Added Info for Final Flashcards
What does ABI stand for?
Acquired Brain Injury
What does GCS stand for?
Glasco Coma Scale
What does LOC stand for?
Loss of consciousness
What does PTA stand for?
Post traumatic amnesia
What is the definition of TBI?
Form of ABI
Caused from sudden trauma to the brain - IE. result of sudden and violent hit or when object pierces the skull and enters the brain
Symptoms can be mild, mod, or severe
What is an open TBI?
Penetrates the skull
What is a closed TBI?
No penetration to skull
What are the leading causes of TBI?
MVA
Falls
High risk behaviors
Gunshot wounds
What is a functional recovery of a TBI?
Uncertain mechanisms. Each brain is different and does not respond to injury the same.
What determines the extent of open TBI?
Location, depth, and pathway
What is a diffuse axonal injury?
Result of closed head injury
Brain is alt compressed and stretched
Axons can be stretch or severed resulting in neuronal death
What is a primary TBI injury?
Initial brain injury sustained by impact
IE. skull penetration, fractures, contusions
What is a coup lesion?
Direct brain lesion under the point of impact where brain damage occurs
What is countrecoup?
Injury on opposite side of brain due to rebound effect after impact
What is a secondary TBI injury?
Brain damage as response to initial injury
IE. Hematoma, hypoxia, ischemia
What is an epidural hematoma?
Hemorrhage that forms between skull and dura mater
What is a subdural hematoma?
Hemorrhage that forms due to venous rupture between dura and arachnoid mater
What are examples of seizure drugs?
Dilantin
Tegretol
Phenobarbitol
Keppra
What are the side effects of seizure drugs?
Drowsiness
Ataxia
Confusion
What is a craniotomy?
Removal of part of the skull to access brain
What ages are at risk for severe TBI?
Under 2
Over 60 years old
What are the levels of consciousness?
Coma Stupor Obtundity Delerium Clouding of consciousness Consciousness Vegetative state Persistent vegetative state
What is the definition of coma?
State of unconsciousness and level of unresponsiveness to all internal and external stimuli
What is the definition of stupor?
State of general unresponsiveness with arousal occurring from repeated stimuli
What is the definition of obtundity?
State of consciousness that is characterized by state of sleep, reduced alertness to arousal, and delayed responses to stimuli
What is the definition of delirium?
State of consciousness characterized by disorientation, confusion, agitation, and loudness
What is the definition of clouding of consciousness?
State of consciousness characterized by quiet behavior, confusion, poor attention, and delayed respones
What is the definition of consciousness?
State of alertness, awareness, orientation, and memory
What is the definition of vegetative state?
May have awoken from coma, but still have not regained awareness, have sleep-wake cycles
What is the definition of persistent vegetative state?
Same as vegetative state with a longer duration (> 4 weeks)
Decreased quality of life
What does A and O x 3 mean?
Assess alertness and orientation by asking person, place, and time
What is the Glasgow Coma Scale?
Classify/describe severity of injury during the acute stage of a TBI
Measures motor response, verbal response, and eye opening
Based on 3-15 point scale and categorize outcomes of TBIs
What is the general scale of the Glasgow Coma Scale?
3-8: severe brain injury and coma in 90% of pts
9-12: mod brain injury
13-15: mild brain injury
What are the 3 categories of GCS?
Eye opening
Motor response
Verbal response
What is decorticate posture?
Trunk and LE in ext
UE in flex
What is decerebrate posture?
Trunk and extremities in ext
What characterizes a mild TBI?
LOC and/or confusion <30’
MRI and CT scans often are normal
Commonly overlooked
What are the sx/sx of mild TBI?
Fatigue HA Visual disturbances Memory loss Poor attention Sleep disturbances LOC Dizzy Irritability Depression Seizures Nausea Loss of smell Sensitivity to light and sounds Mood changes Getting lost or confused Slowness in thinking
What is the definition of moderate brain injury?
BI resulting in LOC from 20 min to 6 hr
GCS = 9 to 12
What is the definition of severe brain injury?
