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MS CVA TBI SCI +

Foundations of Disease SCCC PTA program Final

QuestionAnswer
Diabetes Mellitus metabolic syndrome with hyperglycemia and alterations in metabolism of carbs fats and proteins, decondary to absent or reduces production of insulin and or ineffective action of insulin
Type 1 beta cells in islets of langerhans damaged and cannot produce insulin, early onset, patient underweight, lack of effective insulin, ketosis prone, need insulin to live
glucose blood sugar
glycogen stored glucose
glucogenolysis breakdown of glycogen
gluconeogenesis breakdown of fasts and proteins into glucose
lipolysis breakdown of fats
pancreas makes insulin
liver controls glucose levels
insulin hormone produced in pancreas to get glucose from blood stream tot he cell
glucogon gets glucose from cell to bloodstream
three purposes of glucose used as energy stored as glycogen, converted into fatty acids
type 2 cell membrane resistant to glucose leading to hyperglycemia will not progress to ketosis, patient generally overweight, later onset in life
retinopathy eye problems associated withDM
neuropathy nerve damage caused by DM
CVD complication of DM approximately 50%
nephropathy kidney comlications associated with DM, generally kidney failure
Macrovascular disease TIA, Stroke, Angine, Myocardial infarction, cardian failure, PVD
Microvascular Disease diabetic retinopathy, non proliferative, proliferative, macular edema, microalbuminuria, macroalbuminuria, end stasge renal disease, ED, autonomic neuropathy peripheral neuropathyh, osteomyelitis, amputation
risk factors for diabetic ulcers uncontrolable hyperglycemia, durtation of diabetes, PVD, blindness or visual loss, chronic renal disease, older age, peripheral neuropathy, foot deformity, trauma and poorly fitted shoes, callus, Hx of ulcers prolonged elevated pressure, limited jt mob
Gangrene complication of necrosis caused by infection two major types wet and dry and both can lead to an amputation
PT education teach patients to imspect feet and body daily for open wounds that may become infected
symptoms of hyperglycemia excessive thirst polydipsia, urination polyuria, dry skin, hungry polyphagia, blurry vision, drowsy, slow healing wounds, what to do chekc glucose level, call HCP
symptoms of hypoglycemia shaky, increased HR, diaphorisis, dizzy, anxious, hungry, blurry vision, weakness or fatique, headache, irritable, what to do check glucose treat and check again
ketoacidosis is most common in untreated type 1 diabetes mellitus, when the liver breaks down fat proteins in response to a perceived need for respiratory substrate, is a type of metabolic acidosis which is caused by high concentrations of ketone bodies
TBI Truamatic brain injury
brain uses 1/5 of resting cardiac ourput, 1.6 of O2 consumption
Major causes MVA, falls, suicide
direct blow injuries can be closed or open, opne involves penetrating skull,
indirect blow injuries caused by a blow on another part of the body, fall on buttocks or whiplash
types of axonal injuries stretching of axon, twisting of axon, compression of axon, or a reaction of axon to damage
primary damage damage caused by injury nerves and or blood vesels of brain
secodnary damage d death of unaffected cells from bleeing or edema diaschesis
associated trauma to other systems fractures and organ involvment
injury mechanisms compression, hemorhage, hematoma edema: tenion; intracranial pressures: shearing; herniation
concussion transient state of unconcsiousness, associated post traumatic amnesia, closed injury
contusion bleeding and bruising, coup and contrecoup, closed injury
laceration, tearing of tissue, hemorhage and severe edema, open injury
grade 1 concussion mementary confusion, no loss of consciousness, symptoms clear in 15 minutes
grade 2 concussion symptoms last more than 15 minutes
grade 3 concussion you got knocked out, loss of consciousness
subarachnoid hematoma headnache stiff neck, vomitting, photophobia, iritability usually resolves on own
subdural hematoma involves veins, surgical evac required slow healing
