Carrie CNS Flashcards
Seizures definition
Spontaneous uncontrolled abnormal discharge of neurons in the brain
Seizure causes
Primarily idiopathic
Secondary to cerebral scarring from head injury, birth trauma, or infection
Generalized seizure
Petite mal
Absence seizure
Grand mal
Tonic colic seizure
Seizure
status elipticus?
Status elipticus is a seizure that does not stop spontaneously
Massage treatment considerations for seizure
May perform on floormat if seizures involve large uncontrolled movements
Remove objects in vicinity
Keep pillows nearby in case seizure occurs
Hemiplegia definition
Non-progressive condition of paralysis on one side of the body as a result from a CNS lesion
Hemiplegia occurs side? Why?
Occurs on opposite side to which the brain lesion has occurred
Due to the crossover of nerves at the pyramidal tracts in medulla oblongata
Hemiplegia CVA
CVA is a cerebral vascular accident also referred to as a stroke
Last for less than 24 hours TIA, which is a transient ischaemic attack
Hemiplegia causes
Cerebral thrombosis, cerebral haemorrhage due to aneurism and cerebral embolism
Most common cause of stroke leading to hemiplegia
Thrombotic stroke 66%
Embolism 5 to 14%
Haemorrhage 14 to 20%
Hemiplegia causes specific
Head trauma from fall or MVA can result in haemorrhage
Brain tumour can lead to erosion which leads to haemorrhage and then hemiplegia
Hemiplegia commonly affected areas
Internal capsule and vestibular system
Circumduct gate
Swing affected leg forward to clear the floor
Hemiplegic shoulder
Adduction and internal rotation of shoulder with retraction of scapula
Hemiplegia neglect
Neglect of affected side. Can disassociate with affected limb and deny ownership.
Apraxia
Inability to properly organize attempts at movement
Hemiplegia contraindications
Results of CVA make modifications to treatment and Hydro as per hypertension protocol
Tech not on neck, one side at a time
Do not place head in extension or rotation
With tissue fragility, modify Hydro and weight
Multiple sclerosis definition
A condition in which demyelination of a nerve occurs
Sclerotic plaques
Scar tissue, which can cause a slowing, disruption, or blockage of nerve transmission
Multiple sclerosis what is affected?
White matter is affected, lesions found in brainstem, cerebellum, and spinal cord
Some cranial nerves can be affected optic and trigeminal
Multiple sclerosis types
Benign
Attack remitting
(benign or mild attack remitting)
(chronic progressive attack remitting)
Acute progressive
Multiple sclerosis causes
Unclear, but some factors include
Genetic
Environmental
Viral
Immunological
Multiple sclerosis cure?
No cure but strategies include massage therapy increase physical awareness, temporary decrease spasticity, improve soft tissue and joint health decrease contractures decrease stress and increase emotional well-being
Parkinson’s definition
Movement disorder involving the progressive degeneration of nerve tissue and a reduction in neurotransmitters producing in the CNS
Primary signs and symptoms of Parkinson’s
Resting tremor
Bradykinesia
Rigidity
Nonspecific weakness, achiness, or fatigue
Poor postural reflexes
Secondary signs and symptoms of Parkinson’s
Fascinating gait
Disfunction with speech and eating
Handwriting changes
Sleep disorders
Depression
Mental degradation
Bradykinesia
Difficulty with initiation and sustaining movement
Freezing phenomenon
Sudden inability to move feet as if they are rooted to the ground
Festinating gait
Small steps with leaning forward posture
Parkinson’s handwriting changes
Micrographia is progressive, shrinkage, and cramping of handwriting
Parkinson’s progression stage one
Unilateral presentation
Rigidity or tremors
If mild symptoms, no treatment is needed
If moderate symptoms, Massage and Physio are used
Parkinson’s progression stage two
Bilateral
Moderate tremors, rigidity, and bradykinesia
Balance is not affected
Levodopa therapy started
Parkinson’s progression stage three
Significant tremors, rigidity, and bradykinesia
Balance and walking impairment occurs
Unsteadiness, Dystoria and freezing occurs
Parkinson’s progression stage four
Severe bradykinesia
Walking is still possible, but highly impaired
Some assistance with daily activity may be required
Parkinson’s progression stage five
Complete loss of ability to function and independence
Person is immobile
Parkinson treatment
Levodopa is the active form of dopa and a precursor to dopamine
Carbidopa allows more levodopa to access the brain
Cerebral palsy types
Spastic
Athetoid
Ataxic
Dystonic
Mix
Cerebral palsy three causes
Prenatal causes
Birth trauma
Acquired CP
Anoxia
Absence of oxygen
Strabismus
Lack of parallel alignment of eyes
Cerebral palsy muscles
Muscles are chronically tight, causing tight restrictive contractures
Cerebral palsy signs and symptoms. Athetoid
Slow writhing movements
Cerebral palsy signs and symptoms. Choreform.
