Prac VIVA 3 Flashcards
Targeted (10 cards)
SCI
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
SCI results in partial or complete loss of motor, sensory, and autonomic function below the level of injury. Prognosis depends on severity (complete vs incomplete), level of injury, and early intervention.
Primary Problems:
Motor and sensory loss
Autonomic dysfunction (e.g. hypotension, bladder/bowel issues)
Spasticity or flaccidity
Reduced mobility and independence
Short-Term Goals:
Maintain joint range and prevent contractures
Improve sitting balance
Begin functional mobility (e.g., bed mobility, transfers)
Assessments:
ASIA Impairment Scale
MMT, sensory testing
Spasticity:
Functional tools: SCIM, FIM
Respiratory status if high-level lesion
Assessment Interpretation:
Motor ≥3/5 in key muscles → likely functional use
ASIA B–D → incomplete injury = better prognosis
Loss of light touch and pinprick → sensory zone mapping
Interventions:
C1-C3 needs life support
C6- Use tendonsis
C7- Triceps for moblising
T12-L1- Unsupported sitting
L2- Walking with aids
Passive/active ROM, stretching
Task-specific training: rolling, sitting, transfers
Strengthening for intact muscles
Education on skin checks, bladder care
Wheelchair skills and mobility training
Risks/Precautions:
Pressure injuries
Autonomic Dysreflexia (esp. T6 and above)
Postural hypotension
Respiratory compromise in higher injuries
Vestibular
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
Vestibular disorders affect balance and spatial orientation. BPPV is caused by otoconia displacement; UVH results from vestibular nerve or labyrinth damage. Prognosis is good for BPPV with treatment; UVH varies.
Primary Problems:
Vertigo/dizziness
Gait and balance impairment
Visual instability (oscillopsia in UVH)
Short-Term Goals:
Reduce vertigo episodes
Improve balance during ambulation
Increase confidence in movement
Assessments:
Dix-Hallpike for BPPV
Head Thrust Test, Dynamic Visual Acuity (DVA)
Clinical Test of Sensory Integration in Balance (CTSIB)
Dizziness Handicap Inventory (DHI)
Assessment Interpretation:
Positive Dix-Hallpike = posterior canal BPPV
Head thrust with catch-up saccade = UVH
Increased sway in CTSIB = sensory conflict
Interventions:
Canalith repositioning (e.g., Epley) for BPPV
Gaze stability exercises (x1/x2 viewing) for UVH
Balance training under varied conditions
Habituation exercises if motion-provoked dizziness
Risks/Precautions:
Contraindications to Dix-Hallpike: neck instability, recent surgery
Post-repositioning instructions (e.g., avoid lying flat for hours)
TBI
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
TBI causes cognitive, behavioural, physical, and motor impairments. Severity depends on mechanism and duration of PTA. Prognosis is variable, better in mild–moderate injuries with rehab.
Primary Problems:
Impaired balance and mobility
Cognitive and executive dysfunction
Fatigue, spasticity, behavioural changes
Short-Term Goals:
Improve balance during static and dynamic tasks
Restore safe ambulation
Establish basic executive function routines
Assessments:
Glasgow Coma Scale. Measures 3-15.
3-8 severe
9-12 moderate
13-15 nil
PTA (Duration of Post Trumatic Amnesia) Length of time to get 12/12 records outcomes 3 days in a row. 5mins very mild, 5-60mins mild, 1-24 hours moderate, 1-7 days severe
In later stages, DGI, HIMAT and CBM (Community Balance and Mobility Scale
Assessment Interpretation:
HiMAT <54 indicates high-level mobility deficits
Interventions:
Early management- Try to add rotation of trunk, head control, encourage prone position for head lift. Help with extending torso without the extensor thrust.
Later management- Serial casting, splinting,
Truncual ataxia- Core stability tasks, alignment when reaching, reaching outside BOS. Swiss ball, kneeling, half kneeling.