epidural involves arteries compression of brain herniation surgical evacuation required
intracerebral hematoma hematoma with in the brain generally in the white mater
impariments of TBI level of consciousness, a and O memory, executive functions
coma state of consciousness no arousal or awareness no sleep wake cycle eyes closedm short duration 3-4 weeks
vegetative state sleep wake sycle returns, vegetative functions retunr may be aroused but unaware, reutnr of brainstem reflexes, grimacing, vocalizations to nociceptive stimulus grasp response, tonic reflexes
persistant vegetative state you are not moving out of this state
minimally responsive signs of awareness are present
glascow coma scale measure state of coma
ranchos los amigos levels of cognitive function progess once out of coma
decerebrate rigidity extenor pattern rigidity
decorticate rigidity flexor pattern rigidity in uppers extensor pattern in lowers
parkinsons disease shaking palsy, caused by low levels of dopamine produced by substantia nigra in the basal ganglia, it is idiopathic no known cause
parkinsons disease insidious progressive and degenerative involving the basal ganglia as a result of the substantia nigra which results in a deficiency of the neurotransmitter dopamine
Who is PD likely to effect 50-60s, men over women, whites over blacks, 1.5 million people in the US, 1/1000 people, lower prevalence in africa and china,
types of PD postencephalic, pseudoparkinsonian symptoms due to tumors, and boxers brain or head truama, cna be drug induced from synthetic heroin, MPTP, antipsychotic meds
etiology of PD free radicals, external or internal toxins, genetic factors, aging process is accelerated
cause of PD loss of 80 percfent of the dopamine producing cells in th esubstantia nigra
neurotransmitter imbalance imbalance of dopamine and acetylcholine when dopamine to low acetylcholine takes over and movements become shaky the dopamine and ach work together to produce smooth movement
early signs of PD difficulty dressing, alterations in handwrtiting, stiffness slowness, eating difficulty, voice changes, facial masking, blaance issues, tremors
parkinson tetrad tremor, rigidity, bradykinesia, postural instability
tremors pill rolling, common first symptom, resting, distal, can be exacerbated
rigidity cog wheel lead pipe flexores over extensors, not position dependent
brady kinesia slowing of voluntary movement, secondary to delayed initiation, delayed stopping, decreased reaction time, decreased speed and amplitude
akinesia freezing
kinesia paradoxia may be frozen but you can initiate movement
poverty of movment no blinking, facial expression or arm swing in gait
postural instability loss of righting, and equilibrium reactions, festinating gait, loss of anticipatory postural reflex, stooping posture
motor planning feedback mode instead of feedforward, requires cuing, and triggers
sensory PD is a motor disorder but patient may experience abnormal sensations paresthesias, akathisia- restless moving
ANS complications of PD B and B, thermoregulation, flushing of skin, sialorhea(drooling) seborhea- flaky skin, orthostatic hypertension
hypomimia facial masking
hypophonia low voice
micrographia small writing
dysarthria slowed slurred speech
dysphagia trouble swallowing
gait characteristics decreased BOS, decreased stride length, decreased velocity, loss of pivoting, loss of armswing, stooped posture, short shuffling steps, festination, retropulsion(body leaning back as walking) anteropulsion(body leaning forward in gait using momentum)
cognitiv eeffects of PD affected usually secondary to drugs with psycosis effect
treatments of PD surgical pharmaceutical rehabilitation
surgical treatment of PD cryotherapy, pallidotomy, thalamotomy, neural tissue transplants, tremor control therapy, neurostimulation
L dopa synthetic dopamine
carbidopa slows breakdown of l dopa
entacapone extends time period of l-dope in brain
drug complications of treating PD dyskinesias, depression anxiety, psychotic episodes, halucination, wearing off phenomenon, on/off phenom window of drug use small.
