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Neuro-test 3
Exam 3
| Question | Answer |
|---|---|
| Ischemia | blockage of blood vessels |
| Hemiplegia | paralysis on one side of the body |
| Hemiparesis | partial motor loss on one side of the body (weakness) |
| Transient ischemic attack (TIA) | symptoms are mild or isolated, does not last more than 24 hours,symptoms resolve completely |
| Subluxation | Support! Positioning for proper trunk and scapular alignment |
| Hemorrhagic | rupture of blood vessel |
| What is the relationship between TIA's and CVA's? | 1/3 will have a CVA, 1/3 will have more TIA's, 1/3 will have no further incidence |
| What are a few examples of non-modifiable risk factors associated with CVA's? | gender, race, age, heredity and ethnicity |
| CVA | Sudden loss of blood supply to brain that damages/kills brain cells with resultant neurological deficits |
| There is a Increased risk of Deep vein thrombosis (DVT) associated with CVA victims. What should we do to help? | Prevention! Monitor appearance, temperature of LEs; use of compression devices, elastic stockings (TED hose), mobilize client |
| There is a Increased risk of lung infections associated with CVA victims. What should we do to help? | Monitor! Mobilize client, strengthen inspiratory/expiratory muscles |
| There is a Increased risk of incontinence associated with CVA victims. What should we do? | Toileting program! |
| There is a Increased risk of decubitus ulcers associated with CVA victims. What should we do? | Prevention! Relieve and eliminate pressure points; use of specialized mattresses, cushions. |
| There is a Increased risk of aspiration associated with CVA victims. What should we do? | Prevention and monitoring |
| Asymmetrical Tonic Neck Reflex (ATNR) Stimulus? | Stimulus: head turned to one side with chin over shoulder. |
| Symmetrical Tonic Neck Reflex (STNR)Stimulus | Stimulus: Flexion and extension of neck |
| Asymmetrical Tonic Neck Reflex (ATNR) Response? | Response: Extension of arm and leg on face side; flexion of arm and leg on skull side |
| Symmetrical Tonic Neck Reflex (STNR) Response? | Response: Flexion of arms and extension of legs . Extension of arms and flexion of legs. |
| Tonic Labyrinthine Reflex (TLR) Stimulus? | Supine or prone position |
| Tonic Labyrinthine Reflex (TLR) Response? | Extension of trunk and extremities or increased extensor postural tone. Or Flexion of trunk and extremities or increased flexor postural tone. |
| Positive Supporting Reflex (PSR) Stimulus? | pressure to ball of foot |
| Positive Supporting Reflex (PSR) Response? | Extension in leg stimulated (hip and knee extension with plantar flexion of ankle example : toe pointing downward) |
| Crossed Extension Reflex (CER) Stimulus? | Flexion of one leg |
| Crossed Extension Reflex (CER)Response? | Extension of opposite leg |
| Palmer grasp reflex Stimulus? | pressure in palm of hand |
| Palmer grasp reflex Response? | flexion of digits into palmer grasp |
| Plantar grasp reflex Stimulus? | pressure to ball of foot |
| Plantar grasp reflex Response? | Flexion of toes |
| True or False? Automatic movements are part of normal development but may also been seen following damage to the nervous system. | True |
| Righting Actions? | Automatic Act of realigning the head or trunk to an UPRIGHT position in response to disturbance in balance. |
| Without effective righting actions the client would have difficulty with ______? | moving from one position to another such as going from supine position to sitting |
| Protective Extension Reactions? | Extension of arms, hands or legs in response to loss of balance. Serve to protect head when falling |
| Without the protective extension reactions the client would _______? | fear movement or hesitate to bear wt on affected side during two handed activities |
| Equilibrium Reactions? | Act of maintaining or regaining BALANCE in all activities. Made possible by righting reactions and protective extension |
| Without Equilibrium Reactions the client would have difficulty______? | maintaining and recovering balance in all positions and activities |
| Primitive Reflexes | “largely automatic, somewhat stereotypical, consistent, and predictable motor response to a specific stimulus, usually sensory” |
| Neural circuitry for primitive reflexes is either at the ____ level or the ____ level | Brainstem or spinal |
