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N Exam 2
CVA, TBI, balance, perception
| Term | Definition |
|---|---|
| when do you use a RIP pattern? | when pt has spasticity or rigidity- use to break up tone |
| most common orthodic for people with stroke | AFO |
| when shd is subluxed... | make sure shd is supported- wt bearing or open chain w/arm supported |
| if you do parts to whole... | put it all together at end |
| different types of CVA | ischemic, hemorrhagic, TIA |
| ischemic CVA | thrombus, embolus |
| thrombus:atherosclerosis | decrease artery size (slowly gets smaller) |
| embolus:cardiac | event or disease, blood clot to brain, quick onset |
| hemorrhagic CVA | AVM, HTN, aneurysm (SAH), ICH |
| AVM | you're born with this, abnormality that affects circulation in brain arterial venous |
| HTN | hypertension, causes decrease in integrity of vessels in brain |
| aneurysm | SAH- subarachnoid space |
| ICH | intracerebral hemorrage |
| TIA CVA | transient ischemic attack, mild stroke, mini stroke, temporary |
| ischemia leads to | necrosis-ischemic penumbra:surrounding area @ risk |
| edema leads to | increased intercranial pressure |
| decreased blood flow | toxic to neural tissue, increased intercranial pressure |
| stroke extension | stroke is in one area- but there will be results in other areas due to damage to cells that control calcium & glutomate & their levels will increase |
| modifiable risk factors | HTN, heart dx, hyperlipidemia, cigarette smoking, ETOH, sedentary, obesity, oral contraceptive |
| non modifiable risk factors | prior TIA, CVA- gender, more likely for males- race, African Americans- Family hx- age |
| prevention | identify high risk groups-lifestyle modification-regular screenings |
| medical dx | hx & PE, dx tests- CT, MRI |
| using CT for stroke (computed tomography) | cheaper & easier, won't show up if too early, small or embolitic, can ID hemorrhagic, you can r/o tumor and it's more common |
| using MRI for stroke | better in acute, costs more |
| immediate medical rx | monitor & regulate- cardiopulmonary function, BP, ICP, blood glucose, kidney. prevent secondary complications- sz, infection. dissolve clot-heparin, tPA (tissue plasminogen activator). Sx- to remove hematoma or fix vessel |
| CVA rehab | av. hospital stay 5-6 days, team approach, most effective 1st 6-18 months, in about any setting, assessed with FIM score & Fugl-Meyer |
| stroke syndromes | ACA, MCA, vertebrobasilar artery, PCA, lacunar infarct |
| ACA- anterior cerebral artery | more effect in LE, pt typically incontinent, aphasia, some memory & behavior deficits |
| MCA- middle cerebral artery | UE & face, aphasia, homonymous hemianopia- most common |
| vertebrobasilar artery | often fatal-ataxia, effects cranial nerve & cerebellum- feel trapped in body, can't communicate |
| PCA-post cerebral artery | sensory loss & vision |
| lacunar infarct | deep in brain, usually result from DM & HTN |
| L CVA/ R hemi | aphasia, alexia, agraphia, apraxia, negative, anxious, realistic about situation |
| R CVA/ L hemi | perceptual deficits, neglect, Pusher syndrome, dysarthria, dysphagia, impulsive, indifferent, overestimates ability |
| cognitive problems | memory, confabulation, impaired judgment, poor insight, won't get humor, confused, impaired orientatino, decreased attention & arousal |
| behavior problems | lability, flat effect (no emotion), decreased motivation, irritable |
| visual problems | homonymous hemianopsia |
| sensory problems | thalamic pn- pn perseveration- even tho stimulus is removed |
| perceptual problems | unilateral neglect, pusher syndrome, apraxia |
| communication problems | aphasia-expressive (from motor broca, can't say what they mean), receptive (from wernike, when you speak they don't understand), global. dysarthria |
| oralfacial problems | unilateral facial weakness-one side drooping, probs eating/drinking. w/dysphagia increase the HOB. watch for inadequate nutrition |
| mm problems | hypotonus, spasticity, synnergies (strongest components), Brunnstrom: stages of recovery, typical posture of stroke pt. mm weakness. reemergence of primitive reflexes |
| couple other problems | cardiopulmonary deconditioning, bowel & bladder dysfunction |
| secondary problems | contractures, shd pn & subluxation (flaccid or spastic), RSD, shd-hand syndrom, decrease balance, falling, DVT's, pn, stress, go thru stages of loss, pressure sores |
| how PT helps with communication | posture control (sitting balance, head control), eye contact, inhibiting abnormal tone, improve respiration, UE control to use assistive tech (like computer) |