stroke sudden onset of neurological symptoms resulting from a disturbance of the blood supply to the brain
incidence of stroke 700k ppl/yr, 500k first attacks, 200k recurrent
morbidity/mortality of stroke 1/3 recover 1/3 disable, 1/3 die
modifiable risk factors of stroke HTN, smoking, heart disease, diabetes, TIA, high cholesterol, CAD, sleep apnea, birth control pills
non modifiable of stroke age(over 65), gender moremen then women, women die more, ethnicity 2x in AA, family history, prior stroke
symptoms of stroke sudden numbness or weakenss of face, arm or leg, elspecially on one side of the body. trouble speaking, sudden confusion, sudden trouble seeing, in one or both eyes, trouble walking, dizziness LOB, or coordination sudden sever headache with no known cause
ischemic attack embolus blocks area, leading to no blood in area therefore no O2,
hemorhaggic attack blood vessel bursts, secodnary to HTN pin hole in blood vessel
aneurysm weakeing and ballooning of vessel walls
symptoms of right CVA left hemiplegia left hemianopsia, visual sptial skills, motivation, emotional lability, recognition, attention,
left CVA right hemiplegia, right hemianopsia,working memory ,learned skilled movements, brain stem, understaning speech, talking, verbal memory, long term goals,
muscle tone UMN lesion, hypertonia, spasticity, slow disuse atrophy
apraxia association centers inability to do something on command ideational as well as ideomotor
synergies brunstrom, six stages flexors strongers over extensors, six stages moving to normalcy, 6=normal, 5 isolated movement 4 movment in synergy, 3 full synergy, 2 spasticity, 1 flaccidity
flexion synergy shoulder elevators, elbow flaxors, hip flexors
extension synergy , shoulder adductor, and depressors, pronators, hip adductors, hip internal rotators, knee extensors, plantar flexors
hemianopsia half of the visual field is missing, folows plegia of CVA
pushers syndrome pt pushes to affected side
neglect they dont realize there is a side of involvment
aphasia wernickes brocas global depending upon what portion of brain affected wernickes in males, brocas more comon in females
pharmacological affects ticlid reduces risk, selfotel prevents further cell death, tirilazad protects cell from hemorhage, TPA dissolves the clot
Best PT timing early treatment, active treatmenr orient to involved side, bilateral activities, trunk emphasis, proper positioning
neurofacilitation techniques positioning, successive induciton, irradiation, tone inhibition
souques phenom when arm raised over 90 degrees abd or flex fingers fanout
successive induction antagonist facilitates agonist
raimistes phenom overload a strong muscle to get a weak one to fire
homolateral limb synkinesis flex arms legs flex on same side
tone inhibition reciprocal inervation, icing, tapping virbration of opposite muscle, and positioning
problems with sling limit sensory input, place extremetiy into non functional pattern, impairs body image, impairs arm swing in gait can lead to edema of hand
assistive devices encourages asymetry, decreases wlking speed, increase energy expenditure, inhibits WS and WB to weak side, inhibit normal arm swing, may increase hypertonus
common gait deviations slwoer wlking speed, longer cycle, difficulty in singel limb, short stance phase, fast swing phase on stronger side, associated reactions in weak arm, absent trunk rotation, retraction of weak hip during stance phase recurvatum of weak knee,
more gait devieation circumduction hiphiking, extended knee during swing phase, lack of dorsiflexion, +trendelenburg, no push off on weak side
diaschesis flaccid paralysis in muslce bladder and bowel, loss of sensation, areflexia, loss of perspiration, hypotension, bradycardia
stretch injury hyperflexion in c56, hyperextension at c45
falls severe compression vertebra can shatter, axial loading head c45 feet t10 11 12
complete TSCI total loss of motos and sensory in the lowest sacral segment s2-4
incompplete TSCI sacral sparing, partial preservation or complete preservation of motor and sensory function in lowest sacral segment, anal sensation, sphincter function
brown sequard one side of the SC injured common from stab wounds GSW
central cord central part damaged,
posterior chord sensory involvment
anterior cord motor involvment
cauda equina horses tail involvement compression of cauda equina
UMN lesion PMC to AHC, causing spasticity
LMN lesion flaccid areflexia, @ level of lesion
motor level of injury last nerve root that innervates key muscles at F strength
sensory level of injury last nerve root in which sensation is normal, light touch and pin prick
zone of partial preservation neurological levels below injury that may still exhibit some function
impairments TSCI across all body systems, NM, pulmonary, CV ANS, genitourinary, Musculoskeletal, integumentary
breathing complications phrenic nerve c3-5 primary muscle of inspiration, intercostals, t1-12 inspiration and expiration functions, cervical c2-4 acccessory to resp. abd. t6-t12, forced expiration and cough
pulmonary impairments of SCI no independent respiratory function with lesions above c4, respiratory fatique, sleep apnea with high cervical lesions, difficulty clearing secretions, atelectasis(collapsed lung), bronchial obstruction, pneumonia, pneumothorax
CV impairments SCI bradycardia, hypotension, disruption of sympathetic nervous system decreased BP,
ANS impairments SCI thermoreg, orthostatic hypotension, apnea bradyarrythmia, syndrome, autonomic dysreflexia, neurogenic bladded/bowel, sexual dysfunction
GI impairments SCI paralytic iteus, motility stops, stress ulcers-ans not working
Musculo skeletal SCI osteoporosis, heterotropic ossificans, contractures, paraplegia dystonia, spasticity, pain
integumentary SCI decubiti, complications infection abscess, sepsis, osteomelitis, death
PT goals of SCI treatment maintain and improve function
c3 face and neck motion none to litlediaphram, portable ventilation, totally dependent in self care, sip n puff wc, able to use environmental contorl unit
c4, diaphragm trap, dependent on personal care, independent pressure relief with poer tilt in space wc
c5 delt some biceps low respiratory reserve, light grooming and feeding with hand device,sassistance for bathing dressing and transferes with sleiding board
c6 rotator cuff biceps wrist extensors, may acheis ind in perosnal care, assist in transfers, rolling in bed with side rails, manual propulsion in wc, pressure relief, skin inspection, cough with abdominal pressure
c7-8 triceps, writs flexors, finger flex and extends, upper limb except hand intrinsics, may totally independent in personal care, can roll over, sit up in bed, mover in sitting positioning, transfers with and without sliding board wheelchair smooth surface
t1-5 hand intrinsics, and some intercostals, full inervation of UE at t1, can function independent form WC, lacks trunk, trnasfers between floor and WC
t6-12 intercostals and abd, enhanced respiration, may ambulate with bracing and swing thru
l1-3 hipflexors some quads may ambulate with short leg bracing
l4-s1 hamstrings some ankle and foot, ambulation with minimal aids
CV impairments bradycardia, hypotension, disruption of sympathetic nervous system decreased BP,
ANS impairments thermoreg, orthostatic hypotension, apnea bradyarrythmia, syndrome, autonomic dysreflexia, neurogenic bladded/bowel, sexual dysfunction
GI impairments paralytic iteus, motility stops, stress ulcers-ans not working
Musculo skeletal osteoporosis, heterotropic ossificans, contractures, paraplegia dystonia, spasticity, pain
integumentary decubiti, complications infection abscess, sepsis, osteomelitis, death
PT goals maintain and improve function
c3 face and neck motion none to litlediaphram, portable ventilation, totally dependent in self care, sip n puff wc, able to use environmental contorl unit
c4, diaphragm trap, dependent on personal care, independent pressure relief with poer tilt in space wc
c5 delt some biceps low respiratory reserve, light grooming and feeding with hand device,sassistance for bathing dressing and transferes with sleiding board
c6 rotator cuff biceps wrist extensors, may acheis ind in perosnal care, assist in transfers, rolling in bed with side rails, manual propulsion in wc, pressure relief, skin inspection, cough with abdominal pressure
c7-8 triceps, writs flexors, finger flex and extends, upper limb except hand intrinsics, may totally independent in personal care, can roll over, sit up in bed, mover in sitting positioning, transfers with and without sliding board wheelchair smooth surface
t1-5 hand intrinsics, and some intercostals, full inervation of UE at t1, can function independent form WC, lacks trunk, trnasfers between floor and WC
t6-12 intercostals and abd, enhanced respiration, may ambulate with bracing and swing thru
l1-3 hipflexors some quads may ambulate with short leg bracing
l4-s1 hamstrings some ankle and foot, ambulation with minimal aids
MS chronis progressive demyelinating inflammatory disease involving the CNA
demelinating myelin erodes from the axon decrease NCV and more energy to conduct impulses
etiology MS viral autoimmune or combination, first sixteen years determines risk
autoimmune response system attacks itself
plaques slcerosis and scarring of CNS, around spinal cord
incidence of MS white temperate climate, young adult women folk
diagnosis MS made upon evidence of lesions in CNS demonstrated onCT or MRI, or two seperate attacks lasting at least 24 hrs at least one month apart, and involving 2 areas of CNS, progression of symptoms for at least 6 month
course MS unpredictable exacerbations remissions classical coursed, subclinical, benign, relapsing remitting, secondary crhonic progressive, primary progrressive which has no remissions
common attacks corticospinal tract, optic nerve pathways, brainstem and cerebellar pathways, posterior column tracts
somatosensory impariment 5-70 percent or patients, usually first symptom, one limb, one side, all limbs, parethesias, loss of vibration and proprioception, loss of tactile discrimination, l'hermittes sign
l'hermittes sign neck bends forward electircal shock down back
somato motor first noted in gait, corticospinal tract, fluctuating muscle tone, heaviness of limbs, weakness, spastic paresis, spasms, UMN symptoms, cerebellar symptoms + babinski
Visual early symptom, 8% of patients, optic neruitis, decreased visual acuity, photophobia, nystagmus, ptosis, strabismus, pain, dimmin, oscillopsia
ANS complications neurogenic bladder, detrusor internal sphincter dysynergia, bowl problems, abnormal sweating, intolerance to heat, sexual difficulties
cognitive impairments 50% of patients, more prominnetn as disease progresses, mood swings, euphoria, lability, memory problems, reasoning difficulties,
related difficulties central fatigue, paroxsymal symptoms(sudden outburt of symptoms and sudden remisison)
charcot triad is the combination of nystagmus, intention tremor, and scanning or staccato speech
best prognosis acute before 35, monosymtomatis, sensory over motor, complete remission after first attack
worst prognosis early cerebellar signs, early spasticity or trmor
pharmacy ACTH replacement, steroids, immuno suppressant, antiviral mood elevators, antispasmotics(valium baclophen dantrium)
disease modifiers betaseron interferon avonex, copaxone
other treatments dorsal stimulators, snake venom bee venom
arthritis inflamation of joints cna be reumatoid or osteo
RA systemic disease affecting the synovial sac, invovles joints, organ including heart eyes skin vascular, systemic response, malaise, weakness, fatigue, depression ,exacerbations and remissions
three major courses of RA flareups and remissions, long clinical remissions, progressive unremitting
RA affects all structures of join increaes join pressure and joint effusion
granulation tissue in joint pannus, describes the granulation tissues that is formed with the synovium by proliferating fibroblasts and inflammatory cells
joint bones characterized by pitted carilage and bone
joints affected cervical spine, shoulders, finger (ulnar deviation) knees, ankles, toes,wrist general morning stiffness lasting 1-3 hrs, knockkneed, peripheral involvment progressing proximal
deformities hammertoes rhematoid nodule, ulnar drift, vallets of weakend muscles
swan neck hyperextension of PIP, flexion of DIP RA
