Diagnosis Specific Information Flashcards

Question

Community mobility education for people with dementia should include:

Answer 1

Resources For community mobility Senior driving friendly places Valet parking Full service gas stations and grocery stores Application for disabled parking permit Involve family as much as possible

Answer 2

Recent memory loss Difficulty performing familiar tasks Problems with language Disorientation of time and place Poor or decreased judgment Problems with abstract thinking Misplacing things Changes in personality Changes in mood or behavior Lots of initiative

Answer 3

Significant decline in at least 3/5 areas -Memory – Language – Reasoning – Visual spatial ability – Personality traits

Answer 4

-Lost in a car, especially not their own – confusion with primary controls seem uncoordinated with gas/brake pedals – Forget directions – Assess in unfamiliar areas and a typical paths they would normally take. May become confused in unfamiliar surroundings – Conversation may distract them – Very early stages, restrict to certain streets or routes or times of day. Prepare client and family for driving cessation within 3 to 8 months – If has already gotten lost, should stop driving immediately. At risk for being lost with subsequent injuries or death

Answer 5

Loss of gross motor skills and coordination Loss of balance Loss of fine motor skills Problems with walking, stumbling or shuffling the feet May have lost a range of motion

Answer 6

Loss of sensory awareness, sensory processing, spatial relations May lose binocular vision

Answer 7

-Normal -Forgetfulness: no objective evidence of impairment, reports for getting simple things, no problems with ADLs -Borderline Alzheimer’s disease: objective evidence hard to obtain, family confirms problems. May get lost, job performance declines, difficulty with conversation. No problems with ADLs -Mild Alzheimer’s disease: objective evidence of cognitive deficit, difficulty with finances/shopping, difficulty with concentrating. No consistent problems with ADLs -moderate Alzheimer’s disease: objective evidence of dementia, inability to recall address/phone number/names of family members. ADLs beginning to be affected -Moderately severe Alzheimer’s: difficulty in remembering name of primary caregiver, not oriented to time and place, semi-dependent on most ADLs may eat if food is placed on plate. -Severe Alzheimer’s no longer completing voluntary activities. Verbal/psycho motor skills severely limited or lost. Stupor or coma possible. Totally dependent in all ADLs.

Answer 8

Clock drug test, freund clock scoring: any incorrect or missing elements Snellgrove maze test: >60 seconds or any errors Trail making test part B: >180 seconds Brief cognitive assessment tool: 34-43 =MCI; 25 -33 = mild dementia; 0 -24 = moderate to severe dementia MMSE: score of < 24 Short blessed test: 10+ Moca: <26 = MCI; 18/30 or less = potential driving retirement Consider red flags in driving history

Answer 9

-Mild motor disability and no or few risk factors may be fit to drive -Newly diagnosed recommended to plan baseline comprehensive evaluation, consider annual evaluation’s, plan for driving cessation, develop a plan for alternative transportation, start conversations with family about retiring from driving -Severe motor impairment and multiple risk factors should cease driving , be report to licensing agency as allowed, address alternative transportation -Mild to moderate motor disability and few risk factors strongly recommend driving evaluation, begin conversations regarding driving retirement, develop mobility plan for driving cessation

Answer 10

Decreased processing speed High risk score on UFOV Scoring 180+ seconds on trails B Impaired contrast sensitivity Scoring more than seven seconds on rapid pace walk Over 70 years old Tendency to fall Reaction time greater than the norm On multiple medication’s for Parkinson’s

Answer 11

Operational and tactical combat changes here indicate need for concern

Answer 12

MVPT Task shifting on BCAT Trails making a and B

Answer 13

Brake reaction time test Alternating foot tap test Timed up and go Rapid pace walk Chair rise

Answer 14

Impaired cognition is red flag for continued driving. Can be referred to DRS with moderately intact cognition, ability to self correct and utilize compensatory techniques, absence of dementia

Answer 15

Succades and pursuits Contrast sensitivity Confrontational field of view Are intact cognition and ability to use compensatory techniques

