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Neurology Flashcards

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1
Q

how do seizures occur?

A

due to an altered balance between excitatory and inhibitory input

leading to hypersynchronisation of neurons

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2
Q

what is a seizure?

A

an abnormal, uncontrollable, hypersynchronous electrical activation of a large group of neurons

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3
Q

what are the types of seizure?

A

isolated seizure
cluster seizure
status epilepticus

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4
Q

what is an isolated seizure?

A

a seizure lasting less than 5 minutes

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5
Q

what is a cluster seizure?

A

2 or more seizures within a 24 hour period with complete recovery in-between

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6
Q

what is status epilepticus?

A

seizure lasting longer than 5 minutes

OR

2 seizures without complete recovery in-between

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7
Q

what type of seizure is an emergency?

A

status epilepticus

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8
Q

what are partial/focal seizures?

A

asymmetric - one part of the brain is affected

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9
Q

what are the signs of a partial/focal seizure?

A

facial twitching
hypersalivation
behavioural changes

consciousness maintained

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10
Q

what type of seizure produces no change in mentation?

A

simple

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11
Q

what type of seizure produces a change in mentation?

A

complex

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12
Q

what is a generalised (tonic/clonic) seizure?

A

a seizure with bilateral cerebral hemisphere involvement

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13
Q

what are the signs of a generalised (tonic/clonic) seizure?

A

autonomic signs (U/D)

loss of consciousness

identifiable pre-ictal, ictal and post-ictal phases

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14
Q

what is the pre-ictal phase? how can it be identified?

A

phase before seizure onset

may see behavioural changes, altered mentation, attention-seeking behaviour

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15
Q

what is the ictal phase? how can it be identified?

A

active seizure phase - loss of consciousness, muscle contraction, U/D, salivation

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16
Q

what is the post-ictal phase? how can it be identified?

A

minutes to days post-seizure - mainly see abnormal neurological signs and behavioural changes but will vary greatly between patients

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17
Q

what are the 2 main types of extracranial seizure triggers/causes?

A

toxins and metabolic factors

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18
Q

which toxins can lead to seizures?

A 
methaldehyde (slug bait) 
ethylene glycol (antifreeze) 
permethrin in cats 
pesticides 
ivermectin (collie breeds) 
human drugs
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19
Q

what metabolic factors can lead to seizures?

A

portosystemic shunt (blood toxins)
hypoglycaemia
hypocalcaemia

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20
Q

what are the types of intracranial factors which can cause seizures?

A

structural - brain tumour, inflammation, hydrocephalus

functional - idiopathic epilepsy

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21
Q

what is the most common cause of seizures?

A

idiopathic epilepsy

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22
Q

what age dogs are more commonly diagnosed with idiopathic epilepsy?

A

6 months - 6 years

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23
Q

how is a diagnosis of idiopathic epilepsy concluded?

A

normal inter-ictal neurological exam

normal metabolic investigation

normal MRI scan of brain

normal CSF

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24
Q

what diagnostics should be performed if a patient is experiencing seizures?

A

thorough history

blood tests 
MRI scan (IV gadolinium contrast) 
CSF analysis 
videos 
monitoring and recording