bouteniere flexion of PIP, extension of DIP, RA
Ankylosing Spondylitis fusing of vertebrae as well as kyphosis
Osteoarthritis Trophis degeneration not inflmmation
Etiology of OA abnormal physical forces, OBesity, orthpedic problems, trauma,, altered biocheimical processes of cartilage, aging hormones and drugs
SYmptoms of OA pain with exercise, gel phenomenon, osteophyte, hypertrophy of bone, squaring off of bone, enlarged bony jt, crepitus, deformity and loss of ROM ,muslce weakness, and dusue atrophy, aching with cold,
Joints affected, spine, hips, fingers, knees big toes bow legged
bouchards node huge PIP
heberdens node huge DIP
Arthritic Gait pattern slow antalgic, decreased stance, asymmetrical step length, less motion in involved jts, decreased forward and alteral smoothness, + trendellenberg
PT GOals of OA releive paint, analgesis and anti inflammatory, maintain mobility, ROM and exercise, reduce disability, protective splinting adaptice devices, prevent progression with surgery and drugs
pharmacology of Arthritis nsaids corticosteroids, disease modifiers
surgeries for Arthritis synovectomy, tenosynovectomy, tendon surgery, athrodesis, athroplasty the last two are for OA
athrodeissi and atrhoplasty relieve pain provide stability correct or reduce deformity improve function
total hip contraindications hip flex past 90, hip add, and IR
patient education remove things that promote ulnar drift jar opening, stirring spoon, lifitn pots
Glascow COma Scale numbered scale that measures the level of consciousness of a person
exacerbation an increase in symptoms when speaking of MS or RA
remission when a symptom disapears
euphoria an emotional and mental state defined as a sense of great (usually exaggerated) elation and well being
uthoff symptom diplopia or blurred vision in people with MS
dyskinesia decreas of voluntary movement
dysphagie difficulty swallowing
wearing off phenomenon drug wears off
hypokinesia slow movements
hypomimia facial masking
micrographia small handwriting
on/off phenomenon drug on and off
sialhorrhea drooling
seborhea flaky skin
hypophonia weak voice
akinesia no voluntary movements
akathersia reslessness
brsdykinesia extreme slowness
autonomic dysreflexiA HYPERREFLEXIA`
postural hypotension othrostatic hypotension
DVT deep vein thrombosis, clot
heterotropic ossification bone formation within soft tissue
spinal cord dysethesias pain or abnormal sensations
post traumatic seizures seizures after the trauma occurs
multipodus boot boot used for wounds lots of padding
tilt in space wheelchair gives the TBI patient ability to move
status epilepticus refers to a life-threatening condition in which the brain is in a state of persistent seizure
seizure trigger stiumulus that forces a seizure
ansence seizure the person may appear to be staring into space with or without jerking or twitching movements of the eye muscles. These periods last for seconds, or even tens of seconds.
prodromal sign first symptoms
focal seizure seizure occurs in one spot
jacksonian seizure grand mall seizure
aura prodromal sign of seizure episode
anomia trouble recalling words
paraphasia is a notable feature of aphasia in which one loses the ability of speaking correctly, substitutes one word for another, and changes words and sentences in an inappropriate way. The patient's speech is fluent but is error-prone
abulia lack of initiative
disinhibition no inhibitions
emotional labiltiy INABILITY TO CONTROL EMOTION
PERSEVERATION is the uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder
emotional dysregulation syndrome uncontrollable lauching crying, pseudobulbar affect
learned nonuse they dont use affected side
unilateral neglect they negelct a side dont realizxe they even have it
ideomotor apraxia inability to perform a task on command and to imitate gestures even though the person understands the concept of the task
ideoational apraxia an inability to perform a purposeful act automatically or upon command an inability to retain the idea of the task and to formulate the necessary motor pattern
Created by: dels322 on 2009-05-16



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