Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OTH 611 Adult Phys Rehab > After Midterm > Flashcards

After Midterm Flashcards

1
Q

CVA typically affect what type of people

A

older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk increases with age and slightly more common in

A

men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

of the people we will see with stroke there is a small percentage that

A

doesn’t have any impairment at all.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Per 100 stroke survivors - break it down

A

10 have no more impairments
40 have mild residual deficits
40 have long term deficits
10 need institutional care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A very small percentage of stroke have long term

A

nursing home care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is ischemic stroke

A

Most common. There is a blockage in the vessels. with age and time the blockage can develop. plague build up in the vessel walls. over time it will narrow it makes it harder for the blood to push through.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is hemorrhagic stroke

A

less common. vessels get weaker and tear and bleed. typically the person will have surgery to repair the rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is transient ischemic attach (TIA)

A

an event that results in neurological symptoms resembling a stroke.2 Although these symptoms develop suddenly and may last up to 24 hours, they resolve completely, leaving no discernable symptoms or deficits.2 TIAs are considered a “warning sign” of an impending stroke and precede approximately 12% of all strokes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a thrombotic stroke

A

Type of ischemic stroke that is a stationary clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a embolic stroke

A

a type of ischemic stroke, traveling clot formed elsewhere in the body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a lucunar infarct

A

Small holes in deep cerebral hemipsphere, pons or basal ganglia

smaller vessel blockage

pure motor ataxic or sensory loss

good prognosis - mild stroke, mild symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anterior cerebral artery infarct (ACA)

A

Frontal and parietal lobes

majority of corpus callosum

motor and sensory cortices of leg and foot

motor planning areas.

more difficulty walking and better clinical picture with their arm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ACA impairment symptoms

A

contralateral hemiparesis - opposite side of body than brain.

behavioral changes - impulsive.

apraxia - ideomotor or ideational

aphasia - expressive or receptive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Middle cerebral artery infarct afects what type of brains

A

lateral areas of hemispheres

primary motor and sensory cortices face, trunk, arm, hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Middle Cerebral Artery (MCA) impairments

A

left hemisphere damage - apraxia, aphasia

either hemisphere damage

contralateral hemiplegia and sensory loss

homonymous hemianopsia - loss of vision in both of the eyes.

Right hemisphere damage
neglect
visuospatial impairmemnt
emotional lability
behavior disturbance

strong gaze preference toward lesion side.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is homonymous hemiplegia

A

loss of vision of part of both eyes. like half of each eye. they need a behavioral optomitrist. What we call a field cut.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

if patient has a r brain infarct which side will they look to more

A

left side.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is emotional labile

A

inappropriate expression of emotion - like crying or laughing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Broca aphasia

A

trouble with expression, slow effortful speech, short phases less than 4 words. poor repetition ability, comprehension intact.

speech might be really slow and effortful.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Wernicke aphasia

A

receptive aphasia. A combination of real words and made up words.

paraphasias - saying words a little off that it actually should be.

neologisms - non words, made up words

poor comprehension and repetition

speech apraxia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is dysarthria

A

a motor articulation problem. speech is unclear or garbled. they can’t get the mouth to make the sounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is neologisms

A

made up words

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

with a patient with aphasia is it important to do your treatment how

A

in context.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

posterior cerebral artery infarct - where in the brain?

A

temporal and occipital lobes

primary visual areas, memory, visual spatial analysis, writing, & reading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what does the posterior cerebral artery impairment affect

A

Left - anomia, agraphia, acalculia, alexia, dyslexia

Right - cortical blindness
L/R discrimination errors
visuospatial impairments

Either hemisphere damage - contralateral hemiplegia and sensory loss

visual field cut
visual agnosia
memory loss

(look up these words, make seperate cards)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

vertebral basilar artery infarct affects what part of brain

A

pons, midbrain, thalamus, caudate nucleaus, lateral medulla, cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

deficits from vertebral basilar artery deficits

A

Loss of consciousness
brainstem or cranial nerve damage
hemi or quadriplegia
memory loss
agitation
comatose or vegetative state
locked in syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Patient scenario
Toni has is HIV+ along with stroke. multiple strokes, presents with more weakness in L than R. she’s has bilateral CVA’s (less common). She was depressed in rehab. uses a power wheelchair. LIves alone in accesable apartment. hospital bed, roll in shower. Wears bilateral AFO

What are some challenges with her as she ages impact on occupation?