retinal exam and blood pressure measurement
if possible

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25
which blood tests are performed when investigating seizures?
``` haematology biochemistry fasted blood glucose pre- and post-prandial bile acids possibly ammonia ```
26
which other conditions/disorders can mimic seizures?
``` narcolepsy/cataplexy fly-catching movement disorder syncope 3rd degree AV block canine epileptoid cramping syndrome peripheral vestibular disease ```
27
what is narcolepsy/cataplexy? how does it present?
a sleep-wake disorder with flaccid collapses loss of muscle tone but no autonomic signs
28
what is fly catching and how does it present?
unknown cause - dog appears to be chasing/trying to catch imaginary flies (mins-hours) normal mentation, no autonomic signs
29
what is movement disorder? how does it present?
an episodic disorder - patient remains conscious and performs involuntary movements that are spontaneous and uncontrolled neurologically normal between episodes
30
what is syncope? how does it present?
temporary loss of consciousness ('fainting') due to reduced oxygenation to the brain
31
what can cause syncope?
cardiac-related (most common) neurological hypoglycaemia hypocalcaemia
32
how does 3rd degree AV block present?
prolonged hypoxic event with partial seizure-like episodes
33
what is canine epileptoid cramping syndrome? how does it present?
movement disorder affecting mostly border terriers | patient conscious and responsive with no autonomic signs and normal mentation
34
what is involved in emergency management of seizures?
``` oxygen therapy place IV catheter (if possible) administer diazepam assess circulation and temperature intubate if required active cooling if hyperthermic mannitol if seizure >15 mins or suspected cerebral oedema collect full bloods ```
35
how do you triage a seizuring patient (over the phone)?
stay calm and reassure owner enquire into previous history, toxin exposure, head trauma establish how long patient has been seizuring and how many times ask if patient is conscious and responsive any U/D advise to travel when safe to do so
36
what kennel considerations should be made with seizure patients?
minimise noise and light in kennel bottom kennel/easily accessible seizure plan on kennel with doses calculated/medication drawn up sign on door to limit staff numbers/traffic
37
what steps should you take if a patient seizures?
stay calm and note the time, call clinician in charge for help remove any dangers dim lights and reduce noise as much as possible limit handling monitor vital signs follow seizure plan if one in place do not put hands in/near patients mouth!!
38
what steps should you take when the patient comes into the practice after seizuring?
``` reassure the owner triage - ABC provide oxygen therapy obtain IV access ASAP administer anticonvulsants check temperature and actively cool if required consider mannitol consider intubation and CRI if frequent/extended seizures ```
39
what is the first line treatment for managing seizures?
Phenobarbital (epiphen) tablets
40
how does phenobarbital work?
acts on GABA receptors in the brain to increase frequency of synaptic inhibition and reduce neuronal excitability
41
what are the advantages of phenobarbital?
high efficacy and safety, low cost
42
what are the disadvantages of phenobarbital?
takes ~2 weeks for steady state plasma concentration to be reached requires regular blood tests many side effects
43
what are the side effects of phenobarbital?
``` hepatotoxicity in high doses sedation polyuria/polydipsia polyphagia ataxia ```
44
what else can be used in first line management of seizures?
potassium bromide (libromide) - can be used alone or in conjunction with another antiepileptic drug
45
what are the disadvantages of potassium bromide?
side effects takes ~ 4 months to achieve steady state plasma concentration renally excreted - not good for px with renal compromise regular blood rests required causes lung issues in cats
46
what are the side effects of potassium bromide?
``` gastric irritation nausea polydipsia/polyuria sedation pancreatitis (rare) ```
47
what is levetiracetam (keppra)?
used as an adjunct to other AEDs - unknown method of action
48
what are the advantages of levetiracetam?
primarily excreted unchanged in urine excellent oral bioavailability well-tolerated
49
what are the side effects of levetiracetam?
ataxia vomiting sedation
50
which drug is licensed specifically for idiopathic epilepsy?
imepitoin (pexion)
51
which dogs cannot take imepitoin?
