Acquired CNS injury & Spinal Dysraphism Flashcards
6 concussion accommodations you would initially recommend for school in girl with concussion
modified attendance
reduced workload
frequent breaks
quiet place to work
limited computer work (sunglasses)
written instructions reminders
2 side effects of mild TBI that impact academic success
headache
fatigue
photo/phonophobia
anxiety
difficulty concentrating
memory challenges
4 signs of tethered spinal cord
“stretch induced dysfunction of the caudal spinal cord and conus”
Associated with any open or closed spinal dysraphic lesions
Symptoms:
1. Progressive motor and sensory dysfunction
2. Gait abnormalities
3. Loss of bladder control
4. Lowe extremity, perineum, or lumbosacral pain
5. Progressive scoliosis
3 etiologies for upper extremity weakness (new) in myelomeningocele
syrinx
chiari 2 malformation (posterior fossa compression)
worsening hydrocephalus
2 etiologies for lower extremity weakness (new) in myelomeningocele
tethered cord
worsening hydrocephalus
6 specific transition items in spina bifidia
- Sexual health & reproduction
- Bowel and bladder regime
- Academic and employment accomodation needs
- Social skills training
- Guardianship & trusteeship if cognitive impairment
- Medication and self care strategies
- Skin monitoring
3 non-pharmacological strategies that may help motivation at school after concussion
Sleep hygiene
Individuals learning plan
Environmental accomodations (quiet space, preferred seating)
Goal specific tasks
Define concussion
Mild traumatic brain injury usually secondary to contact or acceleration/deceleration or rotational forces that changes the causes axonal injury, cerebral inflammation and changes to cerebral blood flow
5 phyiscal signs a child has concussion?
balance coordination
gait difficulties
disorientation/confusion
memory problems
GCS visual problems
SCAT-5 tool
Developmental measure is most affected post TBI
executive functioning
3 environmental factors that influence outcomes post TBI
3 factors making children less than 3 years more prone to brain damage after accidental TBI
CPS: Acute head trauma
5 examples of executive functions and how they might be affected post TBI
Processing speed
Attention
Memory
Emotional regulation
Impulsivity
primary and secondary ADHD after TBI differences
Onset ADHD after injury
Family history positive in primary
secondary ADHD less likely to respond to stimulants
post mTBI list 3 psychiatric illnesses?
Anxiety
Depression
ADHD
PTSD
how long should concussion symptoms take to resolve?
within 4 weeks
what is the difference between concussion and mild TBI?
they are the same
in TBI, based on the below symptoms what location of lesion do you expect?
a. ADHD:
b. PTSD / New onset obsessions:
c. Lack of motivation:
d. Depression:
e. Aggression/Conduct:
a. ADHD: Frontal lobe
b. PTSD / New onset obsessions: Temporal
c. Lack of motivation: Frontal
d. Depression: Frontal
e. Aggression/Conduct: Prefrontal cortex
Define mild moderate and severe TBI
4 ways to support family centered approach to care on post TBI unit?
3 non-neurological medical considerations for patient on ABI rehab unit after TBI who is not ambulating and impaired LOC
4 causes of pain after TBI
what is heterotopic ossification? tx?
bone formation in soft tissue
symptoms: pain, erythema, swelling, warmth , loss of movement
Tx: passive ROM, NSAIDS, radaition, surgery
when to return to learn and play after mTBI
48 hours rest
Return gradually to activities that do not exaccerbate symptoms
what is the roleof neuropsychology testing in post concussion management?
NOT for diagnosis of concussion
Baseline NOT the standard of care
Consider if prolonged symptoms to target accomodations and supports
6 clinical factors that increase risk of persistent symptoms after concussion?
concurrent or previous mental health
concurrent or previous headaches or sleep problems
previous learning difficulties
previous TBI or pre injury concussion symptoms
female
Adolescent
elevated initial symptom burden
family or social stressors
3 interventions that enhace recovery in concussion?
4 counselling points for sexual/reproductive health in myelomeningocele?
Lower lesion level is associated with sexual satisfaction
Bowel and bladder incontinence can interfere with sexual activity, strategies for complete emptying prior to sexual activity may help
Fertility is not affected; contraceptive methods are needed if pregnancy is not wanted
Folic acid recommendations 4mg daily if pregnant
STI prevention and safe sex practices (including condom use)
Checking for perineal injury before and after sexual activity
NO LATEX condoms
fill in the gaps
Describe the cognitive/behavioural profile in myelomeningocele
IDD - rare
SLD - high number
ADHD
Language disroder
girl with myelomingocele and VP SHUNT - acute headache
Dx? symptoms? Ix?
Dx - Increased ICP shunt failure
Symptoms –>
Ix - CT head
team members for spina bifida team?
PT – assess equipment and mobility supports
OT – ADL support and home modifications as needed for ambulatory level
Urology – bladder control
Neurosurgery – surgical considerations and treatment, monitoring post-operative and monitoring VP shunt if associated hydrocephalus treatment
Psychology – neurocognitive testing
Orthopedic surgery – scoliosis, foot deformity
+/- GI
Differentiate tethered cord symptoms from chiari II malfomartion:
Tethered cord:
- Progressive weakness, sensory loss
- Pain in legs, perineum or lumbosacral region
- Gait abnormalities
- Bladder incontinence
- Progressive scoliosis
Chiari II malformation
- Dysphagia
- Stridor
- Apnea
- Aspiration
- Arm weakness
5 risk factors for spina bifida
Family history
Folate deficiency
Exposure to folic acid antagonists (valproate, carbamazepine, phenytoin)
Maternal hyperthermia in the first trimester
Poorly controlled diabetes
Obesity
symptoms of mild TBI in school?
-impaired attention
-impaired memory
-headache
-sensory sensitivity
-mood
4 signs of tethered cord in myelomeningocele
constipation, urinary retention, changes in lower limb sensation, increased tripping and falling, change in reflexes, lower back pain, new orthopedic foot deformity
5 accomodations in school for child with concussion
Gradual increase in return to school and work load
Avoid tests
Minimize screen use
More time for assignments
quiet environment
encourage social participation & social supports
DDx for upper arm weakness in spina bifida patient
shunt failure
chiari II malformation
syrinx
4 sexual education topics in child with physical disability
- fertility
- pregnancy prevention
- sti prevention
- consent
- bowel and bladder management
- skin monitoring
