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PPO 2 > Neuro Rehab for Acquired brain injury > Flashcards

Neuro Rehab for Acquired brain injury Flashcards

1
Q

who makes up the interdisciplinary rehab team for acquired brain injurty

A
  1. phsyiatrist: MD/DO that writes orders for all kinds of therapies that are needed.
  2. neurologist
  3. neuro-opthamologist
  4. internist/general practitioner
  5. psychologist
  6. physical therapist/vestibular
  7. occupational therapist
  8. speech therapist
  9. vocational rehabilitation
  10. social worker
  11. optometrist
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2
Q

What is the role of the optometrist

A

correct refractive errors, asses functional vision, diagnose ocular health issues; treat with lenses, prisms, and visual rehab therapy

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3
Q

Acquired brain injury is an umbrella term that includes any condition/even resulting in a sudden, non progressive change in nerurological processsing which can include:

A

stroke, traumatic brain injury, post surgical neurologic complications, vestibular dysfunctions

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4
Q

What is the new definition of vision rehab

A

rehab of the entire visual system, from tracking, vergence, and accomodative function of the eyes to rehab and management of sensory processing, the integration of vision with the other senses and a focus on how visual processing impacts behavior and cognitive function.

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5
Q

What is traumatic brain injury

A

occurrence of injury to the head that is documented in a medical record

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6
Q

What things fall under the category of the TBI

A
  1. decreased level of consciousness
  2. amnesia
  3. skull fracture
  4. neurlogical abnormality
  5. intrcranial lesion
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7
Q

Coup refers to ____insult

A

acceleration

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8
Q

contre- coup refers to

A

deceleration

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9
Q

Shearing forces may lead to;

A

breakage of blood vessels, diffuse axonal injury

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10
Q

What are the consequences of mild TBI

A
  1. Postconcussion Syndrome: lingering symptoms after the injury which include headache, dizziness, fatigue, noise intolerance, loss of conc, poor memory etc.
  2. Post Trauma vision syndrome: signs and symptoms may include convergence insufficiency, high exo/eso phoria, oculomotor defecits
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11
Q

what is Cerebral vascular accident

A

a syndrome of rapidly developing symptoms or signs of focal loss of cerebral function with no apparent cause other than that of vascular origin. 80% are ischemic

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12
Q

What is the occiptal lobe responsible for

A

controur, contrast depth

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13
Q

what is frontal lobe responsible for

A

motor planning, self directed eye movements

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14
Q

what is temporal lobe responsbile for

A

recognition of peoples faces, places and processing motion

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15
Q

what is parietal lobe responsible for

A

spatial organization of objects and visual attention

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16
Q

What is the parvocellular pathway responsible for

A
  1. ventral stream
  2. central processing/focal vision
  3. “what is it?” used for representation/recognition
  4. accommodation involved to tell us details of the object, shape, and color
    LGN –>occipital –>temporal
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17
Q

What is the magnocellular pathway

A
  1. dorsal stream
  2. peripheral process/ambient vision
  3. “where is it”
  4. pursuits, saccades and vergence tell us spatial relationships to det where we are and where it is
  5. LGN–>occipital–>parietal
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18
Q

What are characteristics of central/focal processing

A
  • detail info
  • what is it
  • high resolution
  • color vision
  • conscious
  • central 2 degrees
  • static
  • innate
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19
Q

what are characteristics of peripheral/ambient processing

A
  • gestalt
  • where am in and where is it
  • low resolution
  • non concious - non color
  • entire visual field
  • dynamic,
  • learned
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20
Q

what is ambient vision

A

a constant stream of data about the loc of your body in space, the location of other people and objects, and info about how quickly and in what direction thos people.objects are moving

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21
Q

What does ambient vision lead to

A
  • binocularity
  • accurate judgement of distance and movement
  • defining our self image/view of the world
22
Q

What are some interferences with central processing

A
  • refractive shifts

- accomodative dysfunction

23
Q

what are some interference with peripheral processing

A
  • gaze palsy
  • fixation dysfunction
  • pursuit/saccadic dysfunction
  • binocular dysfunction
  • eye muscle paralysis
24
Q

What are deficits of oculomotor dysfunction

A
  1. limitation of gaze
  2. nystagmus
  3. speed and quality of pursuits and saccades
25
Q

What are potential symptoms of oculomotor dysfunction

A
  1. inability to follow objects smoothly
  2. reading problems
  3. skipping words
  4. re reading words
  5. word/letter reversals
26
Q

what are deficits of accomodative dysfunction

A
  1. accomodative insufficiency
  2. pseudo-myopia
  3. speed and quality of accomodative response
27
Q

