Rehab Exam 2 Review Flashcards
(61 cards)
1
Q
Types of stroke
A
- Ischemic: Clot blocks blood flow, most common type (80% of strokes)
- Hemorrhagic: Blood vessel rupture
- Brain attack
2
Q
Stroke (modifiable risk factors)
A
- Hypertension
- Heart Disease
- Diabetes
- Diet
- Obesity
- Stress
- Smoking
3
Q
Stroke (non-modifiable risk factors)
A
- Age ( > 55 yo)
- Gender (females b/c they live longer)
- Family History
4
Q
Transient Ischemic Attack (TIA)
A
- Temporary interruption of blood flow
- No residual brain damage/deficits
- “TIA only lasts a day” - sx lasts few minutes or hours, but no more than 24 hours
5
Q
Stroke (CVA)
A
- 4th leading cause of death in US
- Deficits last longer than 24 hours
- Permanent changes
6
Q
T-PA
A
- Clot-buster for ischemic, not hemorrhagic CVA
- Given within 3 hours
7
Q
L sided CVA (R sided deficits)
A
- Difficulties with communication, processing info in sequence and linear
- Behaviors: Cautious, anxious, disorganized, more hesitant
8
Q
R sided CVA (L sided deficits)
A
- Difficulties with spatial-perceptual tasks, understanding the whole idea of a task or activity
- Behaviors: Over-estimate abilities, unaware of deficits, impaired safety insight (affects motivation), impulsive
9
Q
CVA positioning (Bed Supine)
A
- Affected shoulder-supported (pillow)
- Affected knee supported (bolster/pillow)
10
Q
CVA positioning (Bed Sitting)
A
- Affected knee supported (bolster/pillow)
11
Q
CVA positioning (Lying on unaffected side)
A
- 1/4 turn back from complete sidelying
- Affected shoulder forward, support on pillow
- Affected side supported on pillow
12
Q
CVA positioning (Lying on affected side)
A
- Sidelying
- Affected shoulder forward, no support
- Affected knee slightly bent, no support
- Unaffected hip/knee @ 90˚, pillow support
- Affected side of body, pillow support
13
Q
CVA positioning (Sitting in chair)
A
- Affected shoulder forward, supported on pillow, arm trough
- Feet flat on ground
14
Q
Pusher Syndrome
A
- Ipsilateral pushing (contraversive pushing)
- Active pushing with stronger extremities toward weak side –> fall toward hemi side (high-fall risk)
- Caused by deficit in processing somesthetic info - no sense of pushing, fear in pt; instability, asymmetry, deficits in transfers, standing
15
Q
Pusher Treatment (Interventions)
A
- Vertical positioning (postural orientation)
- Active movements and WS toward stronger side
- Visual cues (mirror, lines, environmental prompts - walk around table, push onto wall)
- Ball
- Cross weaker LE over stronger/pusher LE
- Air splints: promote weaker LE extension
- Tapping: promote muscular activation
- If use cane, shorten it to facilitate WS to stronger side
- Doorway or corner to facilitate symmetry
- Block stronger extremities from moving onto postures that will result in pushing
- Engage pt in problem solving
16
Q
How to work with patient that exhibits left-sided neglect
A
- Active visual tracking/scanning with head and trunk rotation to left side (involved side); red line on floor or mirror to separate sides
- Imagery
- Direct pt attention to neglected/hemi side
- Cover good eye; force to see with left side
17
Q
Thalamic Pain
A
- Central Post-Stroke Pain (CPSP)
- Constant burning pain
- Intermittent sharp pains
- Exaggerated pain response to stimuli
- Intolerable
- Delayed onset (weeks to months)
- Spontaneous recovery is rare
- “Shoulder Syndrome”: RSD (Reflex Sympathetic Dystrophy) or Shoulder-Hand Syndrome - Arm is on fire (4 stages - first two stages are reversible, last two stages are not)
- Treat RSD with scapular mobility, RSD
18
Q
Diplopia
A
- Double vision
- Both eyes work, but not together
- Treat by covering one eye with patch to see world how it should be
- Switch periodically - refer to OT to see how often to change eyes
19
Q
Homonymous Hemianopsia
A
- Loss of vision in the contralateral half of visual field (nasal of one eye and lateral field of other eye)
- R sided damage results in L-sided deficit
- Incorporate mirror, PNF to cross midline
20
Q
Ataxia
A
- Uncoordinated movement appears when voluntary movement attempted (Ex: trying to walk on floor, lack of proprioception)
21
Q
Apraxia
A
- Impaired voluntary learned movement characterized by inability to perform purposeful movements
- Motor Praxis: Ability to plan and execute coordinated movement
- Types of apraxia: Ideational (cannot produce movements either on command or automatically); Ideomotor (cannot produce movements on command, but able to carry out habitual tasks automatically)
22
Q
Agnosia
A
- Inability to recognize familiar objects
- Object (visual), Auditory (nonspeech sounds), Tactile (by touch), Finger (cannot recognize fingers)
23
Q
Anosognosia
A
- Lack of awareness and insight
- Perceptual impairment (includes denial, neglect, lack of awareness of the presence or severity of one’s paralysis)