BI resulting in LOC for greater than 6 hours
GCS = 3 to 8
What are the prognosis indicators for TBI?
Duration of coma
Memory impairments
Age
What does aterograde mean?
Inability to create new memory
Last to recover post-coma
*Think anterior = not able to move forward and create new memories
What is the definition of post-traumatic?
Time b/t injury and when pt able to recall recent events
What is the definition of retrograde?
Inability to remember events prior to injury
What occurs during the acute management/ICU of TBI?
Minimize secondary injury and life support
Mechanical ventilation
Stent to control ICP
Meds
Surgical intervention
What ICP level is considered dangerous?
20 mmHg
What are the classification tools for TBI?
Glasgow Coma Scale
Rancho Los Amingos Scale
What is the Ranchos Lose Amigos scale of cognitive functioning?
Assess BI recovery
Measures levels of awareness, cognition, behavior, and interaction with environment
Can plateau at any time and not get completely through Ranchos scale
How are the levels of RLAS ranked?
Level 1 = most serious
Level 8 = normal and appropriate
What is the developmental sequence for TBI posture treatment?
POE Quadruped Bridging Sitting Kneeling/half-kneeling Modified plantigrade Standing
What is modified plantigrade?
Standing with B UE support
What is a suspensory strategy?
Crouch strategy
What is Alzheimer’s Disease?
Progressive neurodegenrative disorder
What are the physiologic characteristics of Alzheimer’s Disease?
Neurons normally involved in ACh transmission deteriorate within the cerebral cortex
Amyloid plaques and neurofibrillary tangles = more damage
What causes Alzheimer’s Disease?
Unknown
Thought to be lower levels of NT, higher levels of Al- within brain tissue, genetic inheritance, autoimmune disease, abnormal processing of amyloid, and virus
What are the sx/sx of Alzheimer’s disease?
Difficulty with new learning and changes in memory and concentration
What is the progression of AD?
Disorientation, word finding difficulties, emotional lability, depression, and poor judgement
What are the middle stages of AD?
Behavioral and motor probs such as aphasia, apraxia, rigidity, bradykinesia, shuffling gait, decrease (I) ADLs, perseveration, agitation, violent behavior, and wandering
What are the end stages of AD?
Severe intellectual and physical destruction, incontinence, functional dependence, seizure activity, and inability to speak
What is the tx for AD?
No cure
Meds can help symptoms
How does PT benefit AD?
Maximize function and education
What risks are posed to AD pt?
High risk for infection and pneumonia, contractures, decubiti, and fractures
What is ALS?
Chronic, degenerative resulting in UMN and LMN impairments
What are the physiologic characteristics of ALS?
Demyelination, axonal swelling, and atrophy within cerebral cortex, premotor areas, sensory cortex, and temporal cortex cause the sx
Rapid degeneration that causes denervation of mm fibers, mm atrophy, and weakness
What is the cause for ALS?
Unknown
Thought to be caused by genetics, slow acting virus, metabolic disturbances, toxicity of lead and aluminum
More common in men between 40-70 years old
What are the sx/sx of ALS?
Asymmetric mm weakness, cramping, and hand atrophy
Mm weakness d/t denervation cause fasciculations, atrophy, and mm wasting distally to proximal. Ends in eventual resp paralysis
Dysarthria, dysphagia, and emotional lability
What is the primary indicator of ALS?
Motor impairment without sensory impairment
What is the tx for ALS?
No cure
Meds may help with sx
What PT interventions are there for ALS?
QOL and education
Low-level exercise
ROM, mobility training, AD, w/c prescription, bronchial hygiene, and energy conservation
What is Parkinson’s Disease?
Primary degenerative disorder
Decrease dopamin production
Degeneration of dopaminergic pathways create imbalance b/t dopamine and ACh
What is Parkinsonism?
Describes sx that are most commonly seen. Can be used to describe sx outside of PD such as hand tremors, slow movement, limb rigidity, and gait and balance pattern
What makes Levadopa a successful drug for PD?
Can cross BBB and convert to dopamine
What is the etiology of PD?
