exam #2 Flashcards
1
Q
Cause for a brain injury in: infants
A
Abuse; neglect
2
Q
cause for a brain injury in: toddlers
A
Abuse; falls
3
Q
cause for a brain injury in: early elementary
A
Falls; pedestrian-motor vehicle accidents
4
Q
cause for a brain injury in: late elementary/middle school
A
Pedestrian-bicycle accidents, Pedestrian-motor vehicle accidents, Sports
5
Q
cause for a brain injury in: high school
A
MVA
6
Q
define: Congenital and Perinatal Brain Injury
A
during or before birth
7
Q
define: aquired brain injury
A
Brain injury incurred after a period of normaldevelopment
- Internal causes
- External causes
8
Q
open head/penetrating brain injury are more likely to
A
experience seizures than closed head injuries with open usually at corpus callosum
9
Q
which brain injury is more common, open or closed?
A
closed
10
Q
mechanism of injury: coup
A
site of contact
11
Q
mechanism of injury: contracoup
A
other side of injury
12
Q
Shearing and tearing of neurons throughout the brain causes…
A
permanent damage
13
Q
predictors of outcome after a brain injury
A
Duration of coma Post-traumatic amnesia (PTA) Age Location of injury Pre-injury functioning Support systems: recovery will be more effectivewith family
14
Q
outcome predictors: coma
A
Coma is a state of unconsciousness in which the person cannot be aroused or does not respond, even to painful stimuli
15
Q
2 coma scales
A
Glasgow Coma Scale(more popular)
Rancho Los Amigos Scale of Cognitive Levels
16
Q
glasgow coma scale extreme range is…
A
3 worst 15 best
17
Q
coma on the glasgow coma scale is considered an…
A
8 or less score
18
Q
Moderate Head Injury—-GCS score of…
A
9 to 12
19
Q
Mild Head Injury—-GCS score of..
A
13 to 15
20
Q
mild brain injury: concussion
A
Nausea and vomiting Headache Fatigue Dizziness Poor recent memory Post traumatic amnesia less than 1 hour GCS of 13-15
21
Q
moderate brain injury
A
Coma less than 24 hours
Post-traumatic amnesia 1- 24 hours
GCS of 9-12
22
Q
severe brain injury
A
Coma more than 24 hours
Post-traumatic amnesia more than 1 day
GCS 3-8
23
Q
Interrupted synaptic connections have…
A
“cascading effect”
24
Q
PT common TBI treatment
A
tone reduction. Slow stretching, posture, compression of joints, heat, rocking, alternating movements
25
whixh vertebrae are at a risk for changes in sympathetic nervous system when damaged
T6 and above
26
which percent of SCI are caused by traumatic injuries?
42 percent
27
which percent of SCI are caused by non-traumatic injuries?
58 percent
28
what are common cause of death after a SCI?
pneumonia, embolus, septicemia (infection of the blood)
29
what are the most common SCI locations?
C1-C2
C5-7
T12-L2
30
SCI most common mechanisms of injury
Cervical rotation flex
Hyperflexion
Cervical Hyperextension injures
Compression Injuries-vertical compression
31
SCI subtypes: complete
complete transection of motor and sensory tracts
32
SCI subtype: incomplete
Central Cord Syndrome
Anterior Cord Syndrome
Posterior Cord Syndrome
Brown Sequard Syndrome
33
what are myotomes c5-t1
```
C5=deltoid
C6=biceps/wrist extensors
C7=triceps
C8=thumb extensor/finger flexors
T1=finger abd/add
```
34
what are myotomes L2-s1
```
L2=hip flexors
L3=quads
L4=dorsiflexors
L5=great toe extensor
S1=plantarflexors
```
35
define Myelopathy
Spinal cord process
36
define Radiculopathy
Nerve root process
37
UMN weakness
spasticity, weakness, atrophy, sensory findings, bowel and bladder complaints
38
LMN weakness
paresthesias(lack of sensation), fasciculations, weakness, decreased DTR
39
ASIA impairment scale stands for
American Spinal Cord Injury Association)Impairment Scale
40
A and E on the ASIA impairment scale stands for...
A= complete
| E=normal
41
Central Cord Syndrome presents like
```
Hyperextension injuries, tumor,
Paresis or plegia of arms > legs
Posterior column spared
Sensation UE > LE; sacral sparing
Perforating branches of the anterior spinal artery at greatest risk for vascular insult
Good prognosis
```
42
Anterior Cervical Cord Syndrome presents like..
```
Typically after hyperflexion
Motor loss
Pain and temperature loss
Dorsal column preserved
Autonomic dysfunction
Sacral sparing
50% Recovery
```
43
brown sequard is...
1/2 the body effected
| usually due to penetrating trauma (gun shot wound)
44
spinal cord ends at...
L2
45
define apoptosis
programmed cell death) (after cells die, the body goes through cell death saying kill all cells and die)
46
morbidity in acute SCI phase can cause...
```
Pressure ulcerations in 25%; most commonly over the sacrum with people with sci
Atelectasis / pneumonia in 13%
DVT in 10%
Autonomic dysreflexia in 8%
UTI
```
47
mortality in SCI due to
Leading cause of death are pneumonia, PE (pulmonary embolis), followed by heart disease and sepsis
48
Neuropathic spinal pain
Occurs at or below the level of injury
Reported in 6 – 50% of patients
Results from: changes in neuronal function, increased spontaneous activity and / or reduced thresholds of response
Descriptors: temperature, electric
Evaluation must look for other causes of pain, e.g. unstable spine, cystic myelopathy, other new condition e.g. renal stone
Treatment: physical therapy (electro), anticonvulsants, antidepressants
49
key motor scale
```
0 = total paralysis
1 = palpable or visible contraction
2 = active movement, gravity eliminated
3 = active movement, against gravity
4 = active movement, against some resistance
5 = active movement, against full resistance
NT = not testable
```
50
early SCI treatment activities
Mat activites: Teach rolling to prevent pressure sores
Prone –scap strengthening (c4 and c5 maybe even c6); prone on elbows; alternating stab exercises
Supine – onto elbows (C5-6 may need assist); Supine on elbows to the long-sitting postion
Long Sitting: pushup
Transfers
51
intermediate SCI rehab treatment activities
```
Self ROM
Transfers – wheelchair to floor and vice versa
Advanced wheelchair skills
Ascend and descend curb
Aquatic Therapy
```
52
advanced SCI rehab treatment activites
Ambulation training
Standing? – Parallel Bars!, KAFO(knee ankle foot orthotic)
Forearm crutch gait activities
How to get up from the floor
To get to this phase could take 2-3 months. To be able to walk need to have some abs. t8 needed
53
define parkinsons disease
a progressive neurodegenerative disease which involves the loss of cells in a part of the brain called the substantia nigra.
54
PD symptoms is under 40
It seems that dystonia (involuntary muscle contraction)
| trembling is less common in younger people and cognitive disorders
55
PD often considered a
It is often classified as an “extrapyramidal disorder” something that happens at the medulla oblongata.
56
four signs of parkinsons
```
tremour
festinating gait
mask like face
rigidity
pill rolling effect
poor posture reflexes
```
57
5 potential causes of PD
```
Idiopathic
Toxic exposure
Arteriosclerotic
Shy-Drager syndrome
Postencephalitic leads to substancia nigra
Steele-Richardson-Olszewsli syndrome
Drug Induced
Trauma
```
58
PT treatment for PD
```
Extension to work against trunk flex
Trunk rot’n
Reciprocal motion
Weight shifting
Facial mobility
Hand dexterity
ADLs
```
59
common activities to do with people with PD
```
Sit to stand from chair
Figure of eights walking around chairs
Step turns-breaks up festinating gait
Walk and clap – reciprocal (over other sides)
Shift fwd and lean back (Tai Chi)
Backstroke in standing
Hip walking on floor
Treadmill
Laser pointer
Step over bolsters-any sort of obstacle
```
60
MS pathology
Scar-like plaques commonly on the basal ganglia, optic nerve, 3rd and 4th ventricles, midbrain (basal ganglia), pons and spinal cord
61
The measure of progression* of MS (extremes only)
0 – Normal Neurological exam
10.0 - Death due to MS, results from respiratory paralysis, coma of uncertain origin, or following repeated or prolonged epileptic seizures.
62
what is the most common type of MS
RRMS
63
what is RRMS
It is characterized by one or two flare-ups every 1 to 3 years, followed by periods of remission.
64
benign MS
The most common symptom is sensory (paresthesia, pins and needles) (33%) and Optic Neurtis (33%) (their first attack either the 2 of those). The younger the Dx usually indicates a more favorable course.
65
PPMS
Primary progressive MS generally appears in people in their forties, and it is the only form of MS that affects men and women equally.**
66
how is MS diagnosed
(1) a patient must experience two separate attacks at least one month apart--an attack, also called a flare or relapse (exacerbation), is the sudden appearance (lasting at least 24 hours) of a classic MS symptom--and (2) there must be detectable damage to the myelin of the CNS. There must be a history of myelin damage. It must have occurred more than once and must not have a causal connection with other demyelination diseases
67
areas where MS is more prevalent
: Northern USA, southern Canada, northern and central Europe, Southern Scandinavia, eastern Russia, South Africa and NW Austrailia
68
MS frequency stats
The high frequency zones for MS at 50-120/100,000 population are Europe, Canada, Russia, Israel, Northern U.S.A., New Zealand and South-East Australia.
Lowest frequency zones for MS at 5/100,000 population are Asia, Africa and South America
69
MS management
```
Graded Exercise
Aerobic exercise
Cold (avoid heat)
Muscle Tone – may use fasc/inhib techs
ROM
Sensory feedback – pain
Functional training
Gait training and adaptive aids
```
70
define ALS
Amyotrophic lateral sclerosis
71
ALSis...
progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord.
degeneration of the motor neurons
72
what is an initial sign of ALS?
Muscle weakness is a hallmark initial sign in ALS, occurring in approximately 60% of patients.
73
ALS survival rate
Eighty per cent of those diagnosed will die within two to five years. Less than 10 per cent of cases are hereditary and are called familial ALS, 90 per cent of ALS cases have no known cause and are referred to as sporadic ALS. ALS is not contagious.
74
ALS diagnosis
EMG (electromyography, is an important part of the diagnostic process. (of the nerve going to a muscle
75
PT for ALS
- stretching and strength programs to maintain strength and range of motion, and to promote general health.
- Swimming may be a good choice for people with ALS, as it provides a low-impact exercise to most muscle groups.
- Regular stretching can prevent contractures.
- Below a 10 rep
- Chest physio for assisted coughing
76
define Gullian Barre
inflammatory disorder of the peripheral nerves.
77
Gullian Barre is characterized by...
It is characterized by the rapid onset of weakness and, often, paralysis of the legs, arms, breathing muscles and face
78
how is GBS diagnosed?
The rapid onset of (ascending) weakness, frequently accompanied by abnormal sensations that affect both sides of the body similarly, is a common presenting picture.
79
what causes GBS
Perhaps 50% of cases occur shortly after a microbial (viral or bacterial) infection such as a sore throat or diarrhea
80
symptoms of MG
eyelids, chewing, swallowing, coughing and facial expression (muscles of the face more common).
81
what causes MG
In MG, there is as much as an 80% reduction in the number of Ach (exhititory neurotransmitter) receptor sites.
82
MG classifications (extrememes)
```
CLASS I (1)Any ocular (eye) muscle weakness; may have weakness of eye closure; all other muscle strength is normal.
CLASS V(5) Defined by intubation, with or without mechanical ventilation, except when employed during routine postoperative management. (ventilator support)
```
83
treatment for MG
no known cure but Common treatments include medications, thymectomy and plasmapheresis. Spontaneous improvement and even remission may occur without specific therapy.
84
post polio syndrome symptoms
slowly progressive muscle weakness, unaccustomed fatigue (both generalized and muscular), and, at times, muscle atrophy. Pain from joint degeneration and increasing skeletal deformities such as scoliosis are common.
85
what causes PPS
The cause is unknown. However, the new weakness of PPS appears to be related to the degeneration of individual nerve terminals in the motor units (almost like they got burned out) that remain after the initial illness.
86
criteria for diagnosing pps
-neuromuscular examination, and signs of nerve damage on electromyography (EMG).
-(having polio before)
-fatigability (decreased endurance), with or without generalized fatigue, muscle atrophy, or muscle and joint pain. Onset may at times follow trauma, surgery, or a period of inactivity, and can appear to be sudden. Less commonly, symptoms attributed to PPS include new problems with breathing or swallowing.
Symptoms that persist for at least a year.
87
how is pps treated
-There are currently no effective pharmaceutical or specific treatments for the syndrome itself. However, a number of controlled studies have demonstrated that nonfatiguing exercises muscle strength. can improve
Low impact aerobic excersise
88
what is thoracic outlet syndrome
Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels or both(in brachial plexus) (neurovascular), because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit.
89
3 main causes of thoracic outlet syndrome
Anterior scalene tightness
Costoclavicular approximation
Pectoralis minor tightness
90
what is..Anterior scalene tightness
Anterior scalene tightness-for side bending neck
Compression of the interscalene space between the anterior and middle scalene muscles-probably from nerve root irritation, spondylosis or facet joint inflammation leading to muscle spasm.
91
what is.. Costoclavicular approximation
Costoclavicular approximation-clavicle pressing down on 1st rib
Compression in the space between the clavicle, the first rib and the muscular and ligamentous structures in the area-probably from postural deficiencies or carrying heavy objects.
92
what does Pectoralis minor tightness cause in thoracic outlet syndrome
Pectoralis minor tightness
Compression beneath the tendon of the pectoralis minor under the coracoid process-may result from repetitive movements of the arms above the head
93
symptoms of thoracic outlet syndrome
Symptoms include neck, shoulder, and arm pain, numbness, or impaired circulation to the extremities (causing discoloration). Often symptoms are reproduced when the arm is positioned above the shoulder or extended. Patients can have a wide spectrum of symptoms from mild and intermittent, to severe and constant. Pains can extend to the fingers and hands, causing weakness.
94
how is TOS diagnosed
Certain maneuvers of the arm and neck can produce symptoms and blood vessel "pinching" causing a loss of pulse (alan test).
95
the adson or scalene maneuver
The examiner locates the radial pulse. The patient rotates their head toward the tested arm and lets the head tilt backwards (extends the neck) while the examiner extends the arm. A positive test is indicated by a disappearance of the pulse.
96
allen test
The examiner flexes the patient’s elbow to 90 degrees while the shoulder is extended horizontally and rotated laterally. The patient is asked to turn their head away from the tested arm. The radial pulse is palpated and if it disappears as the patient’s head is rotated the test is considered positive.
Stretches scalines
97
What is the treatment for thoracic outlet syndrome?
stretches
98
define carpal tunnel syndrome
Carpal tunnel syndrome is a painful progressive condition caused by compression of the median nerve in the carpal tunnel.
99
carpal tunnel syndrome
Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm. As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks.
100
define bells palsy
- Bell’s palsy is a condition that causes the facial muscles to weaken or become paralyzed.
- It's caused by trauma to the 7th cranial (muscles of the face) nerve, and is not permanent.
101
bells palsy's prevalence
The incidence of Bell’s palsy in males and females, as well as in the various races is also approximately equal.
102
who is effected by bell's palsy
Older people are more likely to be afflicted, but children are not immune to it. Children tend to recover well.
Diabetics are more than 4 times more likely to develop Bell’s palsy than the general population.
The last trimester of pregnancy is considered to be a time of increased risk for Bell's palsy
103
bell's palsy treatment
Prednisone and antivirals might be started as quickly as possible. The "window of opportunity" for starting these medications is thought to be 7 days from the onset of Bell's palsy. Prednisone may be prescribed later if it appears the inflammation has not subsided.
Rest is important. The body has had an injury, and will heal most efficiently with enough rest to maintain strength and immunity at peak levels. It's normal to feel more tired than is usual during recovery.
Food particles can lodge between the gum and cheek, so take extra steps to maintain oral hygiene.
Wear eyeglasses with tinted lenses, or sunglasses (see eye care for additional important information).
Take extra care to keep your eye moist while working on a computer. Even under normal circumstances people tend to blink less frequently while at a computer. For a dry, non-blinking eye, this can be more of a problem. Keep eye drops handy, and remember to manually blink your eye with the back of the index finger.
104
3 branches of glascow coma scale
Eye Opening Response
Verbal Response
Motor Response