- You can teach them, but they still don’t think they need treatment
24
Q
Affect
A
- Emotion or outcome of emotion
25
Brain injury
- CHI: Closed head injury
| - Open HI: Open head injury
26
Focal Injury (TBI)
- Injury localized to site of impact on skull
| - May cause hematoma, edema, contusion, laceration, or combination
27
Coup-countercoup injury (Focal)
- Blow --> injury under site of impact --> bouncing of brain off opposite side of skull
- Two areas of impact directly oppsote each other
- Sports injury/MVA
28
Diffuse Axonal Injury (TBI)
- Widespread shearing of axons
- Caused by acceleration, deceleration, rotational forces
- Axons shear, retract and separate from neuron cell body
- Severe MVA - multiple forces acting on brain
29
Hypoxic-Ischemic Injury (TBI)
- Lack of oxygenated blood flow to brain
- Causes: Systemic hypotension (LBP due to arteriosclerosis); Anoxia (Lack of oxygen due to drowning, suffocation, asthma); Vascular damage to brain
- Global brain damage: Poor cognitive function, outcome expectations lower
30
Increased Intracranial Pressure (TBI)
- Causes: Brain edema (swells); Abnormal CSF Fluid Dynamics; Hematomas (Epidural, Subdural, Intracerebral)
- Normal pressure is 4-15 mmHg
- Greater pressure causes damage
31
Blast-related head injuries (TBI)
- Mild: LOC = less than 1 hr; PTA = less than 24 hrs
- Moderate: LOC = 1 hr up to 24 hrs; PTA = 24 hrs to 7 days
- Severe: LOC = greater than 24 hrs; PTA = greater than 7 days
- Injuries: Primary (changes in atmospheric pressure); Secondary (Flying debris to head; Tertiary (Head hits solid object)
32
Blast-related head injuries (Symptoms)
- Severe headaches
- Decreased sleeping ability
- Mood swings
- Balance problems
- Memory/concentration issues
- Ringing in the ears
- Nausea
- Vomiting
- Sensitivity to noise and light (most common to mTBI)
33
Levels of consciousness
- Coma
- Stupor
- Obtunded
- Delirium
- Clouding of consciousness
- Consciousness
34
Coma
- Minimally conscious: Severly altered consciousness; Minimal, but definite, awareness of self or environment; reproducible cog-mediated behavior; sustained behavior; orient to noxious stimulus and reach for objects
- Vegetative: Decreased level of awareness; Intact eye opening; Intact sleep-wake cycles; Unable to follow commands; Unable to speak
- Persistent Vegetative: No meaningful motor function; No meaningful cognitive function (reflex withdrawal from noxious stimuli); Absence of awareness of self and environment
35
Stupor
- Unresponsive state
| - Pt can be aroused briefly with vigorous, repeated sensory stimulation
36
Obtunded
- Sleeps often
- Decreased alertness, interest in environment when aroused
- Delayed reactions
37
Delirium
- Characterized by disorientation, confusion, agitation, loudness
38
Clouding of consciousness
- Characterized by quiet behavior, confusion, poor attention, delayed processing
- Does not interact a lot; not sure what's going on or where they are
39
Consciousness
- Alert and aware; oriented; memory intact
40
Rancho Los Amigos - Level of Cognitive Functioning I, II, III
- Decreased of Low-Level Response
- Low level pt (coma)
- Treat with ROM, positioning interventions, early transition to sitting posture, stretching, serial casting
- Promote movement/learning by guiding pt's body; provide tactile, proprioceptive, kinesthetic stimulation
- Educate pt family on behavior issues, memory recall, that it's part of the injury(important part of POC)
- Co-treatments (ex: work with OT)
- Guided techniques for ADL: sitting, grooming
41
Rancho Los Amigos - Level of Cognitive Functioning IV
- Confused-Agitated Response
- Most challenging stage
- Post-traumatic agitation, confusion, amnesia, disorientation, aggression, non-compliance, combative
- Interventions are creative/flexible
- Work near pt level of function and attempt to improve endurance rather than progressing
- Will not carryover new learning - pt lacks short and long term recall
- Requires positive reinforcement
- Plan what to work on before you enter room
- Consistency, model calm behavior, expect egocentricity; pt has limited attention span; if can't redirect, change task; treat age appropriate; give control between two options
- Safety: Pt unaware of limitatons, impulsive and unsafe
- Pt/family education
42
Rancho Los Amigos - Level of Cognitive Functioning V, VI
- Confused-Inappropriate and Confused- Appropriate
- Pt confused, but with structure; can follow simple commands
- Goals: Functional task; meaningful task; shape task to pt ability; optimize succes; increase complexity and task demand progressively
- Can handle simple tasks and commands; can break down complex tasks into sections
- BWSTT, CIMT
- Developmental sequence, facilitation techniques
- Pt education: pt may improve mobility skills but lack insight into safety awareness (educate on safety)
43
Rancho Los Amigos - Level of Cognitive Functioning VII, VIII
- Late confused-appropriate (Early stage - Automatic-appropriate)
- Goal: Can function/perform tasks into community environment
- D/C from inpatient rehab (wean from external structure of rehab hospital)
- Day treatment program: Interdisciplinary (PT, OT, ST); Recreational therapist (community activities); Community re-entry; Return to work/school; Address behavioral issues
- Integrate into community: cog, physical, emotionally; treatment simulates or integrates "real world" - community skills, social skills, daily living skills
- Pt included in decision making
- Pt/family education: How to cope with residual deficits
44
Treating ROM/Contractures in BI
- Guided --> Assist --> Active --> Resist --> Independent
45
Glasglow Coma Scale
- Measures level of consciousness: Scene of accident --> ER --> During early recovery
- Three areas: Eye-opening; Motor response; Verbal response
- Scores = 3-15
- Coma = equal to or less than 8 (severe TBI)
- Mod TBI = 9-12
- mTBI = 13-15
46
Autonomic dysreflexia
- Pathological autonomic reflex that can be life threatening (Call 911 immediately)
- Occurs in SCI T6 and above - autonomic nervous system - with complete and incomplete lesions
- Noxious stimulus below level of lesion (urinary retention, catheter kink, tight clothing)
47
Autonomic dysreflexia (symptoms)
- Sudden onset
- Pounding, excrutiating headache
- Hypertension
- Bradycardia
- Profuse sweating
- Increased spasticity
- Restless
- Vasodilation (flushing) above level of lesion
- Vasoconstriction below level of lesio
- Constricted pupils
- Nasal congestion
- Goose bumps
- Blurred vision
48
Autonomic dysreflexia (treatment)
- Some facilities: activate code
- If pt is flat, bring him to sitting (to lower BP)
- Identify stimulus and relieve it (usually bladder)
- If do not immediately find stimulus, drain bladder - when was last time voided bladder, check clothing, catheter
49
Brown-Sequard Syndrome
- Hemisection of SC (usually by stabbing)
- Ipsilateral loss: proprioception, vibration (paralysis, sensory loss)
- Contralateral loss: pain, temperature
- Contralateral loss is several dermatome levels below lesion level (b/c spinalthalamic tract ascends 2-4 segment in same side prior to crossing)
50
Central Cord Syndrome
- UE involvement > LE involvement
- Can walk, but not use arms
- Caused by cervical hyperextension injury
- Compressive forces --> hemorrhage and edema in central SC
51
Posterior Cord Syndrome
- Rare condition
- Loss of proprioception, epicritic sensation (wide base steppage)
- Intact pain, light touch
- Intact motor
52
Anterior Cord Syndrome
- Loss of pain and temperature (spinothalamic tract damaged)
- Loss of motor (corticospinal tract damaged)
- Cause: Cervical flexion injury --> damage to anterior SC
53
Sacral Sparring
- Incomplete lesion
- Sacral tracts spared from injury (most central of sacral tracts preserved)
- Intact perianal sensation
- External sphincter muscle contract
- Often first sign of incomplete cervical SCI
54
Cauda Equina Injuries
- Usually incomplete (large number of nerve roots and large surface area
- Peripheral injury (not central), LMN
- Potential to regenerate like, because it's peripheral nerve
- Full neurological recovery is uncommon
- Long axons make location of injury far from site of innervation
- Scarring on axon may block regeneration
- Muscle may not be functional once regeneration occurs
- Regeneration slow (1mm/day)
55
Compensation vs Recovery
- Consider:
- Severity of sensorimotor deficits
- Severity of secondary complications/co-morbidities
- Is motor recovery feasible?
- Chronic versus acute (Recovery more likely to occur in acute)
- Strength/weakness of pt - Ability to learn harder tasks
- Severity of cognitive, behavorial, medical barriers
- Funding
- Discharge destination
56
Dual-Task Intervention
- Performing physical task (walking) simultaneously with a cognitive task (talking)
- Should match goals the patient must achieve
57
Conflabulation
- Pt fills in missing info with stories
- Info missing b/c lack of memory/lack of knowledge
- Not attempt to be deceptive; pt truly believes what they're saying
- Lesion in prefrontal cortex
58
Persveration
- Pt "gets stuck" with continued repetition of words, thoughts, actions
- Unrealted to current context
59
Apathy
- Dulled/blunted response
- Can be misinterpreted as depression or lack of motivation
- Not under volitional control of pt
60
Labile
- Uncontrolled or exaggerated emotion
- Emotion inconsistent with mood or circumstance; quick change
- Pt unable to control emotional fluctuations
61
Executive Function
- Complex, inter-related processing to produce action
| - Volition, planning, purposeful reaction, effective perfanceds