Unknown
Thought to be caused by genetics, CO toxicity, excess manganese or copper, vascular impairment of striatum, encephalitis, and HD or AD
What are the sx/sx of PD?
Resting tremor (pill-rolling) that increases with stress and disappears during sleep
What are the early sx/sx of PD?
Balance impairments, difficulty rolling and rising from bed, fine motor impairments, and difficulty bathing and dressing
What are the progressive sx/sx of PD?
Hypokinesia, sluggish movement, difficulty initating and stopping movement, festinating and shuffling gait, bradykinesia, poor posture, dysphagia, and cogwheel/lead pipe rigidity
What is cogwheel rigidity?
Tension in mm that gives way in little jerks when the Mm is passively stretched
What is lead pipe rigidity?
A “smooth” rigidity
Does not stop and give, stop and give
What is freezing in a PD patient?
Body can’t move the way they want to during amb
What is tx of PD?
Dopamine replacement to reduce movement disorders, bradykinesia, rigidity, and tremor - IE. levadopa, sinemet, madopar
What PT interventions are there for PD?
PWR
LSVT BIG
Rock Steady
What is Guillain-Barre Syndrome?
AKA acute polyneuropathy
Autoimmune disorder
Temp inflammation and demyelination of the peripheral myelin sheaths
Potential axonal degeneration
What is the etiology of Guillain-Barre Syndrome?
Unknown
Thought to be autoimmune response in response to previous resp infection, flue, immunization, or surgery
What are the sx/sx of GBS?
Distal symmetrical motor weakness and mild distal sensory impairment, and possible resp paralysis
Absent DTRs, inability to speak or swallow
When does GBS normally peak?
2-4 weeks after onset
What is the tx of GBS?
Hospitalization - immunosuppressive and narcotics
Cardiac monitoring, plasmapheresis, and possible mechanical vent
What PT interventions are involved with GBS?
Education, pulm rehab, strengthening, mobility training, w/c and orthotic prescription, and AD training
What PT interventions are involved in acute care for GBS?
PROM, positioning, and light exercise
What are special considerations to GBS?
May experience pelvic floor weakness, deep mm p!, arrhythmia, tachycardia, postural hypotension, and heart block
What is a heart block?
Heartbeat decreases and becomes so slow and the beat does not occur fast enough between chambers to pump out
What is Huntington’s Disease?
CNS disorder characterized by degeneration and atrophy of basal ganglia and cerebral cortex
Progressive disease
What is the cause of Huntington’s Disease?
Genetics
What are the sx/sx of Huntington’s disease?
Involuntary choreic movement, mild alt in personality, grimacing, tongue protrusion, and ataxia
What are the sx/sx of late stage Huntington’s disease?
Mental deterioration, depression, dysphagia, incontinence, immobility, rigidity
What is the tx for Huntington’s disease?
Meds to tx sx (anticonvulsants and antipsychotics)
What PT interventions are done for Huntington’s Disease?
Max endurance, strength, balance, postural control, and functional mobility
No way to stop or reverse sx
What is MS?
Produce patches of demyelination of myelin sheaths that surround nn within brain and SC
Decrease nn conduction
Sx based on location and extent of demyelination
What is relapsing-remitting MS?
Relapse with full recovery or some residual neurological sx
What is primary-progressive MS?
Disease progression from onset, without plateaus or remission
Usually dx later in life
What is secondary-progressive MS?
Initial relapse-remitting course, followed by progression at variable rate that may also include occasional relapses and minor remissions
What is secondary-progressive MS?
Progressive disease from onset, but without clear acute relapses that may or may not have some recovery or remission
What is benign MS?
~20%, abrupt onset, one or a few exacerbations and complete or near complete remissions
What is Lhermitte sign?
Flex of neck may induce a tingling, electric shock like feeling down the shoulders and back
What is the cause of MS?
Unknown
What are the possible causes of MS?
Genetics, viral infections, and environment
Slow-acting virus may initiate an autoimmune response
What population is most at risk for MS?
20-35 y/o, caucasian, F
What are the sx/sx of MS?
