Acquired CNS injury & Spinal Dysraphism

Question 1

6 concussion accommodations you would initially recommend for school in girl with concussion

Answer 1

modified attendance
reduced workload
frequent breaks
quiet place to work
limited computer work (sunglasses)
written instructions reminders

Question 2

2 side effects of mild TBI that impact academic success

Answer 2

headache
fatigue
photo/phonophobia
anxiety
difficulty concentrating
memory challenges

Question 3

4 signs of tethered spinal cord

Answer 3

“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

Question 4

3 etiologies for upper extremity weakness (new) in myelomeningocele

Answer 4

syrinx
chiari 2 malformation (posterior fossa compression)
worsening hydrocephalus

Question 5

2 etiologies for lower extremity weakness (new) in myelomeningocele

Answer 5

tethered cord
worsening hydrocephalus

Question 6

6 specific transition items in spina bifidia

Answer 6

1. Sexual health & reproduction
2. Bowel and bladder regime
3. Academic and employment accomodation needs
4. Social skills training
5. Guardianship & trusteeship if cognitive impairment
6. Medication and self care strategies
7. Skin monitoring

Question 7

3 non-pharmacological strategies that may help motivation at school after concussion

Answer 7

Sleep hygiene
Individuals learning plan
Environmental accomodations (quiet space, preferred seating)
Goal specific tasks

Question 8

Define concussion

Answer 8

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

Question 9

5 phyiscal signs a child has concussion?

Answer 9

balance coordination
gait difficulties
disorientation/confusion
memory problems
GCS visual problems

SCAT-5 tool

Question 10

Developmental measure is most affected post TBI

Answer 10

executive functioning

Question 11

3 environmental factors that influence outcomes post TBI

Answer 11

Question 12

3 factors making children less than 3 years more prone to brain damage after accidental TBI

Answer 12

CPS: Acute head trauma

Question 13

5 examples of executive functions and how they might be affected post TBI

Answer 13

Processing speed
Attention
Memory
Emotional regulation
Impulsivity

Question 14

primary and secondary ADHD after TBI differences

Answer 14

Onset ADHD after injury
Family history positive in primary
secondary ADHD less likely to respond to stimulants

Question 15

post mTBI list 3 psychiatric illnesses?

Answer 15

Anxiety
Depression
ADHD
PTSD

Question 16

how long should concussion symptoms take to resolve?

Answer 16

within 4 weeks

Question 17

what is the difference between concussion and mild TBI?

Answer 17

they are the same

Question 18

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:

Answer 18

a. ADHD: Frontal lobe
b. PTSD / New onset obsessions: Temporal
c. Lack of motivation: Frontal
d. Depression: Frontal
e. Aggression/Conduct: Prefrontal cortex

Question 19

Define mild moderate and severe TBI

Answer 19

Question 20

4 ways to support family centered approach to care on post TBI unit?

Answer 20

Question 21

Answer 21

Question 22

3 non-neurological medical considerations for patient on ABI rehab unit after TBI who is not ambulating and impaired LOC

Answer 22

Question 23

4 causes of pain after TBI

Answer 23

Question 24

what is heterotopic ossification? tx?

Answer 24

bone formation in soft tissue
symptoms: pain, erythema, swelling, warmth , loss of movement
Tx: passive ROM, NSAIDS, radaition, surgery

Question 25

when to return to learn and play after mTBI

Answer 25

48 hours rest Return gradually to activities that do not exaccerbate symptoms

Question 26

what is the roleof neuropsychology testing in post concussion management?

Answer 26

NOT for diagnosis of concussion Baseline NOT the standard of care Consider if prolonged symptoms to target accomodations and supports

Question 27

6 clinical factors that increase risk of persistent symptoms after concussion?

Answer 27

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

Question 28

3 interventions that enhace recovery in concussion?

Answer 28

Question 29

4 counselling points for sexual/reproductive health in myelomeningocele?

Answer 29

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

Question 30

fill in the gaps

Answer 30

Question 31

Describe the cognitive/behavioural profile in myelomeningocele

Answer 31

IDD - rare SLD - high number ADHD Language disroder

Question 32

girl with myelomingocele and VP SHUNT - acute headache Dx? symptoms? Ix?

Answer 32

Dx - Increased ICP shunt failure Symptoms --> Ix - CT head

Question 33

team members for spina bifida team?

Answer 33

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

Question 34

Differentiate tethered cord symptoms from chiari II malfomartion:

Answer 34

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

Question 35

5 risk factors for spina bifida

Answer 35

Family history Folate deficiency Exposure to folic acid antagonists (valproate, carbamazepine, phenytoin) Maternal hyperthermia in the first trimester Poorly controlled diabetes Obesity

Question 36

symptoms of mild TBI in school?

Answer 36

-impaired attention -impaired memory -headache -sensory sensitivity -mood

Question 37

4 signs of tethered cord in myelomeningocele

Answer 37

constipation, urinary retention, changes in lower limb sensation, increased tripping and falling, change in reflexes, lower back pain, new orthopedic foot deformity

Question 38

5 accomodations in school for child with concussion

Answer 38

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

Question 39

DDx for upper arm weakness in spina bifida patient

Answer 39

shunt failure chiari II malformation syrinx

Question 40

4 sexual education topics in child with physical disability

Answer 40

- fertility - pregnancy prevention - sti prevention - consent - bowel and bladder management - skin monitoring