Answer 16

– Tremor or shaking, pill rolling – Small hand writing, words crowded together – Loss of smell – Trouble sleeping; thrashing, kicking, or punching while in deep sleep -Trouble moving or walking; arms don’t swing when walking, shuffling gait, rigidity, pain in shoulders or hips, Brady kinesia – Constipation – A soft or a low voice – Masked face – Dizziness and fainting -impaired posture and balance; stooping, leaning, or slouching – Cognitive impairment(Including spatial awareness/proprioception) – Changes an ocular motor movements impacting vision processing

Answer 17

– Medications may have adverse side effects – Visual scanning, awareness of blind spots, moving into lanes – Coordination for turns, parking, lane changes or pedal management; sustained breaking, smooth acceleration – Processing, decision-making, reaction, timing – Large portion of people with Parkinson’s stop driving by five years of the disease -Impaired contrast sensitivity; has been shown to be a good predictor of crash risk for people with Parkinson’s – Falling asleep is a common risk – Noticing differences in contrast – Difficulty with depth perception

Answer 18

– Resistive steering to diminish effects of tremors – Special rearview and outside mirrors to enhance vision due to limited trunk rotation, rigidity, or tremors – Develop habit of relaxation time prior to driving to reduce stress – Use a longer than normal following distances – Refrain from driving an inclement weather or at night – Plan driving trips to give plenty of time to get to destinations without being a hurry – Plan to adjust for good and bad days

Answer 19

Coordination for timing, fluidity, and planning: rapid pace walk and chair rise test

Answer 20

Every six months or sooner based on decline

Answer 21

– Poor planning due to inadequate scanning – Inability to shift according to changing demands of driving task – Distractibility – Poor judgment And insight – Confusion – Reduced awareness of traffic conditions – Impaired left right discrimination – Inadequate use of space – Poor time and space management – Decreased flexibility in thinking

Answer 22

-decreased performance and complex visual searching tasks -Less likely to pass driver training program – Required twice as many sessions for successful training -Instruct by showing not just telling – Remove excess of stimuli at first - schedule short training sessions

Answer 23

When pain is limiting performance. DRS can consider a specialty adaptations, such as mirrors, adaptive equipment, etc. could improve performance

Answer 24

– Impaired accommodation – Change in visual field – Binocular dysfunction – Visual information processing disorder

Answer 25

– Left hemi with possible sensory deficits – Vision: visual acuity, homonymous hemianopsia, left visual field neglect – Unilateral neglect of affected side – Difficulty in scanning visual space; visual perceptual deficits – Apraxia – Difficulty crossing midline of body

Answer 26

– Deviates to left of Lane – May not look to left at stop, yield, right on red – Does not always get into left turn lane for a left turn – May do lane changes without checking left mirror or head check – Denies errors – Is overconfident and impulsive – Has unrealistic goals – Typically cannot be trusted to do something that they shouldn’t - high frustration due to performance not improving despite repetition

Answer 27

– Right hemi with possible sensory deficits -Right homonymous hemianopsia or field cuts – Aphasia – Apraxia – Compulsive or slowness – Poor left/right discrimination – Impaired thought processes – Emotional lability – Risk for depression – Intact visual perceptual skills allow learning when communication is impaired – Memory impairment

Answer 28

– Cannot process information to make decisions or judgments with impaired attention to environment – Distractibility – Impaired attention and concentration impacts learning

Answer 29

– Attention and concentration – Memory and orientation – Slowed information processing -problems with judgment – Problem-solving difficulties – Loss of initiative – Emotional problems – Loss of capacity for social perceptiveness

Answer 30

Short term memory is most affected, affects where a person is going and why Negatively impacts learning and assimilation of new information, difficult for teaching new drivers

Answer 31

Delayed response time and slowed visual motor coordination

Answer 32

Poor safety awareness Impulsiveness Impaired insight

Answer 33

Difficulty recognizing errors Difficulties with transfers Difficulty with choosing a strategy, prioritizing, and flexibility

Answer 34

Irritability Immaturity, silliness Apathy Loss of emotional control/emotional lability Problem with self control and self-discipline, lose his temper easily