| Associated Reactions | Involuntary movements that accompany another movement; May be observed in young children, during periods of fatigue or stress, or after neurological insult |
| OT should observe and record what when working with clients who have certain difficulties with postural control? | Alignment of head, neck, trunk, pelvis (centering of body around vertical midline): Postural tone (stability of proximal joints, activation of anti-gravity muscles); Static and dynamic balance (active trunk flexion, extension, lateral flexion, rotation) |
| When a pt has CVA does it affect the same side of body to the hemisphere or the opposite side of the body to the hemisphere? | affects the opposite side of the body to the hemisphere that was injured |
| What is Ischemic stroke caused by? | a thrombus ( stationary blood clot) or embolus (traveling blood clot);more common- 87 % of cases; can affect small or large areas |
| What is hemorrhagic stroke caused by? | rupture of a blood vessel with bleeding into the brain; there is no room for extra blood flow in the brain so that causes pressure; only 10 % of cases |
| What are some risk factors associated with CVA's? | can be modifiable or non-modifiable, high cholesterol, obesity, high B/P, contraception, gender, race, smoking and age |
| What can CVA's affect? | mental function, sensory function, neuromuscular and movement related functions, voice and speech |
| Who was Brunnstrom? | Signe Brunnstrom was a PT from Sweden. She practiced from the WWII era to the 1970's. She died in 1988 |
| What are Limb synergies? | Gross patterns of limb flexion and extension that originate in primitive spinal cord patterns and primitive reflexes |
| What is synergy? | Patterned, recognizable flexion or extension movements of the entire limb, evoked by attempts to move one by sensory stimuli, characteristically seen during the period of recovery (following a CVA) |
| Upper extremity | Flexion synergy is usually stronger |
| Lower extremity | Extension synergy is usually stronger |
| Describe the position of the UE flexion synergy pattern | Scapula-depressed & retracted, shoulder- abducted,internally rotated,elbow-flexed,forearm-pronated,wrist-flexed,ulnar deviated,fingers-flexed. |
| What are some complications of a stroke? | DVT's. increased risk for seizures, subluxation of the glenohumeral joint, lung infections, UTI's, skin breakdown, aspiration |
| What is the role of the OT when working with patient who has had a CVA? | improve motor function, integrate sensory-perceptual and cognitive function, maximize independence, encourage returning to life roles, promote health overall |
| RICE(what does this stand for) | rest, ice, compression, elevation |
| If a client has edema and we are massaging the area, what direction should we be going ? | distal to proximal- direction is key |
| What are some compensatory techniques used when working with client who has had CVA? | hand dominance retraining, teaching one-handed techniques |
| CVA often affects vision, what are some examples? | may affect distance vision, peripheral awareness, or accommodation or may cause diplopia; hemi-inattention is often a problem |
| CVA often affects tactile, what are some examples ? | changes in touch, pain, pressure, temperature, vibration and proprioception |
| What are some examples of spatial relations deficits related to CVA? | may have difficulty with shape recognition, depth perception, figure-ground distinction, and vertical/horizontal discrimination |
| Unilateral neglect | inability to interpret perceptual messages from the hemiplegic side of the body |
| Body Awareness Deficits related to CVA | difficulties with dressing due to not knowing where body parts are |
| agnosia | inability to recognize objects despite intact senses |
| Initiation and motivation deficits related to CVA | difficulty starting and finishing a task; decrease in intrinsic motivation |
| How many stages of motor recovery are there? | 6 |
| Stage 1 | Flaccid-inability to perform any movement in the arm. Hand has no function |
| Stage 2 | Spasticity develops;increased tone;limb synergies are present;facilitate voluntary control of synergies;Gross grasp beginning in hand with minimal finger flexion |
| Stage 3 | Spasticity increasing;facilitates voluntary control of synergies;Gross grasp, hook grasp possible,no release in hand |
| Stage 4 | Spasticity declining;isolated voluntary movements;limited movements;Gross grasp present,lateral prehension developing,small amount of finger extension & some thumb movement. |