What might be important home and community encironment adaptations

what activity adaptations that might be appropriate

A

modifying transfers, adaptations for loss of vision. strength, weakness, cognition, memory. She says she independent.

home and community adaptation - jar openers, easier to grip pots and pans.

activity adaptation - if there is a congntive deficity, timed medication dispenser.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Acalculia / dyscalculia

A

the inability or impaired ability to perform simple mathematical calculations previously mastered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Agnosia

A

the inability to recognize objects, persons, smells or sounds despite having normal sensory functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

agraphia / dysgraphia

A

the inability or impaired ability to produce written language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Alexia / Dyslexia

A

the inability or impaired ability to read written language despite preservation of other aspects of language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Aneurysm

A

a weakening of an artery wall resulting in a bulge or distension of the artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Anomia

A

the inability to name objects or persons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Anosognosia

A

An unawareness or denial of a neurological deficit that is clinically evident

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Aphasia

A

an acquired multimodality language disorder that results from damage to the language center of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

apraxia

A

The inability to perform purposeful actions despite having normal muscle function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

arteriovenous malformation

A

A tangle of abnormal blood vessels connecting arteries and veins without an intervening capillary bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Contracture

A

An abnormal shortening of muscle tissue rendering the muscle highly resistant to passive stretching. Typically results in permanent restrictions in joint motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Contralateral homonymous hemianopia

A

An ocular condition where vision has been lost in the same field halves of both eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Dysarthria

A

A speech disorder resulting from paralysis, weakness or incoordination of the muscles involved in speech production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Dysphagia

A

An eating disorder involving difficulty in manipulating and transporting liquids / solids from oral cavity to pharynx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

hemianesthesia

A

A loss of sensation in either half of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

spasticity

A

A velocity - dependent increase in tonic stretch reflexes. Also denotes a form of muscular hypertonicity with exaggeration of tendon reflexes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Subluxation

A

an incomplete or partial dislocation of a joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Occlusion of the internal carotid artery commonly results in

A

contralateral hemiplegia, hemianesthesia, homonymous hemianopia, changes in mental functions, and behavioral disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If the stroke occurs in the dominant hemisphere (i.e., hemisphere containing the representation of speech and controlling the extremities used to perform skilled movements such as writing and kicking a ball; the left hemisphere in the majority of individuals), the patient may also present with

A

aphasia, agraphia or dysgraphia, acalculia or dyscalculia, and apraxia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

If the nondominant hemisphere is involved, the patient may present with

A

visual perceptual impairments, unilateral body or spatial neglect, anosognosia, and dressing apraxia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

An occlusion of the anterior cerebral artery typically produces

A

contralateral hemiparesis and somatosensory loss, impacting the leg to a greater degree than the arm.5 Behavioral disturbances, apraxia, and mental changes—such as confusion, disorientation, decreased initiation, and impairments in attention and short-term memory—are often present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

The chart review reflects the patient had a L sided infact R sided hemiplegia and impairment of light touch, localization, pain and temperature in the RUE as the main impairments. Which type of CVA did they MOST likely have?
ACA, MCA, Lacunar, vertebral basilar

A

Lacunar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Lacunar Stroke symptoms

A

Pure motor, ataxic or sensory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What symptoms would be present with an Anterior Cerebral Artery ACA stroke

A

Contralateral hemiparesis—greater involvement of the leg and foot Contralateral somatosensory loss—greater involvement of the leg and foot Left unilateral apraxia Behavioral disturbances Mental changes Inertia of speech or mutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

The patient has a PMH of untreated HTN which lead to a weakened internal carotid A. Burst. Which type of CVA did the patient MOST likely have? Hemorrhagic or ischemic