| typical posture of adult hemiplegic: head | lat flexion toward involved side, rotation away from involved side |
| typical posture of adult hemiplegic: UE | scap: depression, retract. shd: add, IR. elbow: flex. forearm:pronation. wrist: flex, ulnar dev. finger: flex |
| typical posture of adult hemiplegic: trunk | lat flex toward involved side |
| typical posture of adult hemiplegic:LE | pelvis: elevation, retraction. hip: IR, ADD, ext. knee: ext. ankle: plantarflex, supination, inv. toes:flexion |
| synergy patterns | Brunnstrom, when pt attempts mvmt, these occur. |
| UE flexor | scapula retraction, elbow flexion, wrist/hand flexion |
| UE ext | shd IR & ADD, forearm pronation |
| LE flexor | hip flex |
| LE ext | hip add, knee ext, ankle plantarflex |
| looking for tone w/ PROM, what do you feel? | will feel like they are pulling against you, like they're stuck |
| typical sitting posture | pt might lean fwd or bkwd, feet apart, sit on affected side & lean to other side, post pelves, kinda scared |
| balance | COG over BOS & auto postural adjustments |
| 2 components of balance | 1)anticipating 2)on-going/concurrent |
| systems needed for balance | sensory, perceptual & motor |
| sensory | touch & proprioceptive pressure-somatosensory, visual-visual accuity & peripheral vision, vestibular-can resolve postural dilema |
| perceptual | cognitive, if not paying attention or not able to understand it can cause problems |
| motor | standing strategies-ankle/hip/step |
| in which stage of motor dev do we start working on balance? | controlled mob |
| common probs with static balance | wt distribution (putting wt on 1 side in sitting or standing), BOS (wide BOS is usually compensating for balance prob), sway (increase in sway is another compensation) |
| common probs with dynamic balance | fear (causes stiffness), changes in LOS, changes in balance reactions (if speed or timing of reactions are delayed- intensity of reaction can also cause probs whether too much or too little) |
| M-CTSIB | modified clinical test for sensory interaction in balance- tells us abt sensory conflict- separates different parts of balance so we can see what the problem is |
| balance efficacy | pt evaluates self |
| where do more falls occur... ECF/hospitals or home? | 3x more in ECF/hospitals |
| intrinsic factors that cause falls | impaired cognition, vision, & sensation, postural changes, balance problems, loss of flexibility & strength, poor endurance, fatigues quickly, loss of mobility, gait changes, pain |
| hypotonia | low tone (ex. Downs syndrome) |
| dysmetria | problem judging distances |
| dysdiadokinesis | inability to control rapid alternating movements |
| intentional tremor | trying with effort to do something, constant throughout movement |
| postural tremor | only happens in certain position |
| movement decomposition | generalized weakness so movement not as good |
| ataxia | gait, wide base, high guard, stagger |
| dysarthria | speech, motor problem |
| scanning (speech) | looking for words- speech not fluid |
| asthenia | decrease strength |
| key structures of vestibular dysfunction | 3 semicircular canals (SCC), saccule & utricle |
| 3 semicircular canals | fluid + hair cells, angular acceleration/deceleration, velocity |
| saccule & utricle | fluid + hair cells + Otolithes, linear movement, gravity dependent, static head tilt |
| VOR (cerebellum) | vestibular occular reflex, gaze stability w/head mvmt, extrinsic eye mm control, smooth pursuit, scanning, saccade: quick eye reposition (compensatory, functional-reading) |
| vertigo | body/environment is moving/spinning Vestibular |
| dysequilibrium | sensation of being off-balance |
| oscillopsia | vibrating motion of objects in visual environment that are known to be stationary |
| lightheadedness | may faint, pre syncope, brain ischemia, orthostatic hypotnesion, VBI (vestibrobasilar insufficiency), hypoglycemia |
| vertigo | nausea |
| nystagmus | oscillating eye movement |
| frenzel lenses | special glasses that magnify pt eyes |
| BPPV | benign paroxymal positional vertigo- vertigo brought on by diff positions |
| meds for vestibular dysfunction | antihistamines, antianxiety, anticholinergic (motion sickness) |
| habituation ex | reduce symptoms with provoking activities/positions |
| dynamic gait index | developed to assess the likelihood of falling in older adults. designed to test 8 facets of gait. total score 24. greater than 19/24 is predictive of falls risk in community dwelling elderly |
| perception | integration of sensory impressions into information that is psychologically meaningful. memory + sensation |
| transfer of training approach | practice tasks with similar perceptual requirements will carry over to other tasks |
| SI (sensory integration) approach | controlled sensory input to facilitate desire motor response, CNS processing (ex: rubbing w/ different textures, ice, wt bearing, spinning) |
| somatagnosia | impairment of body scheme |
| position in space | inability to perceive special concept: up/down, under/over, in/out |
| ideomotor apraxa | inability to perform a task on command or imitate gestures, even tho the pt understands the task. pt is able to perform previously learned tasks automatically |
| ideational | inability to perform a purposeful motor task either automatically or on command. the pt has no concept of taks |
| tinetti assessment tool | balance and gait portions |
| Berg | lots of sitting, standing, EO, EC, turning, std on one leg |
| vestibular rehab | evaluation sheet. oculomotor & vestibulo-ocular exam, physical status, positional vertigo/nystagmus, motion sensitivity quotient |
| dizzy feelings | circle feelings you are calling dizziness |
| habituation ex | Brandt-Daroff, sit EOB feet flat, turn head, lie down, sit up, turn head other way... no symptoms count to 30. symptoms wait until they are gone then count 30. 3x session... 3 sessions day |
| standing balance ex | feet apt, feet together, feet in half tandem, feet in full tandem. firm or foam. |
| Vestibular-ocular ex | once every hr or 2 shake your head side to side and read one list of words |
| causes of TBI | MVA (motor vehicle accident), falls, violence, war, sports & recreation (child-bicycle) |
| main people getting TBI | men 15-24 |
| TBI prevention | helmets, seatbelts, dont get DUI, use protective equipment with sports |
| EDH- epidural hematoma | "talk & die" |
| SDH- | subdural hematoma |
| obstructive hydrocephalus | enlarged ventricle as a result of impaired CSF-decreased response, impaired concentration, HA, vomiting, sudden irritability, increase BP & decrease HR- rx with mannitol or shunt |
| TBI dx tests | EEG, evoked potentials, MRI, CT scan, PET scan, PE, glasgo coma scale (less than 8 =coma), Ranchos Los Amigos Levels of Cognitive Function (LOCF) |
| coma vs vegetative state | vegetative state is several months- some brain stem reflexes return, may occasionally open eyes, sleep & waking cycles, response to pn sometimes, but still basically unconscious. coma-EC, no volitional mvmt, 3-4 wks |
| complications, secondary problems of TBI | infection, mm atrophy, pneumonia, contractures, DVT's pressure sores |
| PT interventions in acute phase of TBI | PROM, positioning, mm setting, bed mob, EOB & OOB ASAP, tilt table |
| medications for TBI | sz meds (phenytoin-dilatinin, phenobarbitol-luminol, carbamazepine-tegretol), tylenol, NSAIDs, wk narcotics, antidepressants, antipsychotics, botox, phenol, baclofin, valuim, dentrilene for spasticity. |
| heterotrophic ossification | abnormal bone formation is soft tissue of mm as result of immobility-most common in hip |
| LOCF Levels I, II, III | comatose |
| LOCF Levels IV, V, VI | confused |
| LOCF Levels VII, VIII | appropriate |
| LOCF Levels VIII, IX, X | purposeful, appropriate |
| LOCF Level I | no response/total assist |
| LOCF Level II | generalized response/total assist, response with gross body mvmt (ex roll in bed), physiological changes, &/or vocalization, response delayed |
| LOCF Level III | localized response/total assist, specific response consistent w/stim, strongest response to pain & bad odors |
| LOCF Level IV | confused-agitated (bizarre world)/max assist, attention: brief, general. memory: no STM. learning:none. behavior: agressive/flight, mood swings. no purpose, no cooperation, egocnetric. speech: confabulating, incoherent |
| LOCF Level V | confused-inappropriate-nonagitated/max assist. alert, wandering-"go home". brief w/structure, more specific. memory: impaired, some return of old learning. no new learning. behaves without structure, random/ nonpurposeful. no prob solve. confused speech |
| LOCF Level VI | confused-appropriate/mod assist. may realize in hospital. incr in attn & memory. new learning. simple commands, poor awareness of limits, speech appropriate w/structure |
| LOCF Level VII- robot phase | auto appropriate/min assist. realize what happened to them. depression. irritable, uncooperative |
| LOCF Level VIII, IX, X | purposeful appropriate/stand by assist to Mod I. doing better. figuring out how they will be from now on |
Created by:
jessigirrl4
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