Environmental cues and structured practice for cognitive deficits
Risks/Precautions:
Falls (esp. with impulsivity, poor insight)
Fatigue-limited capacity
Seizure risk in moderate–severe TBI
MS
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
MS is a progressive autoimmune demyelinating disease of the CNS with relapsing-remitting or progressive subtypes. Common symptoms include fatigue, weakness, spasticity, ataxia, and visual/vestibular issues.
Primary Problems:
Fatigue
Spasticity and weakness (esp. lower limbs)
Balance and gait dysfunction
Short-Term Goals:
Improve walking distance with reduced fatigue
Maintain joint ROM and muscle strength
Improve static and dynamic balance
Assessments:
Schwab and Engfland ADL’s scale.
MS Impact Scale
FAS
6-Minute Walk Test
Interventions:
Fatigue management (pacing, energy conservation)
Strength and balance training (intervals may help fatigue)
Spasticity management (positioning, functional stretching)
Aerobic training, tailored to tolerance
Task-specific gait and stair training
Risks/Precautions:
Fatigue management critical — avoid overheating
Monitor for relapse signs
Be mindful of fluctuating symptoms across the day
Peripheral Polyneuropathies
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
Guillain-Barré Syndrome (GBS) is an acute, immune-mediated demyelinating neuropathy. Rapid onset of symmetrical ascending weakness and areflexia. Results in flaccid paralysis
Primary Problems:
Weakness, especially distally
Sensory loss (glove/stocking distribution)
Balance and gait impairment
Respiratory risk in severe cases
Short-Term Goals:
Prevent contractures and maintain ROM
Begin upright tolerance and transfer practice
Improve muscle activation in key functional muscles
Assessments:
MMT and functional strength
Sensory testing (light touch, vibration, proprioception)
Balance (Berg or Step Test)
Functional scales: FIM,
Assessment Interpretation:
Flaccid paralysis initially → recovery pattern often proximal to distal
Sensory deficits contribute to postural instability
Areflexia supports diagnosis
Interventions:
Gentle AROM and stretching early phase
Positioning to prevent pressure injuries
Progress to active-assisted and resisted training
Gait retraining as strength returns
Task-specific balance and coordination work
Deterioration Phase- Chest care- suction, postural drainage.
Positioning for wound care
TENS
TEDS
Massage and heat for desensiitation.
Platuea Phase
- Positional change, encourage concentration when ROMing
- Reassurance
-Tilt table for orthostatic tolerance
Recovery Phase
- Hydrotherapy, strengthening, functional activities. Stretches, mobilising, balance reeducation
Avoid over fatiguing muscles, low reps, higher frequency and shorter durations.
Risks/Precautions:
Avoid overwork fatigue (axonopathy risk)
Monitor autonomic dysfunction (e.g. HR, BP)
Respiratory monitoring in acute stage
FND
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
FND presents with motor or sensory symptoms that are inconsistent with known neurological disease. Often triggered or exacerbated by stress. Recovery is possible with appropriate interdisciplinary management.
Primary Problems:
Inconsistent weakness, gait abnormalities
Movement disorders (e.g., tremor, dystonia)
High fear/avoidance or catastrophisation
Fatigue and reduced function
Short-Term Goals:
Restore consistent motor control
Increase confidence in movement
Reduce fear-avoidance behaviours
Assessments:
Functional movement observation (distracted vs. focused tasks)
TUG, HiMAT, 10MWT (monitor variability)
Patient beliefs/fear: FABQ, questionnaires
Assessment Interpretation:
Inconsistencies (e.g., normal strength distracted) → FND pattern
Poor motor control despite normal tone/reflexes
High fear-avoidance → barrier to progression
Interventions:
Education: explain diagnosis in non-threatening way
Goal-directed, task-specific training with distraction
Use automatic movements (e.g., rhythm, dual task)
Positive reinforcement, avoid unnecessary rests or aids
Risks/Precautions:
Avoid reinforcing illness behaviours
Consistency and clarity among team members
Psychological comorbidities — involve psych/OT where needed
Ataxia
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
Ataxia is a coordination disorder, often caused by cerebellar degeneration, MS, stroke, or alcoholism. Symptoms include unsteady gait, intention tremor, dysmetria, dysdiadochokinesia. Prognosis depends on underlying cause.