Quick uncontrolled movements without purpose
Cerebral palsy sensory loss. Agnosia
Inability to distinguish objects by touch. Decrease in proprioception.
Cerebral palsy treatment
Physical or occupational therapy
Swimming horseback riding
Surgeries
Massage therapy
Spinal cord injury definition
is an injury to the vertebral column, spinal cord or both, due to a direct or indirect trauma
Spinal cord injury, structure of spinal cord
Motor and sensory pathway tracts
Corticospinal tract is descending tract, motor control, movements of neck, trunk, and limbs
Ascending tract is sensory info to the brain
Spinal cord injury, most common place
Between C4 and C6
Between T12 and L1
Quadriplegia
All four limbs, trunk, pelvic organs at T1 or higher
Paraplegia
Lower limbs at T2 and below
Spinal cord injury causes
MVA
Diving
Sports
Penetrating wounds
Occupational hazards
Spinal stenosis
Non-traumatic injury
Spinal shock
Loss of voluntary motor control, sensory, and autonomic disfunction below lesion
Resolves within 24 hours to several weeks
Poliomyelitis definition
Acute viral infection, specifically affecting the motor neurons in the cord and brainstem
Spinal poliomyelitis
Inflammation and destruction of anterior horn cells at any level of spinal cord
Post polio syndrome
Late complications of paralytic polio
Occurs long after initial infection, 10 to 40 years later
Unknown
Central nervous system comprised of
Brain and spinal cord
Autonomic dysreflexia
Excessive sympathetic response to specific stimuli
Dysphasia
Impaired speech
Aphasia
Inability to speak
Spasticity
This occurs when there is a loss of inhibition of alpha motor, neurons firing
Upper body flexor pattern
Flexion of head/trunk toward effective side
Depression of shoulder
Retraction of scapula
Internal rotation and adduction of GH joint
Flexion of elbow
Pronation of forearm
Flexion of wrist and fingers with thumb adduction
Upper body extensor pattern
Slight extension of neck head
Trunk bent away from affected side
Retraction of scapula
Internal rotation of glenohumeral joint
Rigid extension of elbow with pronation of forearm
Flexion of hand with tight fist
PIP and DIP flexion
Palm facing backwards
Lower body flexor pattern
Abduction External rotation and flexion of the hip
Flexion of the knee
Dorsey flex and inversion of an
Flexion of toes
Lower body extensor pattern
Adduction, internal rotation, and extension of hip
Plantar flexion and inversion of ankle
Extension of knee
Extensor thrust pattern
Vigourously extend limbs while arching back
Positive supporting reaction
Stiffening of leg and extension or flexion
Grasp reflex
Withdrawal of the entire arm and tightly flexed position
How is spasticity useful?
Spasticity and legs can assist with standing or transferring from wheelchair to a bed.
Spasticity Massage techniques
Variety of Swedish techniques
Slow rhythmic, shaking of limb
GTO release
Passive range of motion of affected joint (perform carefully so not to cause stretch reflex)
Rigidity definition
Described as resistance to movement inflection extension, and rotation
Leaded pipe rigidity
Uniform resistance throughout range of motion
Cog wheel rigid
Ratchet like movement of an affected limb
Encourage whole body integration
Stand on weaker side, so Client looks toward weaker side
Encourage client to visualize and feel movement during passive movement
If able, ask Client to do same movement on unaffected side
Diplopia
Double vision
Nystagmus
Constant involuntary cyclical motion of the eye
Dysarthria
Inability to coordinate the muscles of speech
Comprehension difficulty
Speak slowly and clearly rather than loudly
Short sentences are more easily understood
Repetition for instructions of a particular task
Be mindful not to be condescending
Echolalia
Mimicking or passively repeating
Postural imbalances. Scoliosis.
Tendency to collapse on weaker side
Postural imbalances. Hyper kyphosis.
Slumping forward from weak trunk extensors
Decubitus ulcers definition
Skin lesions caused by external pressure, shearing, or friction forces
Decubitus ulcers factors
Sensory and motor loss due to neurological disorders place persons at high risk
May not notice and don’t take action to rectify
May not be able to physically change position
Decubitus ulcers
Commonly occurs over, boney prominences such as sacrum, ischial tuberosity, greater trochanter, spin process, calcaneus, elbow
Decubitus ulcers stage one
Local arrhythmia followed by warmth and hardening swelling over fragile, but intact area
Usually redness will diminish upon release of pressure
If redness does not resolve within 30 minutes may indicate pressure source could also present reddish, brown, or purple blue
Decubitus ulcers stage two
More tissue affected epidermis to dermis
Partial thickness
Blister abrasions or shallow ulcer may be present
Area is moist, pink and painful
Decubitus ulcers stage three
Full thickness, skin loss down to subcutaneous layer
Cavity is created with exudate and crust forming
Crust or eschar is thick and leathery, necrotic tissue
Decubitus ulcers stage four
Full thickness, wound with damage and necrosis into underlaying muscles and bone
Deep cavity that may be covered with eschar
May lead to sepsis