those with seizures caused by anything other than idiopathic epilepsy dogs with impaired hepatic/renal/cardiovascular function
52
what are the side effects of imepitoin?
ataxia vomiting polyphagia
53
what home care considerations are relevant for patients that seizure?
family situation financial situation type of property dog is living in good communication
54
what kind of disease is polyradiculoneuritis?
immune-mediated musculoskeletal disease
55
how does polyradiculoneuritis present?
short-strided gait that progresses to tetraparesis patient can be ambulatory or non-ambulatory dysphonia
56
how long does it take to recover from polyradiculoneuritis?
within 1-4 months once signs stabilise
57
how is polyradiculoneuritis diagnosed?
accurate patient history physical and neurological exam EMG, NCV muscle and nerve biopsies
58
how is polyradiculoneuritis treated?
intensive nursing care and physiotherapy
59
what is myasthenia gravis?
disease of neuromuscular transmission affecting the NMJ
60
what causes myasthenia gravis?
can be congenital or acquired
61
how does myasthenia gravis present?
muscle weakness and fatigue (more obvious when patient is exercising) focal, generalised or acute regurgitation commonly seen due to oesophageal weakness
62
how is myasthenia gravis diagnosed?
presumptive based on history and presentation thoracic radiographs (megaoesophagus) tensilon test
63
how is myasthenia gravis treated?
anticholinesterase therapy plus corticosteroids at immunosuppressive doses intensive nursing care and support
64
what is polymyositis?
immune-mediated inflammatory myopathy
65
what causes polymyositis?
idiopathic but can be associated with systemic disease
66
how does polymyositis present?
exercise intolerance and stiffened gait muscle weakness and atrophy dysphonia, dysphagia, regurgitation signs often wax and wane in initial period
67
how is polymyositis diagnosed?
criteria not well defined - diagnosis of exclusion | main diagnostics are clinical history, biochemistry, electrodiagnostic testing and muscle biopsy
68
how is polymyositis treated?
corticosteroids at immunosuppressive doses intensive nursing care and support azothrioprine can be used alongside steroids
69
what are the clinical signs of aspiration pneumonia?
coughing tachypnoea harsh lung sounds crackles on auscultation
70
which neuromuscular diseases carry the most risk of aspiration pneumonia?
myasthenia gravis | polymyositis
71
which neuromuscular disease carries the most risk of pressure sores?
polyradiculoneuritis
72
which neuromuscular disease carries the most risk of contracture?
polyradiculoneuritis (esp in young)
73
how can you prevent severe aspiration pneumonia?
careful and close monitoring of patients early administration of antibiotics IV fluids + oxygen therapy walking/turning patients regularly very important feeding balls of food from a height severe cases may require mechanical ventilation
74
how do pressure sores form?
recumbency leads to increased pressure over bony prominences, which then leads to ischaemia and necrosis
75
how can you prevent pressure sores?
``` thick padded bedding turn every 2-4 hours donut bandages physiotherapy monitor patients closely ```
76
how does muscle contracture occur?
recumbency and immobilisation | --> leads to adaptive shortening of the muscle and soft tissues, and inelasticity of the soft tissues
77
how is contracture treated?
massage PROM proprioceptive exercises neuromuscular stimulation
78
what is ataxia?
uncoordinated gait
79
what does -paresis/-paretic mean?
weakness, decreased voluntary movement
80
what does -paralysis/-plegic mean?
no voluntary movement?
81
what does mono- mean in regards to gait?
one limb affected
82
what does hemi- mean in regards to gait?
both limbs on one side affected
83
what does para- mean in regards to gait?
both pelvic limbs affected
84
what does quadra/tetra- mean in regards to gait?
all 4 limbs affected
85
when would you perform a neurological exam on a patient?
seizures behavioural changes gait abnormalities change in posture/positioning
86
why might you perform a neurological exam?
identify if nervous system involvement identify specific location/localisation aid diagnosis and prognosis continuous assessment of condition/comparisons
87
what do the upper motor neurons do?
send signals to the lower motor neurons
88
what do the lower motor neurons do?
connect the CNS to the effector organ (muscle) and send a signal to make them contract
89
what factors should you assess during a neurological examination?
mentation gait and posture cranial nerve function postural reactions spinal reflexes sensory evaluation palpitation of head/spine/limbs
90
what does head tilt look like?
one ear is below the other
91
what does head turn look like?
nose is turned towards body
92
what does ventroflexion of the neck look like?
low head carriage
93
what is scoliosis?
lateral deviation of the spine
94
what is lordosis?
ventral deviation of the spine
95
what is kyphosis?
dorsal deviation of the spine
96
what is decerebrate rigidity?
extension of all limbs, head and neck
97
what is decerebellate rigidity?
extension of the thoracic limbs, head and neck
98
what are the common postural tests for spinal cord injury?
proprioceptive positioning (paw placement) hopping visual placement tactile placing hemi-walking wheelbarrowing
99
what spinal reflexes should be present in the thoracic limbs?
withdrawal reflex extensor carpi radialis biceps brachii and triceps reflex
100
what spinal reflexes should be present in the pelvic limbs?
patella reflex | cranial tibial and gastrocnemius
101
which spinal reflexes are part of the trunk?
perineal reflex | panniculus reflex
102
what is the panniculus reflex?
pinching either side of the spinal column to see if skin twitches
103
how do you perform a pain evaluation?
pinching/pressure applied to digits on each limb - looking for reaction from patient (turning, vocalising, trying to bite)
104
what is the important thing to remember about pain evaluation?
it is not the same as withdrawal reflex
105
what are the acute causes of spinal injury?
intervertebral disc disease (IVDD) trauma (fracture/luxation) infarction (fibrocartilagenous embolism)
106
what are the chronic causes of spinal injury?
degenerative disc disease degenerative myelopathy cervical stenotic myelopathy (wobblers)
107
what are the other possible causes of spinal injury (aside from primary acute/chronic)?
``` atlanto-axial subluxation vertebral anomalies neoplasia inflammatory diseases discospondylitis ```
108
what is discospondylitis?
infection of the vertebrae/vertebral disc spaces
109
what additional diagnostics can be used to identify spinal disease?
``` imaging - radiographs, CT, MRI CSF tap (cisternal or lumbar) ```
110
what is involved in conservative treatment for spinal cord disease?
``` 6 weeks strict rest physiotherapy anti-inflammatory drugs analgesia steroid therapy ```
111
what is involved in surgical treatment for spinal cord disease?
hemilaminectomy ventral slot (upper cord) dorsal laminectomy spinal stabilisation/fixation
112
what is a hemilaminectomy?
removal of compressing/problematic bone
113
how does upper motor neuron disease affect bladder function?
``` increased urethral resistance detrusor and urethral sphincter can contract at same time not able to control bladder function urinary retention kidney damage possible difficult to manually express require catheterisation intermittent "squirting" of urine ```
114
how does lower motor neuron injury affect bladder function?
flaccid bladder, does not contract spontaneously continues to fill, resulting in "overflow" leaking of urine bladder muscle is overstretched easy to manually express
115
what are the nursing considerations for patients with spinal cord injury?
``` holistic care enrichment nutrition turning/physio temperature control padded bedding excretion management grooming hygiene ```
116
what is an intracranial disease?
a disease that affects the brain
117
what is the skull vault?
a closed, inelastic compartment that doesn't allow any room for inflammation and swelling
118
what does the skull vault contain?
80% parenchymal tissue 10% blood 10% CSF
119
what is parenchymal tissue?
brain tissue
120
how is cerebral blood flow maintained?
autoregulatory mechanisms maintain cerebral blood flow over a wide range of mean arterial pressures (50-150mmHg)
121
what is intracranial pressure?
pressure exerted between skull and intracranial tissues | normal is 5-10mmHg
122
what is the effect of intracranial hypertension?
results in reduced cerebral perfusion pressure, reduced blood flow and secondary changes
123
what triggers cushings reflex?
severe, acute rise in ICP
124
what is cushings reflex?
a rise in MAP and reflex bradycardia
125
what does cushings reflex indicate?
it is a sign of potentially life threatening increase in ICP and should be treated immediately
126
what are the possible causes of intracranial disease?
``` trauma inflammatory (MUO) infections neoplasia toxins seizures anomalous (hydrocephalous) ```
127
what types of neoplasia can can intracranial disease?
meningioma glioma choroid plexus tumour
128