A

Hemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which of the folowing is true about a tascient ischemic approach TIA.
A. residual dysarthria is common
B. symptoms completely resolve within 24 hrs
C. Residula memory loss is common
D. hemiparesis is more likely int he UE than the LE

A

B. Symptoms completely resolve within 24 hrs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

A clot that breaks away and travels to and lodges in a smaller vessel is known as which of the following?
A. Embolus
B. Thrombus

A

A. Embolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What might the clinical picture look like? Patient 1 - R MCA infarct, ischemic what side is the deficient

A

Left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

R MCA infarct, ischemic. Pt has neglect, visuospatial impairment, emotional lability, bahavior disturbance, contralateral hemiplegia & sensory loss, homonymous hemianopsia, strong gaze preference toward lesion side.
Wht are some things that you want to evaluate?

A

vision, balance - if it’s safe to do so, sensation, upper quarter screen - functional range of motion no goniometry. Barthel assessment, transfers and self care skills. Cognition - does he know where he is and does he know what happened to him. mini mental or inpatient rehab. Maybe texas if he has the attention for it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When doing an assessment of a person with CVA what are some things to consider?

A
  • location and type of brain infarct
  • factor co-morbidities including any prior CVA
  • consider treatment setting
  • client goals and preferences
  • social/premorbid status-living alone? driving?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting
What other information do we need to know?

A

PMH
sensations
how long ago was the CVA
What kind of home
do they live alone
are their steps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting

Which domains would you assess?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting

Which specific assessments would you use?

A

Cooking assessment. executive route finding task, texas, barthel, showering assessment with transfers and general pacing and impulsivity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting

Assessments for ADLs

A

Modified Barthel index shah
AmPAC 65 clicks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting

Assessments for UE

A

UQS
ROM
Strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting

Assessment for cognitive and perceptual

A

MMSE TFLS
SLUMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting

Assessment for trunk and posture balance

A

5 times sit to stand. time them. Tug - walk from one point to another, functional reach test - measure how far they can reach

MAR-R
Functional Reach
5xsit to stand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Patient: 47 year old single male L CVA R hemiplegia
Flaccid LUE
Nonambulatory; uses manual w/c
Expressive aphasia
In subacute rehab setting

assessment for overall

A

occupational profile, what the name of that semi formal assessment ??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Describe the pusher

A

Pt actively pushes toward the hemiparetic side

loss of postural balance and falling toward hemiplegic side

strong resistance to passive correction back to midlie

occurs in 10% of post CVA population

68
Q

which side to to you sit to if the patient is a pusher

A

the unaffected side

69
Q

What helps treat a pusher

A

constant moving. take the unaffected arm out of the equation. cross midline, come in and out of midline so their have to constantly think through midline.

disadvantage the non-hemi side so they can’t push in to that side.

a lot of movement in an out of base of support.

Closed chain movement with the involved side, arm and leg active.

treat both sides of the trunk and keep them moving

70
Q

With the hemiplegic arm we always

A

address the extremity and incorporate it into function

71
Q

hypotonia

A

low tone

72
Q

hypertonia

A

high tone

73
Q

What is the role of the hemi arm if the patient is brushing their teeth

A

it’s used as a support or in visual field

74
Q

Addressing shoulder pain in hemi arms

A

normalize tone - if we can normalize tone, that can normalize spasticity and that can help with pain.

proper handling - educate the family to not tug on the arm. Providing gait belts for home use.

address primary pain source - they might have arthritis on top underneath it all

A/AAROM

Functional use

shoulder support

75
Q

The key for sublexations is to

A

realign, mobilize and activate

reseat the humeral head. There are exercises we can give the patient. isometrics are a good way to help activate the rotator cuff muscles. Some patients can’t do isometrics if they are cognitively impaired.