| Stage 5 | Voluntary movement combinations;Synergies no longer dominant;Spherical & cylindric grasp & release present in hand. |
| Stage 6 | Final recovery stage;isolated movements performed with relative ease;(never normal)all types of prehension,individual finger motion & full range of voluntary extension possible. |
| What is the goal of Brunnstrom's movement therapy? | To facilitate progress through the recovery stage that occur after the onset of hemiplegia. |
| What two sources do sensory receptors receive information from? | internal body structures and external environment |
| Sensory input received is sent to the brain for __________________________. | interpretation |
| The process is ______________ and _____________ and is not consciously perceived. | quick and smooth |
| What are the five primary somatosensory systems? | tactile, deep pressure, pain, proprioception, and kinesthesia |
| What are the two cortical senses? | two-point discrimination and stereognosis |
| What are the five special sensory system? | vision, hearing, smell, taste, and balance |
| What are the two causes of sensory dysfunction? | Damage to the central CNS and damage to the PNS (or cranial nerves) |
| What are the two different kinds of damage to the CNS? | generalized sensory loss (for example MS) and contralateral sensory loss (for example CVA) |
| In the damage to the PNS, sensory loss is specific to the _______________ nerves. | affected |
| Sensory loss can _________________ function in occupational tasks. | impair |
| What are two roles of the occupational therapist for sensory dysfunction? | teach compensation and facilitate recovery |
| Anesthesia | complete loss of sensation |
| Paresthesia | abnormal sensation |
| Hypoesthesia | decreased sensation |
| Hyperesthesia | increased sensation |
| Analgesia | complete loss of pain sensation |
| Hypoalgesia | diminished pain sensation |
| What are the two treatment guidelines for sensory dysfunction? | remedial and compensatory |
| In remedial treatment, the objective is to _____________ normal sensory function. | restore |
| Remedial treatment is more successful with ______________ conditions. (PNS) | reversible |
| The compensatory treatment use strategies to ______________ to sensory loss. | adapt |
| What are some strategies used in compensatory treatment? | precautions to avoid injury, obtaining information through other senses, and environmental modifications |
| What are some effects of sensory changes in CNS dysfunctions? | diminished function in all areas of occupations and decreased inclination to move |
| What are some points you should make when educating a client with a CNS dysfunction? | Safety (first concern), self monitor and be vigilant about safety, and provide opportunities to practice skills in daily tasks |
| In remedial treatment for CNS dysfunction, the goal is to promote recovery of ________________. | sensation |
| When treating someone with a CNS dysfunction, you must ensure that the sensory input [does/does not] increase spasticity. | does not |
| In the compensatory treatment for someone with a CNS dysfunction, it is important to _____________________ safe performance by adapting to sensory changes. | maximize |
| When treating someone with CNS dysfunction,it is important to __________ to potentially dangerous items. | limit |
| When treating someone with CNS dysfunction, what are some things to be conscious of when using tools? | the force involved, change tools frequently, and rest involved areas |
| When treating someone with CNS dysfunction, test the temperature with the ___________________ area. | uninvolved |
| When treating someone with CNS dysfunction, use vision for _________________ and ___________________. | guidance and safety |
| When treating someone with CNS dysfunction, observe the skin for _________________________. | signs of redness or stress |
| When treating someone with CNS dysfunction, have caregivers check for _________________________. | pressure sores |
| When treating someone with CNS dysfunction, stress the importance of not wearing ________________ clothing or jewelry. | restrictive |
| When treating someone with CNS dysfunction, follow a daily routine of _______________ care. | skin |
| reciprocal innervation | spinal level reflex that inhibits the antagonist when the agonist is contracting |
| cocontraction | simultaneous contraction of agonist and antagonist that provides stability |