Visual problems (blurred or double)
Paresthesias
Clumsiness
Weakness
Ataxia
Balance dysfunction
Increased tone
Fatigue
What is the tx for MS?
Lessen the length of exacerbation and minimize health
Corticosteroids
Nutritional and psych counseling
PT education
What are added risks of MS?
Fatigue increased with heat and can be exhausting
Suicide is 7x> than when compared to same age without MS
What are the common PT interventions for MS?
Avoid max exercise Exercise in AM is best Use RPE not HR Educate on skin care Biofeedback for stress management/relaxation Exercise guidelines
What is myasthenia gravis?
Autoimmune disease that affects neuromuscular signals
What is the cause of myasthenia gravis?
Associated with enlarged thymus, diabetes, RA, lupus, and other immune disorders
What are the sx/sx of myasthenia gravis?
Extreme fatigue and mm weakness
Ocular mm
Proximal weakness over distal
Dysphagia, dysarthria, and cranial nn weakness
What are tx options for myasthenia gravis?
Medical emergencies = exacerbations can cause resp mm requiring ventilators
ACh drug therapy, plasmapheresis, and immunosuppressive therapy
PT interventions
What PT interventions are involved in myasthenia gravis?
Resp and pulm intervention
Energy conservation
Sub-max strengthening
What is post-polio syndrome?
LMN pathology affecting anterior horn cells in those previously affected by polio
Autoimmune
What is polio?
Viral infection resulting in neuropathy that includes focal and asymmetrical motor impairments
What is the cause of post-polio syndrome?
Previous dx of polio
Rarely life threatening
What population is most affected by post-polio syndrome?
F > M
What are the sx/sx of post-polio syndrome?
Asymmetrical weakness Slow and progressive weakness Fatigue Mm atrophy Pain Dysphagia
What is the tx of post-polio syndrome?
No meds to alter progression
Lifestyle modification and symptom intervention
PT education
What is involved in PT interventions of post-polio syndrome?
Supervised exercise to improve overall conditioning
Functional independence
Adaptive equipment
What is the Mini Mental State Examination?
Looks at different parts of the brain
What is muscle tone test?
Modified Ashworth Scale
Go for a slower pace through PROM
What are the tests for spasticity?
Modified Ashworth Scale
Clonus
What is Bell’s Palsy?
Temp unilateral facial paralysis secondary to trauma to facial nn
Abnormal pressure from edema or inflammation
What is the function of the facial nerve?
Sensory - taste anterior tongue
Motor - facial mm, lacrimal, submandibular, and sublingual glands
What is the test for Bell’s Palsy?
Close eyes tight, smile and show teeth
Whistle and puff cheeks and identify familiar taste
What are the sx/sx of Bell’s Palsy?
Inability to furrow brow
Drooping eyelid and cannot close eye
No mm tone in cheek
Drooping mouth and cannot smile or pucker lips
What is the cause of Bell’s Palsy?
Unclear
Could be viral infection or inflammation
What is the tx of Bell’s Palsy?
The earlier the tx the better the outcome
Mild involvement should resolve in 2 weeks
More severe might require anti-viral meds and corticosteroids
PT intervention
What PT intervention is included with Bell’s Palsy?
Stimulate facial nn
Facial massage
Exercise
How can you stimulate the facial nn?
Mm tapping
Manual therapy
Visual feedback
What is CTS?
Compression of median nn
Normal tissue pressure of the carpal tunnel
What makes up the carpal tunnel?
Floor - carpal bones
Ceiling - transverse carpal ligament
Nerves, vasculature, and tendons run through
What causes CTS?
Overuse Pressure Trauma RA Pregnancy Diabetes Tumor Hypothyroidism Wrist sprain or fracture
What are the sx/sx of CTS?
Night pain Decreased hand mobility Hand weakness Atrophy Clumsiness
What are the tests to dx CTS?
Tinels sign
Phalen’s test
What is the Phalen’s test?
Inverted prayer sign ~60 sec and see if sx reproduce
What is the reverse Phalen’s test?
Prayer sign - wrist ext
What is polyneuropathy?