Primary Problems:
Impaired balance and coordination
Intention tremor affecting reaching
Dysmetria and poor motor timing
Short-Term Goals:
Improve postural stability during standing and walking
Increase accuracy of upper limb movements
Reduce fall risk with functional mobility
Assessments:
Gait analysis (wide-based, veering, staggering)
Finger-nose test, heel-shin test
CBM, Berg Balance Scale
Dysdiadochokinesia (rapid alternating movements)
Assessment Interpretation:
Dysmetria, intention tremor → cerebellar signs
Wide-based gait with irregular steps
CBM low scores = high-level mobility impacted
Interventions:
Frenkel’s exercises (repetitive coordination tasks)
Gait retraining with visual/physical cues
Reaching with trunk supported → progress to dynamic
Balance exercises with reduced BOS
Slow, controlled movements with cueing (auditory/visual)
Risks/Precautions:
High fall risk → environmental modifications
Fatigue from concentration
Avoid overstimulation (too many inputs)
Falls
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
Falls are multifactorial — often due to sensory loss, poor strength, poor vision, medications, or neurological disease. Leading cause of injury in older adults. Modifiable with targeted intervention.
Primary Problems:
Impaired balance and strength
Sensory deficits
Gait instability
Fear of falling
Short-Term Goals:
Improve balance under various conditions
Increase lower limb strength
Promote confidence in walking
Assessments:
If first fall, test vision and balance (berg)
If more, test vision, gait, ll strength
Falls Screen (vision, sensation, cognition, strength, balance)
TUG / 10MWT
Step Test
Assessment Interpretation:
TUG >13.5s = high fall risk
<5 repetitions on Step Test = reduced dynamic balance
Loss of vibration/proprioception → sensory-based falls
Interventions:
OTAGO Program
Strengthening (sit-to-stand, step-ups, resistance)
Balance retraining (static/dynamic, eyes closed/open)
Sensory retraining (barefoot surfaces, varied BOS)
Education: safe footwear, environment, pacing
Risks/Precautions:
Home hazards (rugs, poor lighting)
Polypharmacy effects
Supervision initially for challenging tasks
MND
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
Overview:
A progressive neurodegenerative disorder affecting upper and lower motor neurons.
Leads to muscle weakness, atrophy, spasticity, dysphagia, and respiratory decline.
Sensory system is generally preserved.
Prognosis is poor — median survival ~3–5 years from onset.
UMN= spasticity, widespread mm wasting. Hypertonia, hyperreflexia Primitive reflexes checked- globellar tap and babinski.
LMN= shoulder sublux, atrophy of specific muscles, fasiculations. Hypo tonia
Atrophy of muscles. Extracellular gliutamate leans to excittotoxicity and calcium overload. Caused by free redicals and inflammatory cascade.
Primary Problems:
Progressive limb and bulbar weakness
Spasticity and fatigue
Respiratory decline
Loss of function and independence
Short-Term Goals:
Maintain mobility and joint range as long as possible
Preserve independence in transfers and ADLs
Reduce secondary complications (contractures, pressure sores)
Support breathing and energy conservation strategies
Maintain independence
Muscles with < G3, will not improve. Avoid vigorous exercise
Phase 1
Stage 1- Increase activity and flexibility and strenght
Stage 2- Same as above but use of orthotics
Stage 3- Focus on pleasurable activities- Walking, Posture Drainage and Deep Breathing, wheelchair prescription.
Phase 2
Stage 4- Pain reduction, heat and massage
Oedema measures- AROM, Isometric contractions
Stage 5- Mechanical ventilation, family education on turning and transfers
Phase 3
Stage 6- Suctioning, positioning, comfort.
Assessments:
ALSFRS-R (ALS Functional Rating Scale – Revised)ALS Severity Scale (Score out of 48. Higher equals better result)
MMT / hand-held dynamometry
FVC or PCF (respiratory) – often with a respiratory team
Fatigue Severity Scale
6MWT (if early stage), gait observation
Seating, postural control, head/neck control
Assessment Interpretation:
↓ ALSFRS-R scores indicate disease progression
FVC <50% → consider respiratory intervention
Mixed UMN + LMN signs: e.g. hyperreflexia with wasting
Fatigue and fear of movement are early signs of decline
Intervention:
Early stage: gentle strengthening, functional mobility training
Mid stage: equipment prescription (orthotics, shower chairs), carer education, energy conservation, respiratory support
Late stage: positioning, pressure care, palliative goals, assistive tech
Exercise should be submaximal and energy-efficient
Risks/Precautions:
Avoid overfatiguing muscles – risk of denervation injury
Monitor for aspiration (bulbar involvement)
Need frequent reassessment due to rapid progression
May require coordination with palliative care or respiratory teams
Consider the emotional impact on patients and families
PD
Condition Overview (incl. symptoms & prognosis)
Primary Problems
Short-Term Goals
Planned Assessments
Assessment Interpretation
Planned Interventions
Risks and Precautions
A chronic, progressive neurodegenerative disorder caused by loss of dopamine-producing neurons in the substantia nigra.
Main motor features: bradykinesia, rigidity, resting tremor, postural instability.
Non-motor: fatigue, mood disorders, cognitive changes, autonomic dysfunction.
Hoehn & Yahr Scale used to stage severity (1–5).
Tremor-dominant and postural instability-gait disorder (PIGD) subtypes.
Symptoms are typically asymmetrical at onset.
Primary Problems:
Bradykinesia and freezing (especially in gait, turning)
Postural instability → falls risk
Rigidity limiting mobility
Reduced step length and speed
Difficulty with dual-tasking
Non-motor issues: fatigue, depression, cognitive slowing
Short-Term Goals:
Improve safety and fluidity of gait (e.g., reduce freezing)
Enhance balance and reduce falls risk
Improve transfers and ADLs
Maintain cardiovascular fitness and mobility
Improve cueing strategies and motor planning
Assessments:
Hoehn and Yahr Stage (e.g. 2.5 = bilateral involvement + balance impairment) 1= unilateral involvement, 1.5= uni and axial.
2. Bilateral without balance loss. 2.5= mild bilateral with pull test
3. Mild to moderate bilat wiuth postural instability
4- severe disablity, able to walk or stand
Marsden for postural/segemental control
Unified Parkinsons Disease Rating Scale
Assessment Interpretation:
↓ TUG / balance scores = high falls risk
Narrow BOS, reduced step length, festination
Freezing may occur with environmental triggers (doorways, crowds)
Dual-task deficits = difficulty multitasking while walking
Intervention:
Cueing: auditory (metronome, counting), visual (tape on floor), proprioceptive (stepping over obstacle)
Gait training: big steps, rhythmic stepping, focus on arm swing
Balance training: perturbation-based, multidirectional, static/dynamic
Dual-task training: functional mobility with added cognitive tasks
Strength training: focus on trunk extension, hip extension
Exercise programs: LSVT BIG, PD Warrior, boxing, dancing
Functional retraining: turning, sit-to-stand, getting out of bed
Risks/Precautions:
Falls risk: especially during OFF periods or with freezing
Orthostatic hypotension (check BP)
Fatigue, especially with overtraining
Medication timing (ON vs. OFF phases) → plan therapy when ON
Watch for cognitive decline, depression, and low motivation
Complex motor learning may be affected by basal ganglia involvement — repetition and cueing important