| heavy work | fixed distal segment while proximal segment is moving (ex: push-ups, wakeboarding) |
| light work | proximal segment is fixed while distal segment moves (ex: typing, hammering a nail) |
| skill | highest level of control; combines the efforts of mobility and stability |
| rollover | when patient rolls over and arm and leg flex on same side of body; activates the lateral trunk musculature |
| pivot prone | full range of extension of the neck, shoulders, trunk, and LEs |
| quadruped | develops stability of lower trunk and legs; patient initially holds position and gradually shifts weight |
| cervicocaudal | head to tailbone |
| proximodistal | body center to extremeties |
| agonist | muscle that contracts to create movement at a joint |
| antagonist | muscle that relaxes, or elongates, to allow movement at a joint |
| motor learning | acquisition of a new skill |
| verbal commands, visual stimuli, tactile input | 3 techniques the OTA should use to facilitate motor learning |
| diagonal patterns | mass movement patterns observed in most functional activities |
| symmetrical patterns | paired extremeties perform like movements at the same time |
| asymmetrical patterns | paired extremeties perform movements toward one side of the body at the same times |
| reciprocal patterns | paired extremeties perform movements in opposite directions at the same time |
| total patterns | developmental postures that require interaction between proximal( head, neck, and trunk) and distal(extremity)components |
| manual contact | refers to the placement of the clinician's hands on the patient |
| stretch | used to initiate voluntary movement and enhance speed of response and strength in weak muscles |
| traction | separation of joint surfaces |
| approximation | creating a compression of joint surfaces |
| repeated contraction | technique based on the assumption that repetition of an activity is necessary for motor learning and helps develop strength, ROM, and endurance |
| rhythmic initiation | used to improve the ability to initiate movement |
| relaxation techniques | an effective means of increasing ROM, particularly when pain or spasticity increases with passive stretch |
| What are some memory deficits R/T CVA? | affects reception, integration, and retrieval of information |
| What are the sequencing and organization deficits R/T CVA? | affects temporal concepts and spatial ordering |
| True or False. Those with CVA usually have rigid thinking patterns? | True, inability to see others perspectives |
| When working with a client that has experienced CVA what should OT teach about safety? | always teach them consequences; may be resistive to feedback |
| problems associated with brainstem stroke? | controls breathing, heart rate, B/P and arousal (basic life functions). Causing dizziness, swallowing difficulties, paralysis, cranial nerve deficits, |
| After a CVA resulting in hemiplegia recovery follows a process usually __________ to __________. | Proximal to distal; shoulder movement can be expected before hand movement. |
| The goal of Brunnstrom's movement therapy is? | To facilitate progress through the recovery stages that occur after the onset of hemiplegia |
| What are associated reactions? | Movements seen on the hemiplegic side in response to forceful movements on the normal side, can be used to initiate or elicit synergies by giving resistance to the contralateral (opposite side)muscle group on the unaffected side. |
| Asymmetrical tonic neck reflex (ATNR) | Head rotation to the left causes extension of the left arm and leg and flexion of right arm and leg. |
| Symmetrical tonic neck reflex (STNR) | Flexion of the neck results in extension of the arm and flexion of the legs. |
| Brunnstrom approach encourages facilitation of __________,as part of recovery. | Synergies |
| Current clinical considerations are only relevant for. | CVA |
| Most therapists do not use the Brunnstrom approach as an intervention strategy; it is used to classify and describe stages of _______ _________. | Motor recovery |
| _________ can be used to facilitate or initiate movement. | Reflexes |
| What stimuli can be used to facilitate movement or tonal change? Ex. Brisk rubbing of skin over muscle belly. | Proprioceptive |
| Synergies are reinforced by the patients voluntary efforts through _________feedback or __________stimuli. | Visual;Auditory |
| problems associated with cerebellum stroke? | abnormal reflexes of head and torso, coordination and balance problems, dizziness, problems with swallowing and cranial nerve deficits |
