Clinical signs and symptoms of TBI Client 34.3

Question 1

Decerebrate rigidity

Answer 1

midbrain, pons, diencephalon

extended internally rotated shoulders, extended elbows, flexed wrists, fingers; extended internally rotated hips, extended knees, ankle plantar flexion, invasion, increased rigidity when awake

position, ROM, neuromuscular blocks, early casting

Question 2

decorticate rigidity

Answer 2

cortical white matter, internal capsule, thalamus, cerebral peduncle, basal ganglia

internally rotated shoulder, flexed elbow, wrists, fingers; extended, internally rotated hips, knee flexion, ankle plantar flexion, inversion, increased rigidity when awake

positioning, ROM, neuromuscular blocks, early casting

Question 3

Bruxism

Answer 3

Persistent jaw clenching, grinding of teeth with or without temporomandibular dislocation or subluxation

neuromuscular blocks, oral orthotics

Question 4

Spasticity

Answer 4

UMN Syndrome, corticospinal pathways

Velocity-dependent resistance, hyperreflexia/ clonus, muscle shortening, present in face, neck, trunk, limbs; worse when a wake and with effort

Bed/chair positioning, ROM, weight bearing, neuromuscular blocks, inhibitive casting, enteral and intrathecal medications, tendon releases, relaxation techniques

Question 5

torticollis

Answer 5

Dystonic posture of the neck, spasticity or contracture of sternocleidomastoid, splenius muscles

Positioning, modalities and ROM, medications, neuromuscular blocks

Question 6

Rigidity and bradykenesia; parkonsinism

Answer 6

substantia nigra, extrapyramidal pathways; also with medications that block dopamine

Velocity independent resistance, lead pipe, cogwheel types of rigidity, worse when awake

positioning, ROM, functional activities, medications

Question 7

Myoclonus

Answer 7

variable lesion locations

abrupt, shock like involuntary jerks in large limb or small muscles when asleep or awake

medications, neuromuscular blocks

Question 8

Tremor

Answer 8

Variable lesion locations

involuntary rhythmic oscillations while awake

weighted devices, weight bearing, medications, neuromuscular blocks, appropriate assistive devices

Question 9

Dystonia

Answer 9

Variable lesion locations

dynamic contraction/relaxation of muscles with slow, writhing, or repetitive twisting movements or sustained contortions, usually distal limbs

positioning, ROM, NM blocks, medications, appropriate assistive devices

Question 10

Athetosis

Answer 10

Basal ganglia, medications with effect on dopamine

slow sinuous movements of the face, tongue, or limbs

relaxation techniques, taper offending medications

Question 11

Chorea

Answer 11

Contralateral neostriatum, thalamus

involuntary dancelike or jerky movements without rhythmic pattern; distal

medications

Question 12

hemiballismus/ ballismus

Answer 12

contralateral sub thalamic nucleus, thalamus, cerebellum

sudden irregular flinging movements starting in the hip or shoulder, occasionally facial or oral with to without rotator component, worse with arousal or excitement, absent in sleep

medications

Question 13

Tics

Answer 13

Lesion location is variable

sudden stereotypic coordinated automatic movements or vocalizations while awake

medications, behavioral management, relaxation techniques

Question 14

pseudobulbar athetoid syndrome

Answer 14

bilateral pyramidal tract

posturaldystonia with fragmentary athetosis, with or without bradykinesia; often preserved intellect/personality

positioning, appropriate assistive devices