Epilepsy: Dressing (3)

A
  1. Avoid jewelry w/ sharp edges
  2. Store clothing at easy to read height - no climbing
  3. Dress small children on the floor (whether they have seizures or the adult does)
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6
Q

OT Tx Examples for Epilepsy: Feeding/eating (8)

A
  1. Educate family/friends for choking hazard
  2. Don’t eat while lying down
  3. Avoid hot temp foods/liquids
  4. Commuter cup for drinking warm liquids
  5. Non-skid mats
  6. Check infant’s mouth periodically for stored food
  7. Secure infant/toddler in highchair
  8. Use chairs with armrests
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7
Q

OT Tx Examples for Epilepsy: Mobility/traveling (8)

A
  1. Use stroller
  2. Wear helmet if needed
  3. Pillows/mat next to bed if possibility of falling out
  4. Possible bedrail if falling is frequent
  5. Alert neighbors what to do if wandering occurs
  6. Drive only when cleared by MD/DMV
  7. Padded clothes, knee/elbow pads if falling is frequent
  8. Carry important names/numbers in bag/medical necklace
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8
Q

OT Tx Examples for Epilepsy: Home safety (6)

A
  1. Keep home free of clutter/wires/cords/throw rugs
  2. Use carpeting whenever possible
  3. Use plastic dishes/cups
  4. W/ oven, use long mits & rack pulls to avoid reaching into oven
  5. Store items you use at accessible heights
  6. Food processors for chopping
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9
Q

What is Huntington’s disease?

A

An inherited chronic degenerative disorder that leads to progressive physical & mental degeneration over time, & is fatal

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10
Q

Signs & Symptoms of Huntington’s Disease (4)

A
  1. Reduced voluntary motor control
  2. Involuntary mvmts (Chorea)
  3. Loss of cognition
  4. Emotional & behavioral problems
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11
Q

Cognitive impairments due to Huntington’s Disease (8)

A
  1. Dementia/psychiatric disturbances
  2. Depression
  3. Apathy
  4. Irritability
  5. Anhedonia
  6. Antisocial behavior
  7. Bipolar behavior
  8. Schizopheniform behavior
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12
Q

What is chorea? How does it progress in Huntington’s disease?

A

Quick, irregular mvmts. First develops in hands.

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13
Q

Stages of Huntington’s Disease: I = Early (5)

A
  1. Subtle changes in coordinaiton
  2. Some involuntary mvmts (chorea)
  3. Difficulty thinking through probs/concentrating
  4. Decreased mood, irritability
  5. May have decrease in ADL/IADL function
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14
Q

Stages of Huntington’s Disease: II = Middle (8)

A
  1. Mvmt disorder more pronounced (rx may begin)
  2. Difficulty w/ speech/swallowing *Need to consume 3,000-5,000 calories due to excessive mvmt
  3. Dysarthria
  4. ADL/IADL more difficult
  5. Memory deficits
  6. Unable to maintain employment
  7. Probs w/ task performance (e.g. sequencing hard)
  8. Suicidal risk
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15
Q

Stages of Huntington’s Disease: III = Late (5)

A
  1. Dependent in ADL/IADL
  2. Chorea either severe or cease
  3. Unable to walk or speak
  4. Still generally comprehends language, has awareness of family/friends
  5. Death due to medical complications
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16
Q

OT Interventions for Huntington’s Disease (15)

A
  1. Daily routine development - checklists (early stage)
  2. Worksite eval, modifications - planners, organizers, reminders, quiet enviro (early stage)
  3. Coping skills to address depression
  4. Community support groups, community involvement, internet access (early stage)
  5. Caregiver education & training
  6. ADL training - dressing, feeding - modifications include no more small buttons, velcro, adaptive equipment, possible bed railings (Middle stage)
  7. Home eval & modifications
  8. Adaptive equipment eval, order, & training
  9. Leisure exploration - very important as worker role is lost
  10. Tai chi (improve balance)
  11. Fall prevention
  12. Fatigue mgmt - schedule breaks throughout day* Need to be scheduled bc person with HD may not recognize fatigue
  13. Splinting/ROM (Late stage)
  14. Visual prompts to help ct complete ADLs (middle stage) - lay out clothes as prompt to change, toothbrush by sink, etc.
  15. Perform ADLs while seated (middle stage)
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17
Q

Mobility devices for Huntington’s disease

A
  1. Rollator (wheels) preferred over walker
  2. When wc is indicated - firm seat, padded armrests for chorea
  3. Better able to move wc with feet - height should be adjusted accordingly
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18
Q

What is Multiple Sclerosis (MS)?

