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PMR 03 - TBI > Day 5 - Medical Complications > Flashcards

Day 5 - Medical Complications Flashcards

1
Q

Write down rehab plan for newly admitted ABI patient.

A

**Physiotherapy**

  1. Postural control
  2. Static & Dynamic Balance
  3. Gait re-education (+/- harness)
  4. Motor coordination of the lower extremities
  5. Cycle ergometry
  6. Casts, splints and passive stretching (planterflexion contracture is common)

**Modalities**

  1. Functional electrical stimulation

**Occupational therapy**

  1. Sit-to-stand
  2. Functional reaching (transfer)
  3. Functional fine motor control retraining
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2
Q

Define Benign paroxysmal positional vertigo (BPPV), PEx and Tx.

A

Definition

Brief episodes of vertigo provoked by movement of the head.

Examination

Dix-Hellpike maneuver

Treatment

Promote static and dynamic postural stability by Epley maneuver

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3
Q

List 4 DDx for vertigo

A
  1. BPPV
  2. Labyrinthine Concussion
  3. Perilymph fistula
  4. Temporal bone fracture
  5. Ototoxicity

Ref: Canadian Coarse Review

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4
Q

Definition of Heterotopic Ossification & List 4 Risk factors🔑

A

Heterotopic ossification (HO) is the formation of mature lamellar bone in extra skeletal soft tissue.

Risk Factors

  1. Prolonged coma (>2 weeks)
  2. Immobility, Hemiplegic
  3. Limb spasticity/↑ tone (in the involved extremity
  4. Traumatized / fractures
  5. Pressure ulcers
  6. Edema
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5
Q

Clinical Presentation of Heterotopic Ossification (HO)🔑

A

Earliest sign often being decreased range of motion in the involved joint.

  1. Pain and ↓ ROM
  2. Local swelling
  3. Erythema
  4. Warmth in joint
  5. Muscle guarding
  6. Low-grade fever
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6
Q

Complications of Heterotopic Ossification (HO)🔑

A
  1. Bony ankylosis
  2. Peripheral nervecompression
  3. Vascular compression
  4. Lymphedema
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7
Q

List 4 Differential Diagnosis for Heterotopic Ossification (HO)🔑

A
  1. Deep vein thrombosis (DVT)
  2. Tumor
  3. Septic joint
  4. Hematoma
  5. Cellulitis
  6. Fracture
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8
Q

Which joints are most often involved in HO post ABI?

A

Hips, shoulders, and elbows. Rarely are the knees affected.

ERABI Model 9

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9
Q

Managment of Heterotopic Ossification (HO)

A

Non-Pharmacological

  • Physiotherapy and Range of Motion Exercises
  • Shockwave and Radiotherapy

Pharmacological

  • Bisphosphonate (Etidronate)

Surgical

  • Surgical excision (after 12 to 18 months to allow maturation of HO)
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10
Q

List 2 Prophylactic interventions for heterotopic ossification

A
  1. Passive range of motion exercises
  2. Etidronate disodium (EHDP)
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11
Q

How do you grade Heterotopic Ossification (HO)?

A
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12
Q

List 3 Diagnostic tests for Heterotopic Ossification (HO)

A
  1. Serum alkaline phosphatase (SAP) elevation
  2. Xray Require 3 weeks to 2 months postinjury to reveal HO.
  3. Bone Scan Sensitive method for early detection of HO
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13
Q

What is currently the gold-standard assessment to confirm a diagnosis of DVT? PE?

A
  1. Magnetic resonance venography or ultrasound.
  2. Computed tomography pulmonary angiogram.
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14
Q

List 3 DVT prophylaxis in TBI

A
  1. low-molecular-weight heparin (LMWH)
  2. Intermittent pneumatic compression
  3. Inferior vena cava (IVC) filter
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15
Q

DVT treatment in ABI and duration

A

First initiated with intravenous (IV) heparin or dose-adjusted SQLMWH

Followed by oral anticoagulation (warfarin or NOAC).

Anticoagulation continues for 3 to 6 months.

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16
Q

Does warfarin needs bridging?