which part of the neurological examination are most likely to pick up on ICP?
mentation (alert, obtunded, stuporous, comatose) | cranial nerve function (menace, PLR, gag, palpebral, vestibuloccular)
129
what is alert mentation?
normal response to surroundings
130
what is obtunded mentation?
awake but less responsive, will sleep if left
131
what is stuporous mentation?
only responds to noxious/painful stimuli
132
what is comatose mentation?
unconscious, unresponsive to any stimuli
133
what mentation signs indicate something could be wrong with ICP?
``` circling head pressing pacing head tilt head turn ```
134
what is the menace response?
covering one eye and moving hand towards the face menacingly - animal should blink/flinch
135
what is the oculocephalic reflex?
physiological nystagmus - eye position correction with movement
136
what does absence of oculocephalic reflex indicate?
poor prognosis for the animal - severe brainstem damage
137
what is miosis/miotic pupils?
constricted pupils
138
what is mydriasis/mydriatic pupils?
dilated pupils
139
what is anisocoria?
unequal pupil size
140
which pupil status indicates a very poor prognosis?
mid-size fixed pupils that are unresponsive to light
141
list some of the clinical signs of intracranial disease.
circling and ataxia head tilt/turn nystagmus, blindness altered mentation/loss of consciousness/coma seizures cheyne-stokes respirations loss of gag reflex and oculocephalic reflex strabismus and non-responsive pupils decerebrate/decerebellate posture
142
what are the 3 domains of the glasgow coma score?
motor activity brainstem reflexes level of consciousness
143
what glasgow coma scale score indicates a grave prognosis?
3-8
144
what glasgow coma scale score indicates a guarded prognosis?
9-14
145
what glasgow coma scale score indicates a good prognosis?
15-18
146
what is the main treatment for raised intracranial pressure?
IV mannitol infusion
147
why is mannitol used to decrease ICP?
hyperosmolar - reduced cerebral oedema increases CPP and cerebral blood flow rapid onset (minutes) effects for 1.5-6 hours
148
what should be infused after mannitol treatment?
isotonic fluids - mannitol has a profound diuretic effect
149
what is the alternative treatment for raised ICP?
hypertonic saline therapy - similar osmolarity to mannitol
150
in addition to mannitol, what else can be used in treatment of raised ICP?
``` sedatives/analgesia anaesthesia mechanical ventilation CRI require intense care and monitoring ```
151
what is involved in nursing management of raised ICP patients?
recumbency - turning, padding, physiotherapy, monitor/manage excretions elevate cranial part of body 30-40° ocular care mouth checks nutritional support - in sternal every 4-6 hours if conscious
152
what is hydrocephalus?
excessive accumulation of CSF within the ventricular system
153
how can hydrocephalus be caused?
obstruction to CSF outflow decreased absorption of CSF increased production of CSF
154
what are the 2 types of hydrocephalus?
congenital - present at birth | acquired - tumour, inflammation, haemorrhage
155
what are the clinical signs of hydrocephalus?
``` behavioural changes slowness in learning loss of coordination visual deficits seizures circling depressed/obtunded mentation enlarged and dome-shaped skull signs can wax and wane ```
156
how is hydrocephalus managed medically?
aims to reduce production of CSF - steroids (prednisolone, frusemide, omeprazole)
157
how is hydrocephalus managed surgically?
aims to divert CSF to another location ventriculoperitoneal shunt - tubing placed from ventricle to peritoneal cavity
158
what is the prognosis for hydrocephalus?
dependent on cause and severity of signs - more severe = more guarded good prognosis for infectious cause tumour = more guarded
159
what is MUO?
meningoencephalitis of unknown origin - inflammatory disorder of CNS
160
what are the 3 types of MUO?
granulomatous ME necrotising necrotising leukoencephalitis
161
why are the 3 types referred to as an umbrella term of MUO?
not possible to determine type in live patient
162
which dogs are more prone to MUO?
small dogs females more than males >6 months of age
163
what are the neurological signs of MUO?
``` seizures muscle tremors blindness head tilt altered balance and posture circling ```
164
how is MUO diagnosed?
clinical examination blood tests MRI - brain CSF analysis
165
what is involved in management of MUO?
immunosuppressive drugs - steroids, cyclosporine, azathioprine, cytarabine antiepileptics nursing care
166
what is the prognosis for MUO?