A

Chronic, progressive demyelinating disease where the loss of myelin is confined to the CNS.
Two criteria: A) 2 attacks & clinical evidence of 2 separate lesion sites OR B) 2 attacks, clinical evidence of 1 lesion with specialized diagnostic evidence of 1 other lesion site (e.g. perimetry test of visual field)

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19
Q

Characteristics of an MS attack (3)

A
  1. Lasts at least 24-48hrs
  2. 30 days must separate the 1st attack from the 2nd attack to differentiate two separate episodes
  3. An attack can occur anywhere in the CNS (Cerebral hemispheres, cerebellum, brainstem, or SC)
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20
Q

Symptoms of MS (9)

A
  1. Dysmetria
  2. Ataxia
  3. Dysarthria
  4. Adiadochokinesia
  5. Intention tremor
  6. Wide-based gait
  7. Hypotonia
  8. Jerky conjugate gaze
  9. Cognitive dysfunction
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21
Q

Name the types of MS (4)

A
  1. Relapsing Remitting MS
  2. Secondary Progressive MS
  3. Primary Progressive MS
  4. Progressive-Relapsing MS
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22
Q

Types of MS - Describe: Relapsing Remitting MS

A

*Classic MS
Clearly defined periods of acute attacks (with or without residual deficit upon recovery) followed by periods of remission & no disease progression.

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23
Q

Types of MS - Describe: Secondary Progressive MS

A

Begins with Relapsing-Remitting MS followed by progressive loss of function at variable rate

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24
Q

Types of MS - Describe: Primary Progressive MS

A

Progression of disability from onset with or without plateaus - steady progression seen with no distinct relapses/attacks where new symptoms appear.