A
  1. Warfarin takes about 5 days to achieve full anticoagulation (INR above 2).
  2. During the first few days of warfarin therapy, patients are prothrombotic due to a decrease in protein C and S (natural anticoagulants) before thrombin levels diminish significantly.
17
Q

Mention 4 risk factors for DVT in ABI patient.

A
  1. Age > 40
  2. Presence of clotting disorder
  3. Severe Injury
  4. Bone Fracture
  5. Prolonged immobilization > Cast
18
Q

List 2 Types of touch and their spinal tract.

A
  1. Light touch: ventral spinothalamic
  2. Pain: lateral spinothalamic
  3. Position: dorsal colum
  4. Vibration: dorsal colum
19
Q

Define silent aspiration.

A

Penetration of food below the level of the true vocal cords, without cough or any outward sign of difficulty.

Such cases may be missed in the absence of a videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) assessment

20
Q

What are the risk factors for dysphagia post-ABI?

A
  1. Severity of brain injury
  2. Duration of coma
  3. Lower Glasgow Coma Score on admission (GCS 3-5)
  4. Severity on CT Scan findings
  5. Duration of mechanical ventilation
  6. Tracheostomy
  7. Translaryngeal (endotracheal) intubation
  8. Severe cognitive and cognition disorders
  9. Physical damage to oral, pharyngeal, laryngeal, and esophageal structures
  10. Oral and pharyngeal sensory difficulties

ERABI Model 3

21
Q

What are the risk factors for aspiration following an ABI?

A
  1. Lower Glasgow Coma Score (3-5)
  2. Presence of a tracheostomy
  3. Poor cognitive functioning
  4. Hypoactive gag reflex
  5. Prolonged period of mechanical ventilation
  6. Reduced pharyngeal sensation
  7. Brainstem involvement
  8. Difficulty swallowing oral secretions
  9. Coughing/throat clearing or wet, gurgly voice quality after swallowing water
  10. Choking more than once while drinking 50 ml of water
  11. Recurrent lower respiratory infections
  12. Dependence on feeding assistance

ERABI Model 2

22
Q

List 4 examples of compensatory strategies

A

(a) oral care and hygiene
(b) food consistency and viscosity alterations
(c) low risk feeding strategies
(d) postural adjustments while eating

23
Q

Describe some low-risk feeding strategies

A

From Heart and Stroke Foundation, 2016

  1. Calm eating environment, with minimal distractions.
  2. Patient is in an upright position with the neck slightly flexed facing midline.
  3. Self-feeding.
  4. Proper oral care.
  5. Feed at eye level.
  6. Feed slowly.
  7. Feed using metal teaspoons (no tablespoons or plastic).
  8. Drink from wide mouth cup or a straw to reduce the neck extending back.
  9. Ensure bolus has been swallowed before offering more.
  10. Properly position the patient and monitor for 30 minutes after each meal.
24
Q

What are some common diet modifications that can aid swallowing?

A
  • For solid textures, food may be diced, minced, or pureed.
  • For fluids, they may be thickened to nectar, honey, or pudding consistencies.
  • Limit mixed consistency foods
25
Q

List at four postures adjustments to improve swallowing function.

A
  1. Chin Down Posture
  2. Chin Up Posture
  3. Head Turn (left or right)
  4. Head Tilt (left or right)
  5. Lying Down
26
Q

List at least two swallowing maneuvers that may be used in dysphagia management.

A
  1. Supraglottic swallow.
  2. Super-supraglottic swallow.
  3. Effortful swallow.
  4. Mendelsohn maneuver.
27
Q

When is the best time to initiate oral care with a patient who has dysphagia?

A

Mouth care should be thorough and performed before eating or drinking

Research suggests that the introduction of oral bacteria to the lungs via aspiration is more problematic than the food or liquid that is aspirated

28
Q

List 4 indications for enteral feeding.

A
  1. significant dysphagia
  2. high rates of aspiration
  3. comatose
  4. medically ventilated.
29
Q

Dysphagia Flow Sheet

A

PMR 03 - TBI (8 decks)

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