CVA, TBI, balance, perception
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| when do you use a RIP pattern? | when pt has spasticity or rigidity- use to break up tone
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| most common orthodic for people with stroke | AFO
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| when shd is subluxed... | make sure shd is supported- wt bearing or open chain w/arm supported
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| if you do parts to whole... | put it all together at end
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| different types of CVA | ischemic, hemorrhagic, TIA
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| ischemic CVA | thrombus, embolus
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| thrombus:atherosclerosis | decrease artery size (slowly gets smaller)
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| embolus:cardiac | event or disease, blood clot to brain, quick onset
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| hemorrhagic CVA | AVM, HTN, aneurysm (SAH), ICH
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| AVM | you're born with this, abnormality that affects circulation in brain arterial venous
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| HTN | hypertension, causes decrease in integrity of vessels in brain
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| aneurysm | SAH- subarachnoid space
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| ICH | intracerebral hemorrage
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| TIA CVA | transient ischemic attack, mild stroke, mini stroke, temporary
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| ischemia leads to | necrosis-ischemic penumbra:surrounding area @ risk
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| edema leads to | increased intercranial pressure
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| decreased blood flow | toxic to neural tissue, increased intercranial pressure
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| 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
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| modifiable risk factors | HTN, heart dx, hyperlipidemia, cigarette smoking, ETOH, sedentary, obesity, oral contraceptive
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| non modifiable risk factors | prior TIA, CVA- gender, more likely for males- race, African Americans- Family hx- age
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| prevention | identify high risk groups-lifestyle modification-regular screenings
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| medical dx | hx & PE, dx tests- CT, MRI
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| 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
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| using MRI for stroke | better in acute, costs more
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| 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
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| 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
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| stroke syndromes | ACA, MCA, vertebrobasilar artery, PCA, lacunar infarct
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| ACA- anterior cerebral artery | more effect in LE, pt typically incontinent, aphasia, some memory & behavior deficits
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| MCA- middle cerebral artery | UE & face, aphasia, homonymous hemianopia- most common
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| vertebrobasilar artery | often fatal-ataxia, effects cranial nerve & cerebellum- feel trapped in body, can't communicate
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| PCA-post cerebral artery | sensory loss & vision
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| lacunar infarct | deep in brain, usually result from DM & HTN
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| L CVA/ R hemi | aphasia, alexia, agraphia, apraxia, negative, anxious, realistic about situation
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| R CVA/ L hemi | perceptual deficits, neglect, Pusher syndrome, dysarthria, dysphagia, impulsive, indifferent, overestimates ability
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| cognitive problems | memory, confabulation, impaired judgment, poor insight, won't get humor, confused, impaired orientatino, decreased attention & arousal
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| behavior problems | lability, flat effect (no emotion), decreased motivation, irritable
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| visual problems | homonymous hemianopsia
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| sensory problems | thalamic pn- pn perseveration- even tho stimulus is removed
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| perceptual problems | unilateral neglect, pusher syndrome, apraxia
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| 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
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| oralfacial problems | unilateral facial weakness-one side drooping, probs eating/drinking. w/dysphagia increase the HOB. watch for inadequate nutrition
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| mm problems | hypotonus, spasticity, synnergies (strongest components), Brunnstrom: stages of recovery, typical posture of stroke pt. mm weakness. reemergence of primitive reflexes
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| couple other problems | cardiopulmonary deconditioning, bowel & bladder dysfunction
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| 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
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| 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)
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| typical posture of adult hemiplegic: head | lat flexion toward involved side, rotation away from involved side
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| typical posture of adult hemiplegic: UE | scap: depression, retract. shd: add, IR. elbow: flex. forearm:pronation. wrist: flex, ulnar dev. finger: flex
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| typical posture of adult hemiplegic: trunk | lat flex toward involved side
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| typical posture of adult hemiplegic:LE | pelvis: elevation, retraction. hip: IR, ADD, ext. knee: ext. ankle: plantarflex, supination, inv. toes:flexion
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| synergy patterns | Brunnstrom, when pt attempts mvmt, these occur.