Answer 35

Retrograde amnesia Post traumatic amnesia

Answer 36

– Fully comprehensive evaluation including full assessment of cognition, vision, perception, motor skills – Look closely at thought processes during driving and risk taking potential – Look closely at fatigue. Not uncommon to get tired after 20–30 minutes of driving, consider cognitive fatigue -critical to require consistency of performance over a prolonged period of time without assist to demonstrate ability to compensate for deficits

Answer 37

No response Generalized response: inconsistent and non-purposeful response to stimuli Localized response is: specific but inconsistent response to stimuli, may follow simple commands Confused -agitated: easily agitated, short attention span, no short term memory Confused – inappropriate: responds to simple commands, easily agitated and unfamiliar situations, ADL with assistance Confused -appropriate: independent in ADL but dependent on external input for direction, follow simple directions, minimal supervision for safety required Automatic – appropriate: appropriate and oriented with unfamiliar environment, minimal supervision required, ADLs independently, impaired judgment Purposeful- appropriate: alert and oriented, able to recall and integrate events, no supervision required, able to tolerate stress

Answer 38

-Should not drive with prosthetic limb due to lack of sensation for feedback on pedals – Requires automatic transmission, may need power steering if steering one handed. -pedal guard required in some cases, especially if wearing right prosthesis – Consider if better to wear prosthesis or to remove during driving -Consider cause of amputation and other comorbidities/possible deficits – Strength and range of motion measurements should be completed including on residual limb – Carefully consider future needs, potential for a future further amputations? – Consider if hand controls would be better than left foot accelerator due to habits/motor patterns -Assess pain – Consider mobility and mobility device/transportation – Consider need for chest strap and/or cushions to assist with stability and positioning – Consider impact of prosthetic on transfers and sitting balance

Answer 39

Rheumatoid arthritis Osteoarthritis Juvenile rheumatoid arthritis

Answer 40

Swelling, tenderness, pain involving one or more joint Impaired grossth and development, limitation of movement, ankylosis , flexion contracture of joints Ambulation becomes limited with aging and me eventually become wheelchair-bound Severe hand deformities may develop

Answer 41

Limited are OM of neck: may need additional mirrors or relocation of outside mirrors forward May need adaptations for opening and closing door or operating doorhandles Wheelchair storage Automatic/power everything due to impaired mobility and weakness Energy conservation: cruise control, Driving habits/routines May required customized steering devices to accommodate hand deformity’s and avoid prolonged grasp Style pull a belt or loopo ( tension adjuster) to assist with seat belt May need assisted device to release buckle for seatbelt Gear selector may require adaptation Consider key extensions May require pedal extensions Check contra indications for driving with medications

Answer 42

Nystagmus Oclulomotor deficits Poor visual acuity Exotropia/external strabismus Intermittent exptropia

Answer 43

Visual perception Seizures Involuntary muscle movements Imbalance in tone and strength Quadriplegia or hemiplegia Startle reflex Speech deficits

Answer 44

Spastic paraplegia Spastic hemiplegia Spastic quadriplegia Athetoid Dystonic (athetoid, ataxic, atonic)

Answer 45

Primarily LE Vision/visual perceptual deficits Usually able to drive Extra time for instruction with much repetition Needs pedal guards, typically uses hand controls Consider changing resistance levels to accommodate for tone Consider reflexes and associated reactions

Answer 46

One side, LE and UE Possible aphasia Don’t use affected side, esp for steering Can sometimes use affected side for turn signal May need to restrain affected arm to prevent inference with steering wheel Consider changing resistance levels to accommodate for tone Consider reflexes and associated reactions

Answer 47

All extremities involved, usually one UE works better than all others Vision/visual perceptual deficits Non integrated reflexes Poor bilateral coordination Poor hand fx Difficulty controlling coordinated movements for quick reaction Tone may be deterrent to hand controls Often needs chest strap Consider reflexes and associated reactions Consider changing resistance levels to accommodate for tone

Answer 48

Uncontrolled movements Speech/hearing deficits Fewer visual deficits, but may have difficulty with oculomotor control Often highly motivated Attention or other cognitive impairments Close eval of all types of visual perception May require extended evaluation May not have enough control for primary controls Look closely at startle reflex. May be able to decrease it by learning to anticipate and control level of startle Try different positions to see affect on ataxia