76
Q

Shoulder slings: pros

A

protection, control, prevention - further over stretching, pressure relief, support, psychological message

77
Q

Shoulder sling: cons

A

learned nonuse
shortens soft tissue
dependence
immobilize
fails to correct malalignment
interferes with normal movement
interfers with function
blocks sensory input
hinders balance
psychological message

78
Q

look up barthel assessment

A
79
Q

In the acute stage of CVA what are the hospital setting priorities?

A

positioning, dysphagia management, fall prevention, early mobilization, beginning self care retraining, COTA role

80
Q

explain how you’d have a patient with a hemi arm lay sidelying?

A

have them reach arms into air to protract shoulder blade then role over.

81
Q

within the first 24 hrs people with stroke will have soft tissue contractures. What will help with this?

A

OT, early mobilization, doing ADLs, encouraging people to move. Teaching the family right away.

82
Q

What would the COTA role be with an early CVA

A

they can participate in some of the evaluation, they take on the treatments if the OTR hands it over.

83
Q

what would rehabilitation stage look like for a pt with a CVA

A

Restoring of compensating for performance skill deficits,
Maximize ADL and IADL independence
UE function
Valance
Functional mobility
Cognition and perception
COTA role

84
Q

which group of people would adaptive devices be hard for ?

A

people with apraxia

85
Q

what are the priorities for CVA in home and health environment recovery?

A

Maximize independence in IADLs
Build skills for return to work
Resume driving & community mobility
Promote engagement in leisure and socialization
COTA role

86
Q

Trunk represents how much of the human body mass

A

more than half

87
Q

weight shift within trunk is essential for

A

normal functional movement

88
Q

What is postural control

A

the motor act of maintaining, achieving or restoring a state of balance during activity

89
Q

balance in the core is directly related to

A

daily occupations

90
Q

balance is what two things in teh OTPF

A

client factor and performance skill

91
Q

higher balance score correlate with higher ________ scores

A

ADL

92
Q

functional reaching training positively influences __________ and ____________

A

trunk control and ADL performance

93
Q

what is the leading cause of fall?

A

impaired balance

94
Q

decreased occupation and independence may be a result of

A

balance deficits

95
Q

what are some signs of balance issues

A

sit to stand, trouble getting out of the chair, wide stance or gait. feet shuffling. sitting slumped over or bad posture

96
Q

Assessments of balance

A
  • chart review, PMH, vitals, gait belt
  • bedside screen - bed mobility - can they scoot, roll over, bridge.
  • Sitting balance - can they sit on edge of bed, can they reach out of their base of support.
  • standing balance
97
Q

static sitting balance fair

A

sitting unsupported without balance loss and without UE support

98
Q

dynamic balance

A

able to sit unsupported able to weight shift and cross midline maximally

99
Q

static standing balance

A

able to stand unsupported standing balance against maximal resis

100
Q

impaired trunk control can lead to

A
  • dysfunfunction in upper and lower extremities
  • potential spinal deformity and contracture
  • increased risk of fall
  • impaired ability to interact with the environment
  • visual dysfunction resulting form head / neck malalignment
  • decreased independence in occupation
  • decreased sitting and standing tolerance, balance, and function
101
Q

Trunk Control Test

A

examines four functional movements: roll from supine to the weak side, roll from supine to the strong side, sitting up from supine, and sitting on the edge of the bed for 30 seconds (feet off the ground).

102
Q

Trunk impairment scale A

A

assessment that evaluates motor impairment of the trunk after stroke. The tool scores static (3 items), dynamic sitting balance (10 items), and trunk coordination (4 items). It also aims to score the quality of trunk movement and to be a guide for treatment.

103
Q

Trunk Impairment Score B

A

This tool consists of seven items. Abdominal muscle strength and verticality items were derived from the Stroke Impairment Assessment Set, and the other five items consist of the perception of trunk verticality, trunk rotation muscle strength on the affected and the unaffected sides, and righting reflexes both on the affected and the unaffected sides.

104
Q

postural assessment scale for stroke patients

A

Assessment that includes items related to trunk control. Scale contains 12 4 pt items. higher the score the better the function. things like sitting and standing without support.