What are potential symptoms

A
  1. blur
  2. headache
  3. pain
  4. double vision
  5. squinting
  6. closing an eye
  7. reading problems
  8. ocular discomfort
  9. tired eyes
  10. watery eyes
  11. falling asleep when reading
28
Q

what are deficits in binocular dysfunction

A
  1. strabismus
  2. muscle paralysis
  3. convergence insufficiency
  4. reduced or slow fusional ability
29
Q

what are potential symptoms in binocular dysfunction

A
  1. head turn/tilt
  2. diplopia
  3. poor depth/spatial judgements
  4. closing an eye
  5. asthenopia
30
Q

What are deficits in visual spatial processing dysfunction

A
  1. visual-vestibular integration problems
  2. visual motor integration problems
  3. difficulty understanding spatial coordinates
  4. disturbances in body image
  5. disturbance in spatial relationships
  6. difficulty sustaining visual attention
31
Q

What are symptoms of visual spatial processing dysfunctions

A
  1. balance issues
  2. poor distance judgement
  3. motor coordination probs
  4. eye hand coordination issues
  5. agnosia: diff in object recognition
  6. apraxia; diff in manipulation of objects
  7. diff with visual memory
  8. diff with figuire ground analysis
  9. diff with writing
32
Q

What are deficits in visual field loss/visual spatial neglect

A
  1. visual field cut

2. visual spatial in attention/neglet

33
Q

what are symptoms of visual field loss

A
  1. oculomotor related symptoms
  2. diff locating objects
  3. diff with gait
  4. diff with balance
  5. bumping into things
  6. diff seeing at night
  7. cant drive
34
Q

What does a vision examination consist of

A
  1. VA measurements
  2. Oculomotor assessment
  3. refraction
  4. binocularity/vergence assesment
  5. accommodative assesment
  6. ocular health assessment
  7. visual field assessment
  8. neurological screeening
35
Q

What are some factors that affect treatment of the patient with an acquired brain injurty

A
  1. visual field loss
  2. visual neglect
  3. midline shift
  4. photphophobia
  5. diplopia
36
Q

What is visual field loss

A

physical sight loss or sensory that respects the anatomy of the visual pathway

37
Q

what is visual field loss measured by

A
  1. confrontation visual fields
  2. tangent screen
  3. automated perimetry
38
Q

What are some treatment options for field expansion

A
  1. fresnel prisms, gottlieb and peli lenses.

2. Prisms are stuck on the glasses and are placed BO on the eye of the side of the defect.

39
Q

what is visual neglect

A
  1. cognitive deficit that refers to the unawareness of objects, people, and visual stimuli presented in a visual space contralateral to the cerebral lesion.
  2. most common with parietal lobe lesions and hemianopia.
  3. you can have neglect, but full visual fields
40
Q

How do you evaluate for visual neglect

A
  1. have patient draw a clock that incorporates both sides of the face of time.
  2. line bisection test: patient draws a line that bisects each line on page, both horizontal and vertical
41
Q

what is the midline shift syndrome

A
  1. the mismatch of info and distorting of space due to disruption of ambient system leading to: alteration of posture and diff with balance.
42
Q

what is the midline shift associated with

A
  1. hemiplegia
  2. hemiparesis
  3. flexion/extension
  4. neglect
    - yoked prisms can be used to shift the midline
43
Q

What is photophobia

A
  1. extreme sensitivity to light inducing pain
  2. may be sensitive to all light, particularly sunlight and flourescent lighting
  3. sensitivity related to the flicker frequency of flourescent lights.
44
Q

What is diplopia

A
  1. ABI can result in sudden onset strabismus, either intermittent or constant
  2. can be horizontal, vertical, or cyclotorsional
  3. diplopia due to ABI can resolve on its own over a period of months.
45
Q

what are treatment options for diplopia

A

grind in fresnel prisms into glasses

46
Q

What is the visual rehab for oculomotor deficits

A
  1. basic scanning and searching exercises

- line activities, michigan tracking, track printed words from books on tape, color in specific letters on a page

47
Q

Visual rehab for vergence deficits:

A
  1. stabilize vergence in primary gaze at far and near

2. facility and sustainability of fusional vergence at far and near

48
Q

visual rehab for accomodative deficits:

A
  1. build up and equalize accommodative amplitudes
  2. work on improving the weaker aspect of focusing
    - a minus lens inc acc
    - a plus lens you have to relax acc
49
Q

visual rehab for visual spatial function

A

work on central peripheral integration

50
Q

visual rehab for visual field loss

A
  1. practice scanning into the blind field
  2. teach the patient to look into their blind field.
  3. nova vision therapy: instrument maps the edge of the blind field and presents stimuli near the border resulting in small inc in the visual field over time

PPO 2 (4 decks)

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