| Brunnstrom's approach evaluates ____________,________,_________,and___________ functions. | Motor; sensory; perceptual; and cognitive |
| T/F Brunnstroms OT therapy application involves the affected limbs in ADL's? | True |
| Brunstrom’s focus – _________ patterns & stages of ________ recovery | synergy, motor |
| NDT main focuses are | FUNCTION & HANDLING |
| T or F: NDT does not want you to use any reflexive movement patterns. | True |
| NDT is all about ___________ tone so you can have normal movement patterns. | normalizing |
| T or F: Patients with CVA will typically have clonus and rigidity. | False: Patients with a CVA can have flaccidity, hypotonicity, normal tone, or hypertonicity including spasticity. |
| NDT recognizes that spasticity produces ___________ sensory feedback and may lead to formation of contractures. | abnormal |
| NDT - What 4 things can affect spasticity? | Emotional Stress, Physical Effort, Temperature, & Rate of Activity |
| What does NDT say can help with emotional stress? | NDT believes helping someone to relax can help with emotional stress, which can decrease spasticity. |
| NDT believes increasing physical effort can _____________ tone. | increase |
| We want the patient to be ____________ with the temperature to help decrease spasticity. | comfortable |
| NDT focuses on normal ________ & normal ______________. | tone, movement |
| T or F: Reduction in spasticity can reduce pain & fear. | True |
| NDT believes factors that contribute to abnormal movement are | Diminished weight bearing, neglect, sensory loss, fear, aphasia, apraxia, cognitive deficits, poor balance, lack of protective extension |
| NDT is a __________________ approach. | remedial |
| T or F: NDT works on fine motor first. | False: NDT focuses on alignment of trunk, pelvis, weight baring symmetry, proximal stability, and then fine motor. Everything else has to be right first. |
| Normal movement( is or is not) possible with abnormal tone. | is not |
| NDT is a _____________ solving approach. | problem (Ndt analyses to find out where the problem is) |
| NDT assessment is top down or bottom up approach? | Top down – know the person to know the needs |
| NDT wants to __________use of compensatory techniques. | Minimize use of compensatory techniques because it can lead to underuse of involved side or overuse of uninvolved side. |
| NDT emphases (quality or quantity) of movement and motor control? | Quality |
| 24 hour management is used by which treatment type? | NDT |
| Where does CIMT originate? | University of Alabama |
| What is the phenomenon whereby individual does not attempt to use affected extremity because of difficulty or effort involved? | Learned nonuse |
| What are some examples of motor control? | catching balance after tripping, head righting response, trunk control |
| What are some examples of motor learning? | Learning a new language, learning to kayak, learning to play a musical instrument |
| What is the acquisition and modification of learned movement patterns? | motor learning |
| What is the ability to produce purposeful movement of the extremeties and postural adjustment in response to activity demands of environment? | motor control |
| What are the features of CIMT? | Task oriented, evidence based, designed to overcome learned nonuse, immobilization of UNAFFECTED side, utilizes shaping techniques, and massed practice |
| Which version of CIMT is 6-8 hours a day, 5 days a week, for 2-3 weeks? | Unmodified |
| What version of CIMT is 3 hours a day, 5 days a week for 4 weeks? | Modified |
| Who developed CIMT? | Dr. Taub |
| What is the inclusion criteria for participating in CIMT? | First CVA, onset of CVA within 1 year, Score of 44 or higher on Berg's Balance, 45 degree shoulder flexion/abduction, 90 degree elbow flexion, 20 degree wrist extension, and 10 degree MP flexion |
| more inclusion criteria | no significant cognitive deficits, lack of co-morbities that would interfere with mobility or function, minimal spasticity, availablilty of individual to assist with home program |
| What is different about CIMT than the other sensorimotor approaches? | It is a modern approach. |
| What Brunnstrom level of recovery would an individual need to display to be eligible for an Unmodified CIMT protocol? | Stage 5 or really motivated Stage 4 |
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kcjesusaves
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