105
Q

The Chedoke-McMaster Stroke Assessment

A

is used to assess physical impairment and disability in clients with stroke. It has two components including the Impairment Inventory (which determines the presence and severity of physical impairments in the six dimensions of shoulder pain, postural control, and arm, hand, foot, and leg quantified in a seven-point staging system) and the Activity Inventory (which measures the client’s functional ability). The Activity Inventory has two components: the Gross Motor Function Index (with items including moving in bed and transferring to a chair) and the Walking Index (with items including walking on rough ground and climbing stairs).

106
Q

Balance assessment

A

modified functional reach test
functional reach test
five time sit to stand test

107
Q

Less used balance assessment

A

time up and go test TUG
Berg Balance Test

108
Q

how do we intervene for balance

A

Create an individualized plan that addresses cause of balance impairement

remediation
compensation
adaptation

109
Q

What parr of the nervous system does Guillian Barre affect

A

peripheral nervous system

110
Q

what the difference between guillian barre and MS

A

they both deal with demylination but GB can have a full recovery, MS is progressive and no cure

111
Q

Are the issues in Guillian Barre asymetrical or symmetrical

A

symmetrical

112
Q

When does Guillian BArre plateau?

A

1-4 weeks after initial onset

113
Q

Sometimes Guillian Barre can affect the

A

respiratory system

114
Q

What are the neurological signs?

A

numbness or loss of sensation, tingling, paresthesias, progressive muscle weakness, sympetrical ascending weakness, ANS involvement.

In severe cases: Orthostatic dizziness
Bowel & Bladder (incontinence)
Cardiac Symptoms

115
Q

What disorder is this? Glove and stocking sensory loss, symmetrical ascending paralysis starting with feet, absence of deep tendon deep tendon reflex

A

Guillian Barre

116
Q

Causes of Guillian Barre

A

Preceding GI or respiratory infection with diarrhea 4 weeks prior in 40-70% of cases (Brooks, 2014)

Immune system attacks myelin, axons of PNS

Bacterial or viral illness with Cytomegalovirus provoking immune mediated nerve dysfunction

117
Q

phases of Guillian barre

A

Onset or acute inflammation
Plateau phase
Progressive recovery phase

118
Q

Describe onset or acute inflammation stage of Guillian Barre

A

first stage. Manifests as weakness in at least 2 limbs that progresses and reaches its maximum in 2-4 weeks
Accompanied by increasing SX
Mechanical ventilation needed for 20-30%

119
Q

Describe plateau phase

A

No significant change in progression
Lasts for a few days or a few weeks when greatest disability is present

120
Q

describe progressive recovery phase of GB

A

Remyelination and axonal regeneration occur and may last for up to 2 years
Recovery starts at head and neck and proceeds distally
50% of patients have complete functional return
35% have residual weakness that does not resolve
Remaining 15% have significant permanent disability

121
Q

what are the assessments used for Guillian Barre ICU - rehab

A

Motor - UQS, manual muscle testing, pinch and grip, maybe goniometry
Sensory- sensation testing (all modalities)
ADL - barthel, AMPAC 6 click, function observation and noting of what type of assist - driving assessment.
cognition - SLUMS, mini mental, texas, MOCA, cognitive performance test, KTA, CPT
Coordination - 9 hole, functional dexterity, box and blocks
Balance - Modified FXL reach, 5xsts, TUG
Other? - Dysphagia, feeding assessment

122
Q

Where do interventions start with GB?

A

Muscle and joint function
Length, strength & ROM
Intercostal & abdominal muscle function
Controlled deep breathing, bridging, rolling exercises, sitting, standing
Intrinsic hand muscles; last to recover
ADL’s
Persistent fatigue, address energy conservation with carefully graded activities

123
Q

For Guilliane Barre, what muscle strength do you have to wait for you do resistance activity

A

3+/5

124
Q

When Guilliane Barre strength is only 1/5 what do you do

A

PROM, muscle reducation but do not over tire muscles, use mouth stick if pt can tolerate

125
Q

for Guilliane barre what do you do if there strength is 2/5

A

Gravity eliminated only. deltoid aid, arm skateboard, mobile arm support on WC.

