WEEK 5 - PHYSIOTHERAPY MANAGEMENT OF NEUROLOGICAL CONDITIONS IN REHAB SETTINGS

Question 1

demonstrate understanding of the similarities and differences in the course, recovery & movement impairments after ABI (stroke and TBI); GBS and FND: PHASES OF RECOVERY

Answer 1

Stroke (ABI)
- acute (0-7 days),
- subacute (7 days - 6 months)
- chronic (>6 months)

TBI (moderate to severe)
- acute - variable, period until medically stable
- rehab phase - can last >1yr in catastrophic injury
- chronic - no standard definition

GBS
- progressive phase (days to weeks deterioration)
- plateau phase (days to weeks)
- recovery phase (weeks to months)

FND
- diagnosis (may take time)
- Rehab

Question 2

demonstrate understanding of the similarities and differences in the course, recovery & movement impairments after ABI (stroke and TBI); GBS and FND - PATHOLOGY

Answer 2

Stroke
- infarct or haemorrhage (intracerebral haemorrhage and SAH from aneurysm or AVM)

TBI
- diffuse +/- focal subtypes (e.g DAI; subdural, epidural, intraventricular haematomas)

GBS
- autoimmune disorder - demyelination of peripheral nerves (+/- axonal involvement in severe cases)

FND
- neurological symptoms not explained by neuropathology

Question 3

demonstrate understanding of the similarities and differences in the course, recovery & movement impairments after ABI (stroke and TBI); GBS and FND - IMPAIRMENTS

Answer 3

Stroke
- different impairments depending on site of stroke

TBI
- different impairments depending on lesion/s sites

GBS
- muscle weakness
- sensory symptoms
- possible cranial nerve involvement ; ANS involvement

Question 4

demonstrate understanding of the similarities and differences in the course, recovery & movement impairments after ABI (stroke and TBI); GBS and FND - MOVEMENT IMPAIRMENTS

Answer 4

Stroke
- depends on site of lesion e.g decreased fractionation (MCA/ACA)
- decreased coordination (cerebellar stroke)

TBI
- depends on site of lesion and patient may have mixed movement presentation (UMN signs on side, ataxia on other)

GBS
- muscle weakness (no problem with fractionation)

FND
- Variable motor presentation - frequently weakness with inconsistencies on assessment (e.g Hoovers sign)

Question 5

demonstrate understanding of the similarities and differences in the course, recovery & movement impairments after ABI (stroke and TBI); GBS and FND - ASSESSMENT OF MOVEMENT CONTROL

Answer 5

Stroke
- ROM, m length, tone
- voluntary mvt control: fractionation (MCA), cerebellar tests (cerebellar stroke)
- Strength testing as appropriate

TBI
- ROM, m length, tone
- voluntary mvt control: fractionation (MCA), cerebellar tests (cerebellar stroke)
- Strength testing as appropriate

GBS
- ROM, m length, strength testing

FND
- functional strength assessment usually most appropriate