Answer 49

Muscular weakness, pain, spasms/cramps Peripheral neuropathy and poor circulation (amputations) Lethargy Dizziness, fainting, alerted consciousness Hypoglycemic episode Hearing loss Mood swings, irritability, depression, restlessness Long term insulin dependent: diabetic retinopathy, coronary insufficiency leading for CHF, insulin shock

Answer 50

Diabetic retinopathy: may have complete blindness with no pre-symptoms Alcohol abuse and insulin dependence may be big indicator of no driving If unstable may need restrictions for time, area, and speed Meds may cause drowsiness, or low energy levels Recommend sugar source kept in car Careful review of sensation in feet (monofilament, 2 point discrimination, tuning fork)

Answer 51

Short stature Hip dislocation Lordosis Possible visual deficits Impaired hand fx Impaired ROM

Answer 52

Special seating for height, back/leg support, and operation of controls Extensions for primary/secondary controls, possibly hand controls W/c storage Ingress/egress devices/step stool Stylex pull a belt for seatbelt May need to move seatbelt buckle, consider good position of belt across chest and lap May need non standard steering devices May need reduced effort and diameter steering wheel

Answer 53

Pain Morning stiffness Sleep disturbance Intolerance to cold Parenthesias Headaches Fatigue Urinary urgency

Answer 54

Irritable bowel Migraines Floppy heart valve Multiple allergies Tmjd Behavioral characteristics (perfectionist, affective disorders)

Answer 55

Consider pain / fatigue with time of day, weather, meds Consider overall ability to manage pain May require considerations for seating Equipment may be beneficial for accommodating chronic pain that impacts movement

Answer 56

Rare progressive muscular dystrophy that impacts cerebellum and spinal cord Gradual decrease in ambulating skills Clumsiness /incoordination due to ataxia Scoliosis Slurred speech Nystagmus and poor night vision Onset 7 to 13 Diabetes common Abnormalities in heart beat rhythms

Answer 57

Needs regular reevaluations Usually requires stationary hand positions due to ataxia and difficulty with opening/closing hands May need redundant switches to avoid accidental activation due to tremors Must learn to stabilize proximal joints to have more control May easily over steer or over brake, especially with quick reactions May have difficulty with transfers, many use scooter Look closely at scanning, tracking, teach to keep eyes moving and use mirrors Often highly motivated Watch for drug/alcohol use (decreases ataxia, but also decreases trunk control)

Answer 58

Relapsing – remitting Exacerbating – remitting Remitting – progressive; progressive – relapsing Primary progressive

Answer 59

Tingling/numbness Double vision Clumsiness/Falls Weakness Ataxia Sensory loss Bladder dysfunction Change in reflexes

Answer 60

Blurred/double vision most common Nystagmus Optic neuritis Gaze weakness

Answer 61

Poor coordination Varying degrees of paralysis Spasticity Slowed or slurred speech Emotional lability or mood swings Bowel/bladder/sexual dysfunction Fatigue Euphoria Depression Cognitive fatigue Vertigo Symptoms were send by heat, overexertion, resistant exercises

Answer 62

Energy conservation! Wheelchair storage Air conditioning is a must May require adaptive equipment due to impaired sensation Stabilize proximal joints Redundant switches Consider cont indications of medications Reevaluation‘s are important Evaluate insight in order to self regulate Short training sessions

Answer 63

Slow progression Muscles slow to relax after contracting, Stiffen, difficult to move Myotonia comes on after long periods of rest Stiffness can be worked off with repeated movement Stiffness occurs in face, feet, hands, front of neck Sometimes muscle enlargement in thighs, shoulders, forearms Other symptoms include bilateral cataracts

Answer 64

Progression is slow Affects face, feet, hands, front of neck Muscle contractions occur with exposure to cold Repetitive activity worsens the condition Rare

Answer 65

Onset 2 to 6 year old, males only First effects pelvis, upper arms, upper legs Wheelchair usually needed by age 12 years old Death usually occurs in 20s May have mild cognitive impairment Impaired endurance Contractors possible

Answer 66

Frequent reevaluation Consider trunk control Careful assessment of range of motion and strength May require extensive adaptive equipment Ensure good insight Short training sessions

Answer 67

Onset as late as 25 years old Slow progression Affects pelvis, upper arms, upper legs first

Answer 68

Progressive weakness in shoulders and pelvis Unset late childhood or early adulthood Cardio pulmonary complications in later stages

Answer 69

Onset teens to early adulthood Forward sloping of shoulders, difficulty raising arms overhead, difficulty closing eyes Disease may span decades

Answer 70

Generalized weakness present in infancy Joint deformities can develop due to shortening of muscles

Answer 71

Onset 40-70 years old drooping of eyelids followed by other signs of eye and facial muscle weakness, difficulty in swallowing May experience weakness and pelvic and shoulder muscles Recurrent pneumonia possible

Answer 72

40–60 years old Weakness of hand muscles, impaired coordination May eventually affect muscles of feet and progress to lower arms and legs

Answer 73

Onset childhood to early teens Shortening of muscles of elbows, knees, ankles Abnormal heart rhythm First affected our shoulders, upper arms, shins Joint deformities common

Answer 74

Onset infancy to late adult life Earliest symptoms of weakness and Proxico muscles of hips and shoulder Difficulty rising from chair, climbing steps, holding arms upright Inflammation of hips and shoulders Fatigue with prolonged walking Weakness develops in matter of weeks or months

Answer 75

Onset between 35–65 Progressive, attacks motor neurons in brain, boule region, spinal cord Generalized weakness and exaggerated reflexes Cognition remains intact Spasticity may occur Impaired speaking, swallowing, breathing Fatigue

Answer 76

Frequent reevaluations Consider future with adaptive equipment, consider how fast it is progressing Short training sessions

Answer 77

Auto immune disorder Weakness of ocular muscles Dysphasia, dysarthria Limb weakness Sometimes rapidly fatal due to respiratory failure/aspiration; sometimes lifespan is a little affected Excessive fatigue after exertion

Answer 78

Onset between ages 10–20 Symmetrical weakness in feet and legs, Hand and forearm, Eventual mild foot deformity , Mild clawing of hands, difficulty in opposing the thumb Face, trunk, proximal limb muscles usually spared Sensation loss in feet

Answer 79

Onset childhood or early adolescence Proximal muscles affected first; usually leg then shoulder, upper arms, and neck Frequent falls

Answer 80

Multiple fractures Joint instability Short stature Limited ambulation, braces/assistive devices/wheelchair Abnormal bone and joint development

Answer 81

Special seat and back cushion for windshield visibility Reduced effort steering and breaking to avoid stress on bones Extensions or remote switch is on all secondary controls Restraint system very important secondary to airbags Do not evaluate until late teens or when bones have stabilized; person is experiencing less or no fractures Hand controls usually indicated to avoid stress on legs Wheelchair storage

Answer 82

Involve one or more extremity Proximal muscles affected more Scoliosis, kyphosis respiratory muscles can be affected with respiration compromised long-term Post polio syndrome; further deterioration of overworked muscles after 30+ years from acute phase of illness

Answer 83

Adaptive equipment may be simple to complex May require reduced diameter wheel, reduce effort steering, remote operation of secondary controls Energy conservation important Consider car topper or van to save energy of loading wheelchair Periodic reevaluation’s as a person ages and post polio syndrome develops

Answer 84

A neurovascular disorder, injury site is the dorsal root ganglion – back to injured nerve

Answer 85

Pain Severe edema Discoloration of lower extremities, cold to touch extremities Lots of hair on legs, shiny skin Father by extreme temperatures, very sensitive to sensations Autonomic dysfunction Movement disorder Trophic changes Auto immune phenomena Stiffness Decreased function

Answer 86

Acute Dystrophic Atrophic

Answer 87

Three months Abnormal pain Vasomotor changes, redness to cyanosis Increased or decreased skin temperature Swelling Decreased mobility Trophic changes May experience abnormal hair growth and sweating

Answer 88

3 to 6 months post injury Edema Decreased passive mobility Pain spreading of extremity or into another extremity Sleep disruption Skin can become a rough and thickened Tremors, spasms, dramatic dystonia

Answer 89

After six months Periarticular swelling and thickening Contractures Severe trophic changes including atrophy Skin thin and shiny, dark or discolored Skin breakdown is common

Answer 90

Weakness or paralysis of LE Sensory loss below level of lesion Bowel and bladder incontinence Scoliosis Impaired trunk control May have poor motor planning

Answer 91

Visual discrimination Visual closure Figure ground Form constancy Depth perception Visual orientation in space

Answer 92

Nystagmus Poor saccadic motions Lazy eye/exotropia Poor ocular motor control Scanning /tracking Poor fixating, especially at midline

Answer 93

Hydrocephaly Chiari malformation Sensory Processing deficits Cognitive deficits, immaturity, attention, etc.

Answer 94

Specialized seating Possible use of hand controls Usually have to educate even in basics of transfers and wheelchair handling, endurance, other ADLs May be slow learners Require more repetition, verbal encouragement, instruction Positive reinforcement, constructive criticism given with sensitivity and gentleness Extended evaluation

Answer 95

Trapezius is spared Generally transportation only/passenger only

Answer 96

Shoulders and biceps

Answer 97

Shoulders, biceps, wrist extensors

Answer 98

Shoulders, pecks, biceps, triceps, wrist extensors Wrist flexors finger extensors

Answer 99

Minimal grasp Shoulder, pecks, biceps, triceps, wrist extensors, wrist flexors, finger extensors

Answer 100

Hip flexors and knee extensors

Answer 101

Impaired Bowel and bladder Control Spasticity, clonus Respiratory and endurance deficits Sensory loss Inability to regulate body temperature Joint deformities in instabilities Complete versus complete injuries Pain, especially at level of injury and below

Answer 102

AC/heat required Consider seat material Pedal guards/leg straps to prevent interference from spasticity Extra trunk and chest belts or lateral support pads Wrist splints may prevent overflow of spasticity to hands when driving Consider medications Observe transfer into vehicle and watch them load wheelchair May benefit from additional mirror system if impaired cervical range of motion Short sessions for energy conservation Provide training tasks to challenge balance

Answer 103

During fetal period muscle development stops and is replaced with fatty tissue

Answer 104

Multiple contractures throughout arms and legs Delayed fine and gross motor skills Weakness Decreased hand function due to multiple contractures

Answer 105

Typically require high tech driving system Vehicle selection can be challenging due to short stature, W/C placing knees add typical height

Answer 106

Poor coordination, poor motor planning

Answer 107

Tracking/scanning, Visual spatial perception Form constancy Visual sequential memory

Answer 108

Impaired reading Visual Distractibility Difficulty with problem-solving and decision-making

Answer 109

Use interpreter and develop communication plan for behind the wheel Reduce visual distractions Provide extra time

Answer 110

Motor and sensory processing impairments, including vision

Answer 111

Consider possible accommodations during clinical assessment Reduce distractions Short sessions Extended evaluation Clear concise and easy to understand instructions Watch for inconsistencies from lesson to lessen Consider recommending restrictions

Answer 112

Temporary hold on driving during recovery and rehab Maximize return of all motor performance skills prior to pursuing driving Hip precautions applied to both feet, crossing foot over is not safe

Answer 113

Sleep disturbances ADHD Anxiety

Answer 114

Avert eyes from critical information Take longer to find critical information on Rodeway Focus in the horizon versus scanning near and far Experience cognitive overload

Answer 115

Visual acuity Visual scanning Visual fields

Answer 116

Attention Divided attention Processing speed Ability to learn Knowledge of rules Mental flexibility

Answer 117

Speed and accuracy of eye hand coordination Reaction times Rapid pace walk Nine hole peg test

Answer 118

Literal interpretation Interpreting nonverbal cues

Answer 119

Speeding tickets Running red lights Illegal turns Visual scanning Lame maintenance Adjustment to stimuli

Answer 120

Drive less More likely to self restrict

Answer 121

Processing impairments Visual spatial scale impairments Impaired motor planning Difficulty timing of movement, initiation of movement

Answer 122

Attention Problem-solving Prioritizing Social behavior Emotional regulation Imagination Planning ahead