126
Q

when Guilliane barre muscle strength is 3/5 what do you do

A

No resistive exercise, AROM antigravity, use dowel exercises of SH and elbow in supine. use long opponens splint

127
Q

if guilliane barre muscle strength is 3+-5 what can we do?

A

graduated resistive exercises when muscles consistently test 3+/5, strengthen wrist flexors and extensors, strengthen hand muscles.

128
Q

what would be good hand wrist extensor strengthening exercises for GB

A

twisty thing, light weight over a wedge or edge of table.

129
Q

Treatment ideas for a person with GB

A

Build fine motor skills, dexterity and hand strength

energy conservation and activity pacing

sensory retraining, mirror therapy compensatory strategies to protect skin

functional mobility

breath control with activity

self care

IADLs

compensatory skill building and equipment

congnition training graduated resistive exercise when muscles test 3+/5,

static dynamic balance in sitting and standing

130
Q

What is dyphasia?

A

Dysphagia means swallowing difficulty

131
Q

How does OT treat dysphasia?

A

Self feeding
Cognition & perception
Sensory and motor skills
Postural control
Altered swallowing mechanism (advanced dysphagia training

132
Q

diagnosis that could lead to dysphagia

A

Cancer of the head & Neck
CVA
TBI
Parkinson’s Disease Dementia
MS
CP
ALS
SCI
Pneumonia

133
Q

Oral preparatory stage of swallowing

A

Voluntary - Food is received and contained in mouth
Preparation of the bolus with the aid of saliva, good lip seal, jaw movement and chewing
Buccal muscles contract to prevent food from pocketing

134
Q

Oral Stage of swallowing

A

During the Oral stage, the tongue elevates and rolls back, sequentially contacting the hard and soft palate, moving the bolus backwards

135
Q

What are oral stage impairments

A

Difficulty manipulating food and liquids in and through the mouth.
Chewing of solid food may be affected.
Weakness and discoordination of tongue movements is commonly seen in oral stage swallowing.
Tongue does not propel the food towards the throat efficiently.
Drooling
Loss of food or liquid from the front of the mouth
Pocketing of food in the mouth/cheeks
Prolonged or ineffective chewing
Poor intake, or weight loss

136
Q

Pharyngeal phase

A

Involuntary stage
Soft palate elevates to close of nasopharynx
Preventing food from escaping into the nose
Tongue base moves back to contact pharyngeal wall
Larynx (voice box) & hyoid bone move up and forward
Epiglottis (top part of larynx) is tilted down and back to guide the food past the airway
Vocal cords close
Bolus is propelled through pharynx
Breathing momentarily stops
Vocal folds come together to further protect airway
Muscles of the pharynx contract Peristalsis (a wave of contraction) moves the food through the esophagus
The lower esophageal sphincter relaxes to allow the food to pass into the stomach
Food passes into the esophagus

The pharyngeal stage lasts approximately 1 second

137
Q

Pharyngeal stage dysphagia or impairments

A

Coughing at meals
Frequent throat clearing
Wet/ gurgle vocal quality
Runny nose/watery eyes
Temperatures after eating/drinking
Delayed swallow initiation
Frequent bouts of pneumonia/bronchitis
Shortness of breath when eating/drinking
Temperature spikes after meals

138
Q

Esophageal phase

A

There is dysfunction of peristalsis (contraction wave) which normally squeezes food from the esophagus into the stomach.
Individuals feel food “stuck” at some level
Related to neurological disorders, mechanical problems (obstructions such as cancer or strictures) or specific motility problems with the esophageal muscles
These may also be seen with aging

139
Q

impairments in the esophageal stage

A

Sensation of food sticking in the chest area or throat
Difficulty swallowing solid food
Heartburn
Drooling
Regurgitation
Unexplained weight loss
Change in dietary habits
Gastroesophageal Reflux Disease (GERD)
Zenker’s Diverticulum
Esophageal dysmotility or stricture

140
Q

how are swallowing disorders diagnosed?

