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Neuro PTA > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is a CVA?

A

Lack of O2 due to secondary ischemia or hemorrhage

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2
Q

What is ischemia?

A

Lack of blood flow due to blockage

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3
Q

What is hemorrhage?

A

Bleeding such as, ruptured blood vessel

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4
Q

What is TPA medication?

A
  • Only ischemic CVA
  • Breakdown clots and thins blood
  • Would make hemorrhagic stroke worse
  • Needs to be given during specific time frame
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5
Q

What are primary risk factors to CVA?

A

HTN, cardiac disease, DM, cigarette smoking, and TIA

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6
Q

What are secondary risk factors to CVA?

A

Obesity, high cholesterol, behaviors related to HTN, physical inactivity, and increased alcohol consumption

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7
Q

What is TIA?

A

Transient Ischemic Stroke - mini stroke

Commonly linked to athrosclerotic thrombosis and most often occurs in carotid and vertebrobasilar arteries

Pt presents with some symptoms and resolves within 48 hours

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8
Q

What is a completed stroke?

A

Total neurological deficits at the onset

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9
Q

What is a stroke in evolution?

A

Usually caused by thrombus and gradually progresses

Total neurological deficits are not seen for 1-2 hr post

Do not know stroke is coming

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10
Q

What is an ischemic stroke?

A

Loss of perfusion to a portion of the brain and within seconds there is irreversible infarction

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11
Q

What are the types of ischemic stroke?

A

Embolus and thrombus

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12
Q

What happens during an embolitic stroke?

A

Travels through bloodstream to cerebral arteries causing occlusion of BV

Most commonly comes from internal carotid

Occurs rapidly and presents with HA

Tissues distal to the infarct can sustain permanent damage

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13
Q

What happens during a thrombotic stroke?

A

Caused by arthrosclerotic plaque and occludes artery causing an infarct

Symptoms can appear in minutes or several days

Usually occurs during sleep or upon awakening after an MI or surgery

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14
Q

What are factors that cause hemorrhagic strokes?

A

HTN can cause rupture of an aneurysm

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15
Q

What are the characteristics of hemorrhagic stroke?

A 
Severe HA
Vomiting
HTN
Abrupt onset
Bleeding and symptoms evolve in relation to speed of bleed
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16
Q

What are L hemisphere CVA characteristics?

A

Weakness, paralysis of the R side

Increased frustration

Decreased processing

Possible aphasia

Possible dysaphagia

Possible motor apraxia (ideomotor and ideational)

Decreased discrimination between L and R

R hemianopsia

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17
Q

What are R hemisphere CVA characteristics?

A

Weakness, paralysis of the L side

Decreased attention span

L hemianopsia

Decreased awareness and judgement

Memory deficit

L inattention

Decrease abstract reasoning

Emotional lability

Impulsive behaviors

Decreased spatial orientation

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18
Q

What are brainstem CVA characteristics?

A

Unstable vital signs

Decreased consciousness

Decreased ability to swallow

B weakness and paralysis

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19
Q

What are cerebellar CVA characteristics?

A

Decreased balance

Ataxia and nausea

Decreased coordination

Decreased ability for postural adjustment

Nystagmus

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20
Q

What is L sided neglect?

A

Do not recognize the L side of body

Important to draw pt attention to the L side

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21
Q

What is ideational apraxia?

A

Has no IDEA what the task requires

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22
Q

What is ideomotor apraxia?

A

Has an idea of what the task requires

Lost kinesthetic memory - no longer able to perform

IE. See pt combing earlier in the day and later when you ask the pt to perform the same task they do not know what to do

Intervention includes part task training

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23
Q

How soon does neuroplasticity become active?

A

During the first 3 months post stroke

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24
Q

What is Locked-In Syndrome?

A

Brain knows what to say or do, but cannot

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25
Q

What are synergy patterns?

A

Brain responsible for complex motor patterns and inhibition of massive gross motor patterns

Higher centers of the brain lose control

How body response when voluntary movement is initiated

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26
Q

Which synergy pattern is strongest in UE?

A

Flexor

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27
Q

What is the flexor synergy pattern?

