Quiz 2 revision Flashcards
(46 cards)
other influences on recovery
Age • Pre-morbid function • Co-morbidities • Isolated or difficult social situation • Patient motivation and attitude
principle 1 of neuroplasticity
Body parts can compete for representation in the brain and
use of body part can enhance its representation
• Representation areas increase or decrease depending
on use
• E.g. the cortical representation of the reading finger in
proficient Braille readers is enlarged at the expense of
the representation of other fingers
• E.g. the representation of tibialis anterior is smaller
after the ankle is immobilised in a cast
In the case of a stroke that damages a body part’s
representation in the primary motor cortex, plasticity
permits some reorganisation that will restore a
representation
• The process must be competitive with all other body parts
principle 2 of neuroplasticity
The premotor cortex can substitute for the motor cortex to
control movement
• While the primary motor cortex has the largest and most
powerful contribution to the function of the corticospinal
tract, the premotor cortex also contributes
principle 3 of neuroplasticity
The intact hemisphere can take over some motor control
• There are ipsilateral corticospinal neural pathways (weak
in humans)
• These pathways innervate many more proximal than
distal muscles
• The transcollosal connections provide another possible
role of the intact hemisphere
• fMRI studies demonstrate that the damaged hemisphere
has increased blood flow when bilateral movements are made
principle 4 of neuroplasticity
Neuroplastic mechanisms can be facilitated
• Physiotherapists can influence cortical reorganisation
after stroke with:
• Rehabilitative techniques
• Sensory stimulation
• Environmental enrichment
MOI for TBI - direct
direct blow to the head
MOI for TBI - indirect
impact from other part of the body
MOI for TBI - blunt
acceleration-deceleration injury commonly resulting in multiple body injuries and widespread brain damage; may causes scalp injuries, skull deformation +/- fractures or depressed fractures +/- perforated dura mater and brain
MOI for TBI - penetrating
open head injury in which the dura mater is breach ed; may be caused by external objects or bone fragments from a skull fracture
Primary brain damage +neuropathic processes
Occurs at the time of injury
• Effects are largely immediate
Neuropathic Processes • Hypoxia • Hypotension • Cerebral metabolic-flow uncoupling • Impairment of cardiovascular autoregulation
secondary brain damage -+ neuropathic processes
Primary injury initiates a cascade of neuropathological processes resulting in more severe and widespread brain damage Neuropathic Processes • Excitotoxicity • Impaired calcium homeostasis • Oxygen free radicals • Inflammatory processes
Intracranial mechanisms for primary brain damage
diffuse
- diffuse axonal injury
focal
- laceration
- contusion
- haemorrhage (subdural, epidural, subarachnoid, intraventricular
intracranial mechanisms for secondary brain damage
-Brain swelling (vasogenic oedema,
cytotoxic oedema)
- Cerebral blood vessel constriction
extracranial mechanisms
hypoxia
hypotension
predictors of outcome following TBI
TBI usually results in immediate loss or impairment of
consciousness
-> period of confusion (PTA)
• Indices of severity of predictors of outcome:
• Depth of coma
• Duration of coma
• Length of post-traumatic amnesia (PTA)
• Depth of coma provides the best clinical picture of a
patient’s current neurological status
• Duration of coma and length of PTA appear to be better
predictors of functional outcome
depth of coma for TBI
The Glascow Coma Scale (GCS) defines the severity of
a TBI within 48 hours of injury
• Most widely used measure of the severity of coma
• Severe = GCS ≤ 8
• moderate = GCS 9-12
• mild = GCS 13-15
Aims of acute neurological physiotherapy management
Provide respiratory care
• Improve respiratory function
• Prevent/ manage respiratory complications
• Optimise musculoskeletal integrity
• Prevent/ minimise/ manage secondary adaptive
changes in soft tissue
• Promote the restoration of motor function
• Discharge planning
Prioritsing physiotherapy assessment 1 and 2
- Cardiorespiratory Assessment
• Life threatening complications must be managed first - Functional Assessment
• Early mobilisation maximises rehabilitation potential
and minimises risk of many complications
• Utilise skills that are unique to physiotherapists
• Recommendations underpin manual handling utilised
by multidisciplinary team
• Patient centred
• Goal directed
• Functional/ task-specific
prioritising physiotherapy assessment #3
assessment of impairments determination of diagnosis determination of prognosis guides physio mgmt D/C planning
minimum requirements of patient to attempt standing
Medically stable/ medical clearance for mobility
• BP, Hb, INR, WB status, ICP, seizures, increasing
neurological deficit
• Cooperative with some level of comprehension
• Pain managed
• DVT screen NAD
• Minimum strength of grade 3 or able to move against
gravity throughout full ROM for hip F/E, knee E, ankle
PF/DF in at least one upper and lower limb
• Attachments managed
• Clinical protocols adhered to
rehab strategies for wernicke’s dysphasia
Picture cards One stage commands Break down questions into key words Use demonstration Use gestures and facial expression Short and simple questions
rehabilitation of broca’s dysphasia
Ask yes/no questions Use visuals scales eg. VAS Give patient time to get words out Use probing questions, e.g. What is it used for? What does it start with?
autonomic dysreflexia
Lesions at or above T6 • Causes an imbalanced reflex sympathetic discharge, leading to potentially dangerous hypertension • Life threatening condition • Medical emergency • Can cause seizures, retinal hemorrhage, pulmonary oedema, renal insufficiency, myocardial infarction, cerebral hemorrhage, and death
Autonomic dysreflexia
Signs – Increased blood pressure – Redness in the face – Severe headache – Heavy sweating • Common causes – Blocked urine catheter – Fracture – Burn injury – Hangnail • Symptoms resolve when cause is removed