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| UE flexor | scapula retraction, elbow flexion, wrist/hand flexion
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| UE ext | shd IR & ADD, forearm pronation
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| LE flexor | hip flex
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| LE ext | hip add, knee ext, ankle plantarflex
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| looking for tone w/ PROM, what do you feel? | will feel like they are pulling against you, like they're stuck
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| typical sitting posture | pt might lean fwd or bkwd, feet apart, sit on affected side & lean to other side, post pelves, kinda scared
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| balance | COG over BOS & auto postural adjustments
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| 2 components of balance | 1)anticipating 2)on-going/concurrent
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| systems needed for balance | sensory, perceptual & motor
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| sensory | touch & proprioceptive pressure-somatosensory, visual-visual accuity & peripheral vision, vestibular-can resolve postural dilema
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| perceptual | cognitive, if not paying attention or not able to understand it can cause problems
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| motor | standing strategies-ankle/hip/step
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| in which stage of motor dev do we start working on balance? | controlled mob
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| 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)
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| 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)
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| 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
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| balance efficacy | pt evaluates self
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| where do more falls occur... ECF/hospitals or home? | 3x more in ECF/hospitals
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| 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
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| hypotonia | low tone (ex. Downs syndrome)
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| dysmetria | problem judging distances
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| dysdiadokinesis | inability to control rapid alternating movements
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| intentional tremor | trying with effort to do something, constant throughout movement
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| postural tremor | only happens in certain position
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| movement decomposition | generalized weakness so movement not as good
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| ataxia | gait, wide base, high guard, stagger
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| dysarthria | speech, motor problem
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| scanning (speech) | looking for words- speech not fluid
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| asthenia | decrease strength
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| key structures of vestibular dysfunction | 3 semicircular canals (SCC), saccule & utricle
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| 3 semicircular canals | fluid + hair cells, angular acceleration/deceleration, velocity
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| saccule & utricle | fluid + hair cells + Otolithes, linear movement, gravity dependent, static head tilt
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| VOR (cerebellum) | vestibular occular reflex, gaze stability w/head mvmt, extrinsic eye mm control, smooth pursuit, scanning, saccade: quick eye reposition (compensatory, functional-reading)
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| vertigo | body/environment is moving/spinning Vestibular
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| dysequilibrium | sensation of being off-balance
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| oscillopsia | vibrating motion of objects in visual environment that are known to be stationary
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| lightheadedness | may faint, pre syncope, brain ischemia, orthostatic hypotnesion, VBI (vestibrobasilar insufficiency), hypoglycemia
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| vertigo | nausea
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| nystagmus | oscillating eye movement
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| frenzel lenses | special glasses that magnify pt eyes
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| BPPV | benign paroxymal positional vertigo- vertigo brought on by diff positions
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| meds for vestibular dysfunction | antihistamines, antianxiety, anticholinergic (motion sickness)
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| habituation ex | reduce symptoms with provoking activities/positions
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| 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
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| perception | integration of sensory impressions into information that is psychologically meaningful. memory + sensation
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| transfer of training approach | practice tasks with similar perceptual requirements will carry over to other tasks
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| SI (sensory integration) approach | controlled sensory input to facilitate desire motor response, CNS processing (ex: rubbing w/ different textures, ice, wt bearing, spinning)
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| somatagnosia | impairment of body scheme
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| position in space | inability to perceive special concept: up/down, under/over, in/out
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| 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
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| ideational | inability to perform a purposeful motor task either automatically or on command. the pt has no concept of taks
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| tinetti assessment tool | balance and gait portions
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| Berg | lots of sitting, standing, EO, EC, turning, std on one leg
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| vestibular rehab | evaluation sheet. oculomotor & vestibulo-ocular exam, physical status, positional vertigo/nystagmus, motion sensitivity quotient
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| dizzy feelings | circle feelings you are calling dizziness
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| 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
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| standing balance ex | feet apt, feet together, feet in half tandem, feet in full tandem. firm or foam.
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| Vestibular-ocular ex | once every hr or 2 shake your head side to side and read one list of words
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| causes of TBI | MVA (motor vehicle accident), falls, violence, war, sports & recreation (child-bicycle)
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| main people getting TBI | men 15-24
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| TBI prevention | helmets, seatbelts, dont get DUI, use protective equipment with sports
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| EDH- epidural hematoma | "talk & die"
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| SDH- | subdural hematoma
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| 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
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| 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)
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| 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
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| complications, secondary problems of TBI | infection, mm atrophy, pneumonia, contractures, DVT's pressure sores
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| PT interventions in acute phase of TBI | PROM, positioning, mm setting, bed mob, EOB & OOB ASAP, tilt table
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| medications for TBI | sz meds (phenytoin-dilatinin, phenobarbitol-luminol, carbamazepine-tegretol), tylenol, NSAIDs, wk narcotics, antidepressants, antipsychotics, botox, phenol, baclofin, valuim, dentrilene for spasticity.
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| heterotrophic ossification | abnormal bone formation is soft tissue of mm as result of immobility-most common in hip
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| LOCF Levels I, II, III | comatose
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| LOCF Levels IV, V, VI | confused
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| LOCF Levels VII, VIII | appropriate
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| LOCF Levels VIII, IX, X | purposeful, appropriate
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| LOCF Level I | no response/total assist
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| LOCF Level II | generalized response/total assist, response with gross body mvmt (ex roll in bed), physiological changes, &/or vocalization, response delayed
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| LOCF Level III | localized response/total assist, specific response consistent w/stim, strongest response to pain & bad odors
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| 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
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| 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
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| 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
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| LOCF Level VII- robot phase | auto appropriate/min assist. realize what happened to them. depression. irritable, uncooperative
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| LOCF Level VIII, IX, X | purposeful appropriate/stand by assist to Mod I. doing better. figuring out how they will be from now on
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