A

FEES (fiberoptic endoscopic ecaluation of swallowing)

141
Q

what is aspiration

A

anytime the person is swalowing and material enters the laryngeal space and falls below the vocal cords and enters the trachea - usually creates a cough

142
Q

what is penetration (swallowing)

A

material enters the larungeal space but does not fall belwo the level of the vocal cords

143
Q

silent aspiration

A

patent lacks sensation (does not cough) in response to aspiration.

144
Q

Implications of dysphagia

A

poor nutrition or hdration

risk of aspiration, which can lead to pneumonia and chronic lung disease

less enjoyment of eating or drinking

embarrassment or isolation in social situations involving eating.

145
Q

what does a nosey cup do?

A

it has a cut out for the nose so the pt doesn’t have to tip their head back

146
Q

Why do we need to think about positioning

A

positioning can help alleviate pain, respiratory and swallow function, poor posture can lead to poor self esteem and will limit how they interact with the environment

147
Q

Symptoms that can affect positioning of a patient

A

abnormal tone

weakness

ataxia/apraxia

cognitive deficits

sensory deficits - can’t feel the need to weight shift

vision deficits and midline orientation they may think they’re upright.

148
Q

Goals for posture

A

postural alignment
postural support and stability
pressure distribution
pressure relief
function

149
Q

position checklist for seating in wheelchair

A

pelvis
Trunk
Head
Lower Extremities
Back Height
Seath Depth
Lower Leg Length

150
Q

Chronic pain

A

pain that lasts 3 months or longer.

151
Q

Fibromyalgia

A

widespread pain with tenderness & stiffness. Independent of an injury or lesion. Etiology unknown. Abnormalities in CNS pain processing suspected. Dianoses of exclusion.

152
Q

Acute pain

A

more specific, pain is a symptom. well defined time of onset. pathology is often identifiable

153
Q

Neuropathic pain

A

due to damaged peripheral or central nervous system and sensations.

154
Q

Management of chronic pain occurs

A

in conjunction with typical OT assessments and interventions such as UQS, ADL assessment etc.

155
Q

What are questions to ask about pain

A

can you describe it
where?
how long?
what do you do that helps?
What do you do that makes it worse?
Do you take anything for the pain?

156
Q

pain assessments

A

visual analog scale
pain disability index
brief pain inventory - short or long version
observe during functional tasks

157
Q

Brief pain inventory

A

self report likert scale - short version or long. 0=no pain, 10=worst pain ever. pain indicated on anatomical diagram

158
Q

aging in place

A

using design, strategies and modifications to keep patients in their own homes.

159
Q

you can be certified in ageing in place through

A

national association of home builders, New York State has resourses on website,

160
Q

Aging in place assessment

A

Home safety self assessment - determine the need of home modifications and needs, pt and caregiver training.

161
Q

What are the 3 main things that can really help a patient make their home more accessable

A

Door handles that are handles rather than knobs.

LED lights so that they are bright.

Rocker wall switches

162
Q

Neuro technology can help rehabilitate

A

-Motor control & performance
-Gross & fine motor coordination
-Functional movement patterns
-Cognition
-Sensory stimulation

163
Q

Neuro technology can help

A

make treatment more efficiently and quickly.

164
Q

ipad use with recovery

A

Self care (grooming, dressing, bathing, hygiene)
IADLs (feeding pets, cooking, shopping, money management)
Cognitive and perceptual skills
Fine motor skills

165
Q

IPad apps for fine motor

A

dexteria
angry birds
labryinth
bubble pop

166
Q

benefits of robotics

A

Reduces therapist strain
Task repetitive dosing
Technical precision and accuracy
Collects objective data about pt. performance
Enhances motivation
Offers precision in desired movement patterns

167
Q

Lacunar Infarct

A

Small holes in deep cerebral hemisphere, pons, or basal ganglia
Smaller vessel blockage
Pure motor, ataxic or sensory loss
Good prognosis

168
Q
A

OTH 611 Adult Phys Rehab (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions