All remaining lectures - except cognition not included Flashcards
1
Q
some of the biggest challenges with working with pts with TBI is
A
permanent cognitive and behavior issues, emotional state, mood changes, communication
2
Q
what does walking wounded mean
A
their motor function and physical states are ok, but cognitively and behaviorly they are not (TBI)
3
Q
top 2 causes of TBI
A
transportation (ex: car, boat, plane)
falls
4
Q
1 cause of TBI for pts 75 and up
A
falls
5
Q
gunshot wound, stabbing, or skull fx would be an ex of what type of TBI
A
open
6
Q
skull fx is an ___ TBI
A
open
7
Q
___TBI’s result from acceleration or deceleration forces
A
closed
8
Q
what is coup countercoup
A
closed TBI,
Coup injury: brain hitting front part of skul
lContracoup: brain hits front part then suboccipital region (axon shearing occurs)
9
Q
not skull, but rather the brain itself….what part of the brain is effected in coup coutner coup
A
anterio-inferior temporal lobes and prefrontal cortex
10
Q
4 classifications of TBI
A
- focal
- diffuse
- hypoxic
- hematoma
11
Q
what is a focal TBI
A
a local one, can cause local swelling or hematomas
cause a mass shifting effect (swelling, blood collection, smushing ventricles and brain tissue)
12
Q
what does DAI mean
A
diffuse axonal injury
13
Q
FOCAL hematomas cause
A
a mass shifting effect (swelling, blood collection, smushing ventricles and brain tissue)
14
Q
explain diffuse TBI
A
Shearing and retraction of axons
Can cause coma = poorer outcome
15
Q
why is a diffuse TBI often a problem to dx
A
DAI may or may not show up on imaging! (there is just edema, no collection of blood)
16
Q
this type of TBI is often caused by drowning, it is
Due to systemic hypotension, anoxia, vascular damage
Can lead to global damage
A
hypoxic, aka ischemic
17
Q
3 main types of hematomas (TBI classification)
A
epidural
subdural
intracranial
18
Q
this type of hematoma is located btwn your skull and dura mater
A
epidural
19
Q
this type of hematoma is often arterial – quick developing
A
epidural
20
Q
with a(an) _______hematoma there is usually a period of normal function, and then quickly there is N/V and UMN sx
A
epidural
21
Q
hematomas are classified according to
A
where the bld collects
22
Q
elders that are on blood thinners that fall and hit their head are prone to ___ hematomas
A
subdural
23
Q
subdural hematomas effect what type of BV
A
venous
24
Q
Venous
Develop slowly, over time
UMN signs and confusion
which type of hematoma
A
subdural
25
main form of secondary damage from a TBI
increased ICP
26
seizures typically occur when after a TBI
Tend to occur immediately after injury and 6 mo – 2 years after
27
normal ICP
Normal ICP = 4 – 15 mm HG
28
imaging that is best for TBI
MRI (CT's don't show the bleeds very well)
29
other testing for TBI
neuropsychological/cognitive
30
standard testing measurment for tx of TBI (not imaging, ut rather an OM)
glascow coma scale
31
a score less than ___ on the gloscow is indicative of poor long term prognosis
8
32
The most commonly used scale for pts in or coming out of a coma = predictive of longterm functional outcome
glascow coma scale
33
glascow ratings
3 – 8 = severe brain injury
9 – 12 = moderate brain injury
13 – 15 = mild brain injury
less than 8 not great
34
3 components of glascow
eye
verbal
motor
35
another common OM for TBI
rachos los amigos
| based off of assistance needed
36
ranchos levels 1-3
I: No Response. Deep sleep. (true coma) (doesn’t even respond to px) Unresponsive to any stimuli.
II:Generalized Response. Reacts inconsistently and nonpurposely in a nonspecific manner. (they don’t change with you if you mix things up)
Respsonses are limited and the same regardless of stimuli.
III
Localized Response. Reacts specifically but inconsistently. Responses relate to the stimuli presented.
May follow simple commands.
37
goals for pts in level 1-3 of ranchos
Increase level of alertness and arousal
Prevent secondary impairments
Improve motor control
Facilitate normal muscle tone
Increase tolerance of positions and activities
Educate family members- to help arouse the pt
Coordinate care among all team members and family
il
38
decerberate posture is what
ext of upper and ext of lower
39
decorticate posture is what
flexed upper, extended lower
40
what is the significance of decerberate or decorticate in regards to tx
we want to position them opp of what the pattern is
41
when doing any form of sensory stimulation, always document what
what type of stimulation you are using, how the pt responded
42
what types of pt response will you document with sensory stimulation
vitals, eye opening, grimacing, arousal, head turning
43
types of sensory stimuli
tactile, olfactory, auditory, vestibular, gustation, kinesthesia (ROM)
44
```
Heightened state of activity.
Bizzare and nonpurposeful activity.
Unable to cooperate with treatment.
Verbalization often incoherent and/or inappropriate.
POOR attention
```
this is what Ranchos level
4 -aggitated and confused
45
what to be mindful of with ranchos level 4
dont overstimulate them, they are aggitated and confused.
| calm down their surroundings
46
goals for ranchos level 4
Prevent outbursts of agitation
Assist patient in controling behavior
Patient’s safety is assured (and that of therapists and family)
Family members understand what to expect at this phase (it’s typically temporary)
Maintain (or increase) physical activity tolerance
Prevent secondary impairments
Coordinate care among all team members and family
47
frustrating aspect of level 4 ranchos
they have no carry over of the session - no memory recall. always have to start over
48
often times, pts in level 4 ranchos have to be monitored how often
24/7 (they may have to be restrained)
49
level 5 ranchos is what
confused, inappropriate
50
explain level 5 ranchos - Confused inappropriate
Able to respond to simple commands fairly consistently.
With complex commands, responses are non purposeful.
Highly distractible and poor attention!
Impaired memory!
51
explain level 6 (ranchos) - Confused appropriate
Needs external direction to complete tasks.
| Follows simple directions well and has some carryover.
52
goal differences with levels 5/6 compared to the others
these pts are often mobile, so keeping them safe as they get around is an issue
53
goals of levels 5/6 ranchos
Increase function, balance, and ADL performance
Improve motor control
Improve impairments (strength, ROM)
Patient’s safety is assured
Family members understand what to expect at this phase
Increase physical activity tolerance
Coordinate care among all team members and family
54
with pts with 5/6 ranchos, is blocked or random practice better
do blocked and give them lots of breaks. there is still cognitive issues
55
level 6 is called (ranchos)
confused appropriate
56
level 7 is called (ranchos)
automatic appropriate
57
level 8 is called (ranchos)
purposeful appropriate
58
robot like is what ranchos level
automatic appropriate (7)
59
only Ranchos level that observes and responds to changing env
8
60
4 components of UE function
Locate target
Reach
Grasp
Manipulate
61
locate target, as a component of UE function, requires what 2 things
vision
| eye head coordination
62
opening of the hand occurs in what component of UE function
reach, it is called aperature
63
role of arm in reach is
place hand in position for function; transportation
64
role of hand in grasp
interact with the env
65
2 types of grip
power -whole hand
| precision- fingers
66
manipulation component of UE function is considered ___ mvmt
fractionated, well coordinated (independently working fingers)
67
posture/stability is most important in what component of UE function
reach
68
the key to successful UE function
variability
69
visual neglect and visual extinction are issues with what component of UE function
locating target
70
visual neglect and extinction usually occur dt lesion on what side of braint
more often associated with R hemisphere strokes
71
eye-head or eye/head/hand coordiation issues that occur with locating a target component of UE function, usually are due to ___ or ___ issues
cerebellar
| vestibular
72
problems with reach include
timing (slower)
coordination (cerebellar dysmetria)
decomposition (they flex shoulder 1st then ext elbow - normally these should occur together)
73
involuntary movement of hemiplegic limb when other limb moves (problem with UE reach)
global synkinesis
| Due to B excitation of cortex and reduced inhibition of opposite hemisphere
74
stroke spacticity (in regards to UE function issue) correlates to _
correlates to movement time and amplitude, but NOT interlimb coordination measures. Interlimb is cerebellar only.
75
the lack of coordination after stroke is the same as the lack of coordination with cerebellar issues (T or F)
F
76
inability to reach in space despite intact motor function, vision, and somatosensation. leads to poor grasp and
Poor visual control of hand
optic ataxia - issue with reach
77
Slowed reach and grasp
Smaller max aperture
Longer time to max aperture
Increased variability in aperture and scaling
Slower and less accurate movements
Poorly modulated fingertip forces
Scaling
Reduced ability to fractionate movement
Stroke vs PD in regards to grasp issues, which group is stroke and which is PD
Slowed reach and grasp
Smaller max aperture
Longer time to max aperture
Increased variability in aperture and scaling -------PD
Slower and less accurate movements
Poorly modulated fingertip forces
Scaling
Reduced ability to fractionate movement ------ stroke
78
ability to grasp is usually done within ___ days post stroke
recovery of - within 90 days
79
probs initiating mvmt in grasp is stroke or PD
PD
80
what effects release in stroke pts (UE function)
probs extending UE
81
with PD, release prob is
slowed
82
main probs with UE motor function dt stroke
Visual field deficits limit reach
Poor UE control leads to compensatory trunk motion
Synergistic movement leads to poor fractionation
Poor scaling of forces
83
main probs with UE motor function dt cerebellar issues
Problems with visual tracking and
| Poor inter-limb coordination
84
main probs with UE motor function dt PD
Problems with speed and initiating movement affects quick reach/grasp
85
key consideration when tx pts with UE motor function issues
Train proximal and distal segments simultaneously
| Don’t wait for proximal control to emerge before distal control
86
apraxia
inability to perform purposeful actions
| inability to carry out skilled movement in the presence of intact sensation, movement and coordination
87
when tx pts with manipulation issues, start with ___ grip then move to ___ grip
start with power move to precision
88
ex of progressing from easier to harder with manipulation tasks/fractionation
items with friction or many points of contact to smaller, smoother surfaces
89
how would a stroke pt using a power grip release an object
flexing wrist
90
4 important aspects of CIMT
has a positive effect on neural plasticity
amount of practice is the key, not the restraint!
for patients with at least 10 degrees of wrist extension
Not recommended in first month post-stroke
91
loss or impairment of language skills in adults who have had a history of normal language skills. The loss or impairment is associated with recent
cerebral pathology or trauma.
aphasia
92
dysphagia
trouble swallowing
93
dysarthria
motor speech prob
94
Damage to the posterior superior left temporal lobe would cause ___ aphasia
```
wernicke (can't comprehend and integrate info)
fluent aphasia (receptive aphasia)
```
95
Alexia: disorder of ___
Agraphia: disorder of ___
Acalculia: disorder of ___
alexia - reading
agraphia- writing
acalculia -math
96
non fluent aphasia characteristics
they comprehend what is coming in auditoriliy, but cannot form the words to speak properly
97
Broca's aphasia is ___ (fluent or non)
non fluent (or expressive)
98
brocas aphasia is damage to the
(ant to the fissure) central sulcus
99
modalities of communication
input: reading and hearing
output: speaking gesturing, writing
100
wernickes is sometimes called ____
sensory aphasia (coming in is hard to interpret)
101
anomia
word retrieval issue (issue with Wernickes)
102
circumlocution
talking around something (issue with Wernickes)
103
substitutions of unintended sounds for
| intended sounds in words
literal or phenomic paraphasia
104
a type of language output error commonly associated with aphasia, and characterized by the production of unintended syllables, words, or phrases during the effort to speak
paraphasia
105
Combination of consonants and vowels with
| appropriate syllable structure and inflection to create new words
neologisms paraphasia
106
pt believes he's speaking the correct way and doesn't understand that others dont understant him
jargon paraphasia
| occurs with Wernickes
107
word error, words chosen are semantically related
Ex: Pt wants to tell you he rode in a car to the clinic but he uses the word train instead (the words are related but not accurate)
verbal/semantic paraphasia
108
diet modifications for liquids include these
```
Thin
Nectar- like
Honey- like
Spoon Thick
Formerly “Pudding thick”
```
109
diet modifications for solids include (for dysphagia)
```
Solid Consistencies
NDD1: Dysphagia Pureed
NDD2: “ “- Mechanical Altered
NDD3: “ “- Advanced
Regular
```
110
what is perception
HOW brain understands what it see’s, feels, smells, tastes &; hears
111
State of responsiveness to sensory stimulation or excitability.
Terms: awake, alert, asleep, groggy, attending
arousal
112
Deficit in new learning; inability to recall information learned after brain
damage
anterograde amnesia
113
Ability to deploy mental resources for purposes of concentration
attention
114
perception comes from the ___ lobe which is often what is effected with pushers syndrome
pariatal
115
what are similarities btwn pushers and traditional stroke pts
motor function impairment matches other stroke pts., other stroke pts can have perceptual deficits also, the one thing that is different is the muscle activation on the non effected side (typically pts post stroke will lean to their “good” side not the “bad” side like pushers).
116
when will the pattern of pushing be at its greatest (what task)
when they are in standing (they push harder when they have more muscles working).
In addition, they resist any passive correction
117
pushers syndrome occurs typically with a ___ sided stroke
right sided stroke (so left body effected)
| with severe hemiplegia (sensory and motor deficits)
118
explain the basics of what happens with pushers syndrome
a sense of imbalance causes the uninvolved limbs to push actively away from the uninvolved side (leaning towards the "bad" side), resulting in a loss of balance to the hemiparetic side
119
typical limb behavior of pushers syndrome (what position)
ext and abd of uneffected side
120
pushers is not an impairment of ____ or ____
not an impairment of cognition, visual/vertical (no impairments of perception from their visual world)
121
Patients with pusher syndrome perceive their body position to be, on average, ____ toward the ipsilesional side.
18 degrees towards the same side the stroke was on in the brain
122
3 characteristics that are listed in the scale to dx pushers syndrome
spontaneous body posture,
abd/ext,
resistance to passive correction of tilted posture
123
4 phases or goals of tx for pushers
4 phases of txgoal 1: help the pt recognize they are pushing
Goal 2. help them compare their posture to things around them so they know that they are off
Goal 3: help them correct the position
Goal 4: maintain the position during functional activity
124
to help correct pushers syndrome, what is a good plan of progression of tx
Start in seated postures, put hands in lap or in the air to prevent the abiity to push, or even constrain UE,
125
if you used a wall to tx/correct pushers syndrome, you would have them lean against the wall on their ___ side
have them lean against a wall on their “good” side (not impaired, bc you want them to feel it) – give them a target to lean to
126
way kirsten mentioned on how to correct/tx pushers on the mat
position them on their good elbow as they lean to the “good side” on the mat and this breaks up the pushing pattern
127
if you were doing wt shifting ex with pushers, you have them lean towards their ___ side and back to midline over and over (to correct)
towards good side then back up
128
early on transfers for pushers you would do ___
scoot transfers
in the clinic you would have them lean/transfer towards their "good" or unimpaired side, at home transfers you would have them transfer towards their impaired side
129
typical stroke pts, we have them transfer to their ___ side almost always
unimpaired
130
which aphasia presents with the patient talking Jargon or jibberish
wernicke's
| comprehending language
131
aphasia can be brought on by ____ (list)
```
suddenly-with a stroke
gradual- tumor growth
can occur with other disorders: Dysar thria
Apraxia of Speech
Cognitive Disorders
Dysphagia
```
132
wernickes aphasia is caused by damage to what three areas of brain
Fissure of Rolando: posterior to central sulcus
Temporal lobe of the left hemisphere
Temporal- parietal lobes
133
where is wernickes area located
posterior superior left temporal lobe (damage causes fluent aphasia)
134
Anomia: word ret rieval/finding difficulties
Circumlocution: describe or talk around something
Paraphasias:
Literal/Phonemic
Verbal/Semantic
Neologisms:
Jargon
these are all issues with what type of aphasia
Wernickes
135
with wernickes aphasia, do pts have more trouble with propositional or non propositional language
propositional - novel (not automatic)
136
effortful, slower speech in indicative of what aphasia
non fluent
137
where is brocas area
directly in front of the motor cortex, left frontal lobe
138
global aphasia
Combo of fluent and Non Fluent aphasia
More severe form of aphasia
Usually caused by occlusion of the left MCA
Diffuse damage to the temporal, frontal, and parietal lobes
Severe impairment s of comprehension, integration, and
formulation of language
139
When using vision, aperature size is
barely larger than object size (much greater without vision)
| without vision we don't have precision of aperature
140
For UE dysfunction, Difficulties locating a target can occur due to problems with ___ and___
ision and impairments of eye-head-hand coordination
141
with stroke, cerebellar dysfunction and PD, what are the issues with reach
Stroke: compensation with trunk movement
Cerebellar: slowed reaction and movement times
PD: slower reaching times
142
how might a pt with cerebellar dysfunction compsensate their reach
Decomposition
Initially flex shoulder then extend elbow
With normal reach, shoulder and elbow joints move simultaneously and are well timed in respect to one another
143
hemiplegia vs hemiparisis
hemiplegia-paralisis on one side
| hemiparisis- weakness on one side
144
alexia, agraphia, acalcula are associated with which apsasia type
Wernickes (fluent)
145
anomia, circumlocution, and paraphasias are associated with which type of aphasia
Wernickes
146
in summary, explain comparison btwn Wernickes and Brocas aphasia
Brocas - they are able to still communicate, and most of the time be understood, they just use simple words or phrases to get their point across.
Wernickes- they have more trouble. They often cannot be understood (bc of jibberish or jargon).
Global is a combo of both (it's the worst kind)
147
an external device worn to restrict or assist motion or to transfer load from one area to another
orthosis
148
a member of the health care team who designs and fabricates orthotic devices, and evaluates patients for devices
orthotist
149
essential components to any task (each component can be altered somehow by an orthosis)
progression
stability
adaptability
150
how can progression be altered by an orthosis
PF can be restricted preventing push off
151
can can stability be altered by an orthosis
balance can be compromised
152
how can adaptabilty be altered with an orthosis
uneven surfaces can throw off a person's ability to adapt
153
overall, what is the primary purpose of an AFO
control foot in saggital plane : prevent foot drop
154
the more anterior the trim line of the AFO, the more support/stability occurs ____
medial and laterally
| prevents medial lateral translation
155
post stroke, do we want to prevent inversion or eversion
inversion (we don't want that synergy pattern)
156
secondary aims/goals of AFO's
prevent medial lateral translation of foot
| support the knee
157
pros and cons of plastic AFOs
Benefits:
Interchangeable with different shoes
Relatively lightweight
Good motion control
Limitations:
Hot
Take up space in shoe
158
with plastic AFO's, what must be a feature of the shoe
must have removable inserts
159
pros and cons of metal upright AFO's
Benefits:
Accommodate changing limb volume
Cooler
Limitations:
Patient restricted to one pair of shoes
160
what would determine whether we recommend for the orthotist to lock the AFO in PF or DF
PF helps to support the knee bc it creates ext at the knee,
if the pt has weak quads, we want to keep knee extended = put in PF
161
Thin, narrow shell allows some motion at ankle
Stance: calf shell moves forward over footplate
Swing: calf shell “springs back” to facilitate foot clearance
allows for more motion at the ankle.
pts movement and body wt provide more flexible movement.
dorsiflexion assist can be built in to this one.
Less stable for pts with spaciticity (doesn’t control medial lateral movement)
this describes what AFO
post leaf spring (PLS)
162
PLS (post leaf spring) AFO prob not appropriate for what pts
highly spastic
| better for lower tone
163
describe the articulating AFO, and how the joint functions or compensations that may occur
This has a PF stop (post stop limits PF) these pts have to bend their knee to compensate – which puts the pt at risk of buckling the knee
164
articulating AFO's, 2 main features of the joints and what they assist or prevent
Screw to stop motion- stops PF
| Spring to assist motion – aids DF
165
This AFO would be a good choice for a pt with ankle and knee weakness. This AFO has no joints, but it has the knee strap. This AFO provides: dorsi assist, and high trim lines in the medial part of foot to controls subtalar motion
non articulating
166
what features in an AFO would help prevent M/L translation of the foot
strap at the ankle, high ant trim lines around the foot,
167
How might a traditional AFO (solid or hinged) assist with knee control?
these aim to prevent knee buckling bc they are set in PF
168
AFO that is often used for children with CP and adults with spasticity.
Foot plate and upright put pressure on PF and ankle invertors to reduce tone
tone reducing AFO's
169
what pts might you use a KAFO with
benefit for SCI pts, or pts with paralyisis of the LE
170
overall aim of a KAFO
prevent knee flexion (buckling)
171
main limitations of KAFO's
bulky and heavy
172
typically, would pts post stroke be good candidates for KAFO
no, these require B upper body strength
173
explain the 2 locks of a KAFO
Drop lock puts knee in into extension
Bail lock allows them to back up to a chair and then it buckles so they can bend
174
hip, knee, ankle afo benefits/limitations
benefits: stability
limitation: not functional, to bulky
175
Type of HKAFO that allows for unilateral stepping
| Posterior + lateral weight shift to one side advances opposite LE
reciprocating gait HKAFO
176
what should we take into consideration when recommending features of a device to an orthotist
Strengths/weaknesses, ROM, spacticity, muscle tone, sensation (dt skin break down)
177
hinge vs solid stop brace
Hinge brace is better for pts who’s quads are already strong, if quads are weak then solid stop.
178
inability to identify or recognize familiar objects & people,
visual system is intact;
parietal lobe damage
i.e. cannot find shoes in closet
visual agnosia
179
cannot ID familiar faces
prosopagnosia
180
R-L discrimination (don’t understand & use concepts of R and L)
bilateral problem assoc with L hemisphere damage
These pts ave difficulty following directions about how to get from one place to another
visual spacial perceptual deficit
181
extensive neglect syndrome
| pt fails to recognize one’s paralyzed limbs as one’s own
anosognosia (they may even mention wanting it removed from their body)
182
Motor Planning Perception /praxis occurs where in brain
L hemisphere (parietal lobe)
183
ability to rapidly conceive of and plan motor acts in response to the environment
praxis
184
inability to carry out skilled movement in the presence of intact sensation, movement and coordination
apraxia
185
apraxia is the Disturbance of two basic functional cognitive processes that allow us to act in the world, what are these 2 processes
Planning – purpose (conceptual)
| Execution – output (production)
186
explain what occurs (functionally) with apraxia
Generally patients spontaneously can use extremity for everyday tasks: Eating, shaving, opening door
However, when asked to pantomime or carry out a series of steps – performance is not correct or smooth in execution.
187
inability to attach meaning to somatosensory information
tactile agnosia
188
inability to identify objects by touch
asterognosis
189
explain sterognosis testing
occlude vision, use hands to identify common objects
190
4 phases of swallowing
Oral preparatory phase
Oral phase
Pharyngeal phase
Esophageal phase
191
what levels of ranchos scale would be appropriate for out pt
7 and 8
1-3 is acute
4-6 in patient
192
a type of language output error commonly associated with aphasia (usually Wernickes), and characterized by the production of unintended syllables, words, or phrases during the effort to speak, includes
Literal/Phonemic
Verbal/Semantic
Neologisms
paraphasia
193
with apraxia, do they have intact sensation, movement and coordination
yes, they can spontaneously perform tasks that utilize all of these components, they just cant pantomime or carry out a series of steps if asked to – their performance is not correct or smooth in execution.
194
reciting the ABCs is what type of speech (propositional or non propositional). Which type is the issue with Wernickes aphasia
ABC's is non propositional, it's automatic
| Wernickes aphasia has issues with propositional -or needing to come up with conversation on their own
195
Broca's aphasia is (fluent vs non) (expressive vs sensory/receptive)
BNE
| Broca's/non/expressive
196
SCI or paralysis, what type of orthotic device is best
KAFO
197
pt with high spacticity what AFO should you avoid and what ones would be good
Spasticity – need to do traditional plastic afo with high ant trim lines
Tone reducing AFO is good for spacticity
PLS (post leaf spring not good for spasticity)
198
Which AFO has a solid plastic frame with no joint at the ankle, they have high trim lines for M/L support = very stable
non articulating