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25
Types of MS - Describe: Progressive-Relapsing MS
Always progressive with distinct periods of more severe symptoms
26
Clinical manifestation of MS (9)
* Dependent on site of the lesion 1. Localized weakness 2. Numbness 3. Tingling 4. Difficulty with coordination 5. Blurring of vision 6. Diplopia 7. Bladder dysfunction 8. Possible cognitive dysfunction (50-75%) 9. Possible sleep disruption
27
MS Precautions (2 primary)
AVOID HEAT - No hot tubs! | Avoid INTENSIVE exercise - don't over do it!
28
What's the most common symptom of MS?
Fatigue
29
What worsens fatigue in MS? (4)
1. Mod/Vigorous exercise 2. Stress 3. Prolonged physical activity 4. Heat
30
What improves fatigue in ct's with MS? (7)
1. Rest periods 2. Sleep 3. Naps 4. Positive experiences 5. Cooling 6. Manageable exercise programs 7. Rx
31
Principles of energy conversation for MS (10)
1. Quantify where unnecessary energy is being used 2. Rest period interspersed with activity 3. Rest before onset of fatiguw 4. Plan rest periods into your day 5. Save energy for activities that are essential or enjoyable 6. Plan ahead & pace yourself 7. Set priorities 8. Learn activity tolerance 9. Break activities down into series of smaller steps 10. Ask for help
32
Interventions for MS cognitive dysfunction
Compensatory strategies 1. Organizers 2. Memory aids 3. Energy conservation 4. Delegate tasks 5. Written instructions 6. Info in manageable chunks 7. Simplify 8. De-clutter
33
OT Interventions for MS: Examples of adaptive equipment (6)
1. Sensory loss - thermometer to test water temp 2. Mobility - wc, walker, scooter, etc. 3. Vision deficits - special lighting, enlarged print 4. Manual dexterity - dycem, jar openers, built-up handles 5. Cognitive - pill sorter, calendar, alarm reminders 6. Bladder control - adult briefs, commode by bed
34
What is Alzheimer's Disease (AD)?
Progressive degenerative disease of the CNS where first symptoms seen are dementia, progresses to loss of speech, swallowing, & ends with a vegetative state
35
Seven stages of AD AKA The Global Deterioration Scale (GDS)
1. No symptoms 2. Forgetfulness of insignificant info 3. Borderline AD - memory loss seen as prob, difficulty following conversation, anxiety about memory loss 4. Mild AD - Cognitive deficits apparent, difficulty w/ finances 5. Moderate AD - difficulty w/ personal info, familt names, etc. ADL difficulty become obvious 6. Moderately Severe AD - Person is semi-dependent 7. Severe AD - verbal & psychomotor skills are severely impaired or lost; may be comatose
36
Why is early OT intervention so critical with AD?
Establishing routines/habits need to occur early because learning does not occur later on.
37
What are OT goals for AD? (3)
1. Maximize occupational performance 2. Increase environmental safety 3. Improve well-being of caregivers
38
OT Intervention Methods for AD (5)
1. Cognitive stimulation/training 2. Caregiver training & education 3. Behavior mgmt techniques 4. Home evaluation/modification 5. Task simplification
39
Adaptive Equipment for AD
1. Locator device for important items 2. Safe return bracelet/tracking device (ppl who wander) 3. Colored toilet seat (contrast for vision impairment) 4. Bath bench (fall prevention) 5. Phone w/ pics & speed-dial
40
Signs & Symptoms of AD
1. Memory impairment (progresses to inability to learn) 2. Aphasia 3. Apraxia 4. Agnosia 5. Impaired executive functioning (e.g. ability to plan, initiate, organize, make safe decisions, etc.) 6. Impairment in visuospatial skills 7. Changes in mood & personality (depression, anxiety, etc) 8. Behavioral probs (e.g. agitation, aggression, etc.) 9. Motor impairments (e.g. balance, gait, etc.)
41
4 Stages of AD
(another classification) 1. Very Mild - Mild Decline 2. Mild - Moderate Decline 3. Moderate - Moderately severe decline 4. Severe Decline
42
4 Stages of AD - Brief description & primary interventions: Very Mild - Mild Decline (8)
Symptoms: Mild memory probs; difficulty w/ initiation, attention, comprehension; feel loss of control, less spontaneous, more anxious; socially intact except close contacts notice changes, decline in job performance Interventions: 1. Listen to ct/collaborate w/ them - ID prob areas & associated feelings 2. Train caregiver to be case manager 3. Provide education/info/support 4. Support continued participation in desired occupations, explore changes in occupational roles 5. Encourage physical exercise & wellness behavior 6. Plan for future restrictions 7. Establish daily routine, post in central location 8. Use enviro aids (calendars, planners, etc.) to support engagement in occupation
43
4 Stages of AD - Brief description & primary interventions: Mild - Moderate Decline (10)
Symptoms: May experience denial/anxiety, moderate memory loss, some gaps in personal history, decreased concentration, lose items, difficulty with problem-solving & complex info, need for supervision increases, decreased sociability, decreased ability to perform IADLs & mild impairment in ADLs Interventions: 1. Emphasize importance of enviro to caregiver 2. Provide enviro support (e.g. lists, pics, posters, etc.) 3. Adapt meaningful leisure, home mgmt, etc. for safe participation to feel independence & sense of control 4. Avoid tasks that involve new learning 5. Simplify enviro/make more accessible 6. Train caregiver in how to support the ct's participation in IADLs & ADLs as appropriate 7. Help family find additional support/respite 8. Maintain opportunities for socialization 9. Use reality orienting activities (e.g. photo albums, pics, etc.) to remind ct of hx 10. Encourage walking, stretching, & balance activities
44
4 Stages of AD - Brief description & primary interventions: Moderate - Moderately severe decline (10)
Symptoms: Reduced affect, apathy, sleep disturbances, repetitive behavior, hostile behavior, paranoia, delusions, aggression, progressive memory loss of well known material, unaware of most recent events, Ox1, deficits in communication, apraxia, slowed response, impaired spatial orientation, unable to perform most IADLs, assistance with many ADLs, beginning incontinence, wandering Interventions: 1. Maintain involvement in meaningful activity, assist caregiver 2. Help caregivers problem solve managing behavior (ID prob, consider precipitants of the behavior, & adapt own behavior or change the enviro) 3. Help caregiver support ct in participation in ADLs, etc. 4. Provide time orientation 5. Maintain consistent daily routines 6. Support socialization within the home & outside in structured enviros 7. Teach family how to simplify tasks & maintain safe enviro 8. Ensure safety in home & other enviro & make adaptations (e.g. alarms, restricted use of heating/sharp objects, cabinet latches, ID bracelets) 9. Review & rehearse name of family members & friends 10. Encourage stand by assisted ambulation, stretching, & exercise on regular basis
45
4 Stages of AD - Brief description & primary interventions: Severe Decline (10)
Symptoms: Severe memory impairment, may forget names but recognize faces, become confused even in familiar setting, gait & balance disturbances, difficulty negotiating the enviro, motor slowing, often unable to communicate except grunting, incontinent B&B, unable to eat, often needs to be placed in nursing home Interventions: 1. Instruct caregivers on how to simply instruct (one-step commands, step-by-step visual cues) for ADLs 2. Encourage caregiver to seek respite & continue leisure occupations 3. Encourage continued socialization by the family - does not need a response from ct 4. Encourage assisted ambulation until ct is no longer able to 5. Dysphagia techniques to promote swallowing, etc. 6. Maintain proper positioning 7. Instruct caregivers in skin inspection 8. Instruct caregivers in transfer techniques 9. Provide controlled sensory input 10. Program of AROM/PROM
46
What is Myasthenia Gravis (MG)?
A chronic, progressive autoimmune disorder affecting neuromuscular transmission resulting in muscle weakness. Primary symptom = weakness & fatigue.
47
Clinical manifestations of Myasthenia Gravis
Fluctuating weakness/fatigue of specific muscles (oculomotor, swallowing, later neck, limbs & respiration), tends to be worse at end of day or after exercise. Can lead to life-threatening bulbar & respiratory weakness.
48
Signs/Symptoms of Myasthenia Gravis (6)
1. Weakness & fatigue of specific muscles 2. Ptosis 3. Diplopia 4. Dysarthria 5. Dysphagia 6. Dyspnea
49
OT Tx for Myasthenia Gravis (5 primary)
1. Energy Conservation (e.g. prioritize, shcedule meaningful activity, avoid fatigue, simplify, rest breaks, etc) 2. Home modification (e.g. cart, store food in smaller containers, rearrange commonly used items, grab bars) 3. Feeding & eating (dysphagia) (e.g. food consistency, posture, avoid distractions, eat when energy high) 4. Vison - compensatory strategies 5. Communication (cards, gestures, enviro mod)
50
What is Amyotrophic Lateral Sclerosis (ALS)?
Progression, degenerative, and fatal disease characterized by progressive muscular paralysis secondary to degeneration of motor neurons within the CNS. Begins with gradual asymmetrical weakness, atrophy, & fasciculations.
51
What are fasciculations (occur in ALS)?
De-innervated muscle tissue has electrical capacitance - meaning, they release small amounts of electrical current that result in small twitches
52
ALS Presentation (6)
1. Begins w/ gradual asymmetrical weakness, atrophy, & fasciculations 2. Affect extremities in distal to proximal progression 3. Sensory complaints - cramps, pain, vague dysesthesias 4. Spreads to more muscle involvement, incr. fasciculations, weight loss, spasticity, & finally bulbar involvement 5. Respiratory muscles may be affected (require ventilator) 6. Cognition, special senses, & bowel/bladder all remain in tact
53
6 stages of ALS (7)
`PHASE 1: INDEPENDENT 1. Mild weakness, ambulatory, Ind. in ADLs 2. Moderate/select weakness, decrease in ADLs 3. Severe select weakness in distal extremities, still ambulatory but fatigue quickly PHASE 2: PARTIALLY INDEPENDENT 4. Flaccidity of arms, edema, w/c dependent, decr. ADLs, dysphagia 5. UE&LE weakness, dependent for many ADLs PHASE 3: DEPENDENT 6. Dependent
54
OT Intervention for ALS
1. Focus on client goals 2. Keep ct independent & mobile for as long as possible 3. Energy conservation 4. Adaptive equipment 5. Functional mobility (cane, wc, etc) 6. Splinting & bracing (maintain functional position) 7. Communication (text to speech, eye gaze communication systems)
55
What is Guillain-Barre Syndrome (GBS)?
Acute inflammation of peripheral nerves, causing sudden onset of acute ascending neuropathic paralysis. Characterized as an autoimmune disease that attacks the myelin sheath covering peripheral nerves.
56
Signs & symptoms of GBS (7)
1. Progresses from legs, to arms/upper body 2. Begins with paresthesias, tenderness over muscle. 3. Progresses to weakness/paralysis, which ascend over several days 4. Flaccidity & absent deep tendon reflexes occurs 5. Maximal weakness occurs within 3-4wks 6. Respiratory muscles affected in most severe cases 7. Cranial nerve involvement may produce bulbar signs (dysarthria, dysphagia, difficulty breathing)
57
Phases of GBS (3)
1. Acute: 1-3wks, progressive loss of function 2. Plateau: 1-3wks, no new symptoms, no improvement in function 3. Recovery: ~2yrs, Improvement w/ re-myelination, most recovery occurs in first 6 mos.
58
OT Intervention for GBS (10)
1. Positioning 2. ROM 3. Energy conservation 4. Psychosocial (support, reestablish some sense of control) 5. Dysphagia 6. Communication system 7. Muscle re-ed 8. ADL retraining 9. Caregiver education & support 10. Splinting
59
Precautions with GBS
AVOID fatigue & muscle over-exertion | Alternate muscle strengthening & endurance training. Over doing it will slow recovery
60
Sign of Carpal Tunnel Syndrome & affects what nerve?
Entrapment of median nerve | Tingling in thumb thru ring fingers, weakness in thenar muscles, wasting of thenar muscles
61
Sign of radial nerve impairment?
Wrist drop
62
What's Bell's Palsy?
CN7, facial paralysis for muscles of expression
63
What's Charcot-Marie Tooth? (7 signs/symptoms)
Heredity polyneuropathy. 1. Slowly progressive with degeneration of nerve tissue 2. Classically see muscle wasting in "stocking glove" distribution 3. Weakness 4. Loss of intrinsic hand function 5. Foot deformities 6. Foot drop 7. Claw hand
64
What's Erb's palsy?
Disorder involving the upper trunk (C5-6) Classically occurs during birth (neck is over-stretched, causing nerve damage) Presents as "Waiter's Tip" - wrist flexion, hand function & elbow extension is preserved
65
What's Klumpke's palsy?
Disorder involving the lower trunk (C8-T1) - acquired via force on arm while in abductiong Presents w/ probs of musculature of hand intrinsics - claw hand presentation, sensory loss
66
What is Complex Regional Pain Syndrome (CRPS) AKA?
Reflex Sympathetic Dystrophy Syndrome (RSD)
67
What is Complex Regional Pain Syndrome?
Severe, prolonged burning or aching pain that in not in proportion to injury; may be unable to determine injury site Often follows noxious event (e.g. CVA)
68
Complex Regional Pain Syndrome Signs/Symptoms (8)
1. Burning or aching pain 2. Edema & skin changes 3. Muscle spasm 4. Abnormal sweating 5. Change in skin color & temp 6. Joint tenderness/stiffness 7. Hypersensitivity 8. Restricted, painful mvmt
69
Stages of Complex Regional Pain Syndrome?
1. Traumatic Stage a) 0-3mos post initial event b) Severe LOCALIZED & burning pain c) Pitting edema d) Vasospasm - change skin color/temp e) Rapid nail & hair growth f) Decreased ROM 2. Dystrophic Stage a) 3-9mos post initial event b) DIFFUSE pain c) Spreading & brawny edema d) Stiffness, redness, heat e) Tropic changes - decr. hair growth, nails brittle, osteoporosis, muscle atrophy, glossy appearance 3. Atrophic Stage a) 4yrs b) Irreversible changes in skin & bone c) Marked atrophy due to disuse d) Severely limited mobility e) Contractures f) Bone softening g) slight reduction in edema h) pale, cool, dry
70
Contraindications for Complex Regional Pain Syndrome?
NO PROM No ice Nothing that increases pain!
71
OT Tx for Complex Regional Pain Syndrome (13)
1. Sensory desensitization 2. Pain mgmt 3. Medication mgmt 4. Pyschosocial support 5. Fatigue mgmt 6. Relaxation techniques 7. Caregiver education 8. Maintain/improve function 9. Adaptive equipment 10. Edema control 11. AROM 12. Gentle dynamic splinting 13. Home modification
72
Specific tx for Complex Regional Pain Syndrome: Reduce pain & hypersensitivity (6)
1. Apply warm, moist heat 2. Fluid therapy 3. Gentle handling of affected limb 4. Acupressure 5. TENS before AROM 6. Gentle manual edema mobilization
73
Specific tx for Complex Regional Pain Syndrome: Edema control techniques (5)
1. Begin immediately 2. Elevation 3. Manual edema mobilization 4. Contrast baths 5. High-voltage direct current in water
74
Specific tx for Complex Regional Pain Syndrome: Other techniques (3)
1. Stress loading (scrub & carry program) 2. Mirror therapy 3. Graded Motor Imagery

Neurorehabilitation (5 decks)

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