A

Scapula = elevation and retraction

Shoulder = ABd and ER

Elbow = flex

Forearm = supination

Wrist = flex

Fingers = flexion with ADd

Thumb = Flex and ADd

Hip = ABd and ER

Knee = Flex

Ankle = DF with supination

Toes = Ext

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28
Q

What is the extensor synergy pattern?

A

Scapula = Depression and protraction

Shoulder = ADd and IR

Elbow = Ext

Forearm = Pronation

Wrist = Flexion with ADd

Thumb = Flex with ADd

Hip = Ext, IR, and ADd

Knee = Ext

Ankle = PF with inv

Toes = Flex and ADd

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29
Q

Which synergy pattern is strongest in the LE?

A

Extensors

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30
Q

What is NDT?

A

Slowing down or cessation of motor development and inhibition of righting reactions, equilibrium reactions, and automatic movements

Promote use of the involved body segments

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31
Q

Define facilitation

A

Elicit voluntary muscular contraction

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32
Q

Define inhibition

A

Decrease excessive tone or movement

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33
Q

Define key points of control

A

Specific handling of designated areas of the body will influence and facilitate posture, alignment, and control

Moves proximal to distal

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34
Q

Define placing in NDT

A

Act of moving an extremity into a position that the pt holds against gravity

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35
Q

Define reflex inhibiting posture in NDT

A

Certain designated static positions that Bobath found to inhibit abnormal tonal influences and reflexes

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36
Q

What are the basics of NDT?

A

ID constraints that limit pt’s ability to perform functional activities

Pt actively participates utilizing strengths and part to whole task training

Use developmental sequence

Proper form/control is a must

REPETITION

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37
Q

What is important about manual cues of NDT interventions?

A

Motor response are heavily influenced by pressure and direction of facilitation

Begin with light pressure and grade based on response

Focus on NOT on R

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38
Q

What are the key points of control of NDT intervention?

A

Placement of physical contact b/t clinician and pt body

Proximal key points

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39
Q

What are distal key points of NDT interventions?

A

Away from the source of the problem, usually at the UE and LE levels

Used to engage pt in activities with minimal control of the clinician

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40
Q

What is the Brunnstrom: Movement Therapy in Hemiplegia?

A

Created and defined synergy and encouraged the use of synergy patterns

7 stages

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41
Q

What are the 7 stages of Brunnstrom Movement Therapy?

A

No volitional movement initiated

Appearance of basic limb synergies - spasticity begins

Synergies are performed voluntarily - spasticity increases

Spasticity begins to decrease and movement patterns are not dictated solely by limb synergies

Further decrease in spasticity with independence from limb synergy

Isolated jt movement with coordination

Normal motor function is restored

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42
Q

Define associated reaction

A

Involuntary and automatic movement of a body part as a result of an intentional active or resistive movement in another body part

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43
Q

Define homolateral synkinesis

A

Flexion pattern of involved UE facilitates flexion of involved LE

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44
Q

What is Raimiste’s phenomenon?

A

Involved LE will ABd or ADd with applied R to the uninvolved LE in the same direction

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45
Q

What is Souque’s phenomenon?

A

Raising involved UE above 100-degrees with elbow ext will produce ext and ABd of fingers

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46
Q

What are the basic principles of PNF?

A

Stronger parts are used to strengthen weaker parts

Normal movement and posture is a balance b/t control of antagonist and agonist muscle groups

Development will follow the normal sequence through a component of motor learning

Manual contacts and correct handling are key

Methods promote or hasten the response of the neuromuscular mechanism through stimulation of proprioceptors

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47
Q

Where should manual contacts be in PNF?

A

Placement to stimulate pressure receptors and provides info to the pt about direction of movement

Placement over the Mm you want to activate in direction of desired movement

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48
Q

What is stretch good for in PNF?

A

Facilitate Mm

Place Mm in elongated position followed by quick stretch to facilitate movement

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49
Q

Why is PNF good for manual resistance?

A

Some decrease internal R while some strengthen

Changes in Mm function as it moves through range

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50
Q

Define chopping

A

Combo of B UE asymmetrical patterns performed as CKC activities

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51
Q

Define developmental sequence

A

Progression of motor skill acquisition where motor control stages are mobility, stability, controlled mobility, and skill

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52
Q

What is controlled mobility?

A

Ability to move within a WB position or rotate around a long axis

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53
Q

What are mass movement patterns?

A

Hip, knee, and ankle move into flex/ext simultaneously

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54
Q

Define overflow

A

Mm activation of an involved extremity due to intense action of uninvolved Mm

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55
Q

What are tips for successful PNF tx?

A

Learn diagonal patterns

Techniques MUST have accurate timing, specific commands, and correct hand placement

V/C are short and concise

Repetition is necessary

R given during the movement pattern is greater if goal is stability. R is less if goal was mobility

Utilize isometric and isotonic Mm contractions

Move through full movement and through all ranges

Developmental sequence used in conjunction with PNF techniques to increase agonists and antagonists

Utilized to increase strength or improve relaxations by enhanced overflow from stronger to weaker Mm

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56
Q

What are the 3 components of PNF diagonals?

A

Flex/ext
Motion towards/across midline
Rotation

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57
Q

What is joint facilitation?

A

Traction and approximation stim receptors w/in jt and structures

Traction = motion

Approximation = stability and WB

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58
Q

What are the mobility techniques of PNF patterns?

A 
Rhythmic initiation
Contract-relax
Hold-relax
Rhythmic rotation
Hold-relax active movement
Jt distraction
Repeated contraction
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59
Q

What are the stability techniques of PNF patterns?

A

Rhythmic stabilization
Alt isometrics
Slow reversal
Slow reversal hold

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60
Q

What are the controlled mobility techniques of PNF?

A

Agonist reversal
Slow reversal
Slow reversal hold

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61
Q

What are the skill techniques of PNF patterns?

A 
Agonist reversals
Slow reversal
Slow reversal hold
Timing for emphasis
Normal timing
Resisted progression
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62
Q

What is rhythmic initiation?

A

Voluntary relaxation - clinician takes body part thru desired ROM

Isotonic contraction - pt helps move body part thru ROM (AAROM)

Resisted isotonic contraction - slightly resist pt thru ROM

63
Q

What is rhythmic rotation?

A

Passive movement in rotational pattern

64
Q

What are agonist reversals?

A

Concentric contraction of agonist resisted thru ROM - isometric hold at end - resisted eccentric contraction back to starting position - isometric hold at start

65
Q

What is Rood?

A

Based on reflex stim model

Tx based on sensorimotor learning

Use developmental sequence to enhance motor control

Exercise only effective if response is correct and it provides sensory feedback that enhances motor learning of response - once response obtained then stim is withdrawn

66
Q

What are the goals of Rood?

A

Obtain homeostasis in motor output

Activate Mm to perform a task independent of stim

Elicit desired reflex motor response

67
Q

What are examples of facilitation in Rood?

A 
Approximation
Jt compression
Icing
Light touch
Quick stretch
R
Tapping
Traction
68
Q

What are examples of inhibition in Rood?

A

Deep pressure
Prolonged stretch
Warmth
Prolonged cold

69
Q

What is a high C-spine SCI?

A

C1-C5

70
Q

What is a mid-level C-spine SCI?

A

C6

71
Q

What is a low C-spine SCI?

A

C7-C8

72
Q

Where does injury occur in a paraplegic?

A

Thoracic, lumbar, or sacral

73
Q

What is an injury called at L1 or below?

A

Cauda equina injury (LMN)

74
Q

What is spinal shock?

A

Physiologic response that occurs b/t 30-60 min after trauma to the spinal cord and can last up for several weeks

75
Q

Define neurectomy

A

Surgical removal of a segment of nerve in order to decrease spasticity and improve function

76
Q

Define myelotomy

A

Surgical procedure that severs certain tracts within SC to decrease spasticity and increase function

77
Q

Define rhizotomy

A

Surgical resection of the sensory component of a spinal Nn to decrease spasticity and improve function

78
Q

Define tenotomy

A

Surgical release of a tendon to decrease spasticity and improve function

79
Q

What is a neurologic level SCI?

A

Most caudal segment of the SC with intact sensory and motor function on both sides

80
Q

How is the neurologic level SCI measured?