variable seizures = poorer better for focal lesions than multifocal improvement within 3 months = good prognosis patients can relapse and represent with clinical signs
167
what considerations need to be taken in regards to nursing considerations of neuro patients?
``` ambulation status/recumbency type of surgery continence temperament normal routine of patient ```
168
what type of bedding should be used for a neuro patients kennel?
thick bedding to prevent sores (duvet/mattress as bottom layer) layer with incontinence pads vet bed as top layer to wick away any urine pad out sides of kennel for extra comfort and injury prevention
169
which methods are available to help a patient empty their bladder?
``` manual expression intermittent catheterisation (males only) in-dwelling catheterisation (larger/aggressive/nervous patients; constantly leaking urine) ```
170
what is overflow incontinence?
where the patient is unaware their bladder is full - overflows and leaks urine (reflexes have been affected)
171
how many times should the bladder be emptied per day?
ideally 4x a day
172
what is the main cause of urine scalding?
overflow incontinence/leaky bladder
173
if passing an intermittent urinary catheter, how often should this be done?
twice daily - always a risk of causing iatrogenic trauma with each catheter passed
174
how do we monitor for UTIs in spinal injury patients?
monitor smell, colour and turbidity of urine | guidance must be given to owner at discharge to monitor urine and take a sample to vet for urinalysis if concerned
175
how can we manage faecal incontinence patients?
check beds regularly keep patient clean/dry at all times - may require regular bathing check skin daily for changes/sore spots apply topicals if necessary (under vet direction)
176
what is a decubitus ulcer?
an open skin wound caused by continued pressure of skin on a firm surface - eventually causes tissue ischaemia in the skin
177
where do decubital ulcers most commonly occur?
bony prominences e.g. ileum, ischium, hock, olecranon and feet
178
how often should patients be turned in order to prevent decubitus ulcers?
every 4 hours as a minimum - more often for more bony breeds
179
how can you prevent decubital ulcers?
turn every 4 hours with great care deep padded bedding, checked regularly keep patients clean and dry donut bandages on elbows and hocks can help prevent prop recumbent patients up with pillows for comfort
180
which products/medications can be used to prevent and treat decubital sores?
clorexyderm for treatment of mild urine scalding talc to help dry a patient after bathing cavilon spray as a no sting barrier around anus/perineum (diarrhoea) flamazine - antibac cream used for surface thickness sores
181
what can you use to exercise the paretic/paraplegic patient?
sling/rear harness | foot covers
182
why do we cover the hind paws when walking paretic/plegic patients?
to prevent trauma to the hind toes and claws (will drag along floor)
183
how can we exercise the tetraparetic/plegic patient?
walk using a secure and supportive chest harness/sling/rear harness may require a hoist/multiple people cover all 4 paws
184
which spinal surgery carries a higher risk of seroma?
hemilaminectomy - more skin movement, separation of layers of tissue and over the midline
185
how is cold therapy useful post-surgery?
provides analgesia and decreases inflammation
186
how long should cold therapy be given post-surgery?
15 mins 4x daily for 48-72 hours
187
how can you prevent patient interference with surgical wounds?
primapore dressing
188
why might self-mutilation happen in neuro patients?
can occur in deep pain negative animals due to paraesthesia, boredom or stress
189
how can self mutilation be prevented?
use a buster collar if a patient starts to like/bite at any part of their body look for any triggers such as a sore
190
what is physiotherapy useful for post neuro surgery?
can help keep joints and muscles mobile as well as retrain limbs to move correctly as mobility improves
191
why do physiotherapy?
promote recovery | prevent further complications
192
how much physiotherapy is involved in recovery from acute spinal cord damage?
aggressive therapy 1-2 weeks after trauma
193
how much physiotherapy is involved in recovery from chronic spinal cord damage?
low impact, low intensity long-term therapy to preserve neuromuscular function
194
how can physiotherapy help with degenerative myelopathy?
can lead to longer survival times
195
what are the benefits of physiotherapy?
``` pain management improved range of motion reduce muscle contraction and tension stimulate the nVS improve blood perfusion improve cardiorespiratory capacity encourage relearning of motor patterns weight management ```
196
how can we make sure patients are safe to undergo physiotherapy?
patients should be clinically stable before commencing therapy - critical surgical and medical needs should have been addressed
197
how should we handle/move dogs during physiotherapy?
encourage natural movement short, regular sessions take it slow keep spine in line (vital!)
198
which patient factors will affect rehabilitation therapy program design?
``` patient size temperament degree of disability location of incision(s) IV/urinary catheterisation bandages and external coaptation comorbidities ```
199
which client factors will affect rehabilitation therapy program design?
physical abilities financial resources schedule and household restrictions emotional needs and concern
200
which facility factors will affect rehabilitation therapy program design?
``` size and indoor/outdoor exercise space availability of lift equipment appropriate modalities facility hours adequate bedding and housing ```
201
which staff factors will affect rehabilitation therapy program design?
availability of sufficient support staff proper training and experience physical ability to lift and transport patients access to specialists
202
what different components are involved in physiotherapy?
massage passive range of motion (PROM) assisted exercises proprioceptive exercises neuromuscular electrical stimulation
203
what are the 4 types of physiotherapy massage?
effleurage petrissage percussion vibration
204
what is effleurage massage?
gentle contact with palm of hand - stroke towards the heart | can be used all over body
205
what is petrissage massage?
therapist rolls, squeezes, compresses and kneads the skin and muscles to increase circulation
206
what is percussion massage?
gentle tapping o the skin with pam or side of hand - increases blood supply and aids relaxation of the muscle
207
what is vibration massage?
limbs are gently shaken to stimulate the whole limb | good for relaxation at the end of the massage session
208
what is coupage?
a technique which loosens secretions and assist in airway clearance by coughing firm cupped hands on chest - caudal to cranial
209
when might we perform coupage?
important in recumbent patients and those suffering from pulmonary disease/aspiration pneumonia
210
what is passive range of motion?
joint mobilisation and stretching | external forces applied to the limbs/axial skeleton - flexion/extension (normal ROM) and monitor for pain
211
how often should PROM be performed?
3-4 times daily for 10 mins
212
how should PROM be performed?
begin at toes and move up limbs care with hips and shoulders consider comorbidities (anything that may affect ROM)
213
what assisted exercises can be performed as part of physiotherapy?
assisted standing/walking assisted sit three-legged standing weight-shifting
214
what proprioceptive exercises help with sensation and awareness of limbs?
``` standing wobble boards uneven surfaces over poles weaving different surfaces ```
215
why perform active exercises as part of physiotherapy?
improve strength | promote independence with functional activities (off lead, normal walking etc)
216
what types of active exercise can be done?
``` lead exercise - slowly and increasing gradually add in steps/stairs/ramps figure of 8, circles encourage sitting and then standing pole walking, weight shifting move head/neck with treats/food balls hydrotherapy ```
217
which patients cannot do pool hydrotherapy?
ventral slot patients due to swimming position | patients in early stages of recovery
218
what is e-stim?
neuromuscular electrical nerve stimulation applied to skeletal muscle to stimulate contraction
219
how is NMES delivered? what does it do?
percutaneously | increases tissue perfusion and can help to slow neurogenic muscle atrophy
220
what are the benefits of e-stim?
``` increases muscle strength, ROM and muscle tone enhances function pain control (some) oedema reduction reduces muscle spasm ```
221
how does e-stim generate effective muscle contractions?
1 electrode placed near motor point of muscle and other placed along the muscle body check for muscle contraction
222
how often should e-stim be used?
10-20 mins daily (depends on patient tolerance)
223
what is the procedure for applying the e-stim?
``` clip hair clean with spirit apply conducting gel place electrode on top of gel set contraction/rest cycle ```

CVNT2 (47 decks)

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