Damage or disease affecting multiple peripheral nn
May involve damage to the axon, myelin sheath, or nerve’s cell body
What is the cause of polyneuropathy?
DM Advanced age Drugs (chemo) Alcohol abuse AIDS Environmental toxins Inherited neurological conditions
What are the sx/sx of polyneuropathy?
Begins B distal LE
Numbness, tingling, and pain in a stocking glove pattern
Loss of position and vibration sense, ataxia, mm weakness, and possible atrophy
Constipation, loss of b/b control, and orthostatic hypotension
What is the tx of polyneuropathy?
Wound management/education
Vestibular/visual balance
Gait training
What kind of gait training is involved with someone who has polyneuropathy?
Visual scan Create an obstacle course WB facilitation through WS Righting reaction Orthotic training AD training Home/community amb
How can you integrate sensation in someone with polyneuropathy?
Different textures - IE. wipe with cotton t-shirt, washcloth, hot water, cold water, etc
Attempt to wake up/stim nn
Fluidotherapy
What is sciatica?
Due to compression of sciatic nerve - herniated disc, tumor, infection, spondylolisthesis, stenosis, and blood clots
Where does sciatica take place?
L4-S3
What is the cause of sciatica/herniated disc?
Natural aging process
Instability of disc
What are the sx/sx of sciatica?
LBP/gluteal pain with radiculopathy
Decreased ROM, TTP, and mm guarding
SLR test
Increased pain in sitting, lifting, forward bending/twisting, sneezing, and coughing
What is the tx of sciatica?
NSAIDs
Cortisone epidural or local anesthetic injections
Surgery - laminectomy, discectomy, laser discectomy
PT education
What PT interventions are there with someone with sciatica?
Pain management Traction Heat Core stabilization McKenzie exercises Stretching Endurance activities - swimming, biking, and walking
What is thoracic outlet syndrome?
Neurovascular compression and damage of brachial plexus nn trunks, subclavian vascular supply and/or axillary artery
What is the cause of thoracic outlet syndrome?
Abnormal first rib, postural deviations, body composition, chronic overhead work, scalenes hypertrophy or spasm, degenerative disorders, and elongated cerv transverse process
What are the sx/sx of thoracic outlet syndrome?
Diffuse arm pain most common at night
Paresthesias
Mm weakness and atrophy
Poor posture
Edema
Discoloration
What are the tests for thoracic outlet syndrome?
Adson's maneuver Wright's test Roo's test Costoclavicular test Hyperabduction test Allen test
What is the tx for thoracic outlet syndrome?
NSAIDs
Surgery
PT education
What PT interventions are involved in thoracic outlet syndrome?
Posture Breathing Ergonomics/body mechanics Stretching Pain management Joint mobs Physical agents PRN
What is the Allen’s test?
See vascular response
Palpate radial pulse and then ulnar artery
Pt fist pumps and holds
Release radial artery then ulnar to see if vascularity comes back
Repeat to the ulnar side
What is trigeminal neuralgia?
Abnormal pressure on or irritation of trigeminal nerve
What sensory and motor impact does trigeminal neuralgia?
Sensory - touch and pain, mucus membranes of nose, sinuses, mouth, and anterior tongue
Motor - mastication
What are the tests of trigeminal neuralgia?
Corneal reflex
Face sensation
Clench teeth
Push down on chin to separate jaw
What is the cause of trigeminal neuralgia?
Tumor or swollen blood vessel
What population is trigeminal neuralgia most commonly at risk?
Females over 50
Common with MS
Most common injury location in narrow space where nn exits brainstem
What are the sx/sx of trigeminal neuralgia?
Unilateral and episodic or constant
What is episodic trigeminal neuralgia?
Sudden sharp, jolting, stabbing, or stock-like pain
Spasms/tics
Triggered by touch or sound most common during shaving, chewing, or oral care
What is chronic trigeminal neuralgia?
Persistent aching or burning that can exacerbate
What are the tx of trigeminal neuralgia?
Pt education of resting jaw position
Massage to masseter
Diaphragmatic breathing
Desensitizing