A

Sensory - refers to normal sensation

Motor - MMT >/= 3/5

81
Q

What is the skeletal level SCI?

A

Refers to level at which by x-ray/other imaging the greatest damage is found

82
Q

Define zone of preservation

A

Poor or trace MMT or sensory function up to 3 levels below neurologic level of injury

83
Q

Define sacral sparing

A

Incomplete lesion

Perianal sensation and/or voluntary control of rectal sphincter mm; movement of toe flexors

Sacral tracts run most medially within the SC

84
Q

What are the categories of incomplete SCI?

A 
Brown Sequard syndrome
Posterior cord syndrome
Anterior cord syndrome
Central cord syndrome
Cauda equina syndrome
85
Q

What is a complete SCI?

A

No preserved motor or sensory function below the level of lesion

Results in tetraplegia

Completeness is not fully known until 6-8 weeks post injury because of spinal shock

86
Q

What is Anterior Cord Syndrome?

A

Occurs to frontal part of SC

Results in loss of motor and sensation (p! and temp) below level of injury because fasciculus cuneatus and gracilis are injured

Can occur with disc herniations, tumors, and when the head is forced into flex

87
Q

What is Brown Sequard Syndrome?

A

Occurs when 1/2 spinal cord is damaged

Results in IPSILATERAL paralysis and loss of vibratory and position sense.

Results in CONTRALATERAL loss of p! and temp

Usually caused by stab wound

88
Q

What is cauda equina syndrome?

A

Injury at or below L1 (PNS - LMN injury)

Flaccidity, areflexia, and b/b dysfunction

89
Q

What is a neurogenic nonreflexive (areflexic) bladder?

A

S2-4 injury; flaccid b/b; sacral reflex arc damaged

90
Q

What is neurogenic reflexive bladder?

A

Hyperreflexic/spastic

Bladder empties reflexively for pt with injury above S2 (Scorebuilders states around T12)

Sacral reflex intact

91
Q

What is a hyperreflexic b/b?

A

Have no voluntary control of b/b, but can still empty

Pt may have scheduled bathroom breaks

Greater risk for UTI

92
Q

What spinal level controls b/b?

A

S2-S4

93
Q

What is Central Cord Syndrome?

A

Most common

Central portion of SC is damaged typically from cerv hyperextension. Also caused from DJD and/or stenosis

Greater weakness in UE than LE

Greater motor deficits than sensory

94
Q

What is Posterior Cord Syndrome?

A

Rare

D/t damage of posterior spinal Aa. IE. compression d/t tumor

Loss of proprioception, 2 point discrimination, vibration, and stereognosis

Motor function preserved

95
Q

According to ASIA what is A classification of SCI?

A

Complete

No S/M function below level of injury

No sacral sparing (no preservation in S4-5)

96
Q

According to ASIA what is B classification of SCI?

A

Sensory Incomplete

S (no M) function is preserved below neurologic level including S4-S5

97
Q

According to ASIA what is C classification of SCI?

A

Motor Incomplete

M function is preserved below neurologic level, more than 1/2 of key Mm below neurologic level have <3/5 MMT

98
Q

According to ASIA what is D classification of SCI?

A

M function is preserved below neurologic level and at least 1/2 of key Mm below neurologic level have strength of >/= 3/5

99
Q

According to ASIA what is E classification of SCI?

A

Normal

S/M functions are normal

100
Q

Define motor level in Standard Neurological Classification of Level of Injury

A

Most caudal

Mm have strength of >/= 3/5 with superior segment tested as normal

101
Q

Define Motor Index Scoring on Standard Neurological Classification of Level of Injury

A

Test each key Mm using 0-5 score, total of 25 pt per extremity = 100 pt possible

102
Q

Define Sensory Level on Standard Neurological Classification of Level of Injury

A

Determined by the most caudal dermatome with a normal score of 2/2 for PINPRICK and LIGHT TOUCH

Impaired does not necessarily mean they do not feel it. Could be hypersensitive

103
Q

What muscles are involved with C4 SCI?

A

Cerv extensors and flexors/diaphragm/traps and LS

104
Q

What Mm are involved with T6 SCI?

A

Accessory respiration Mm/upper back extensors

105
Q

What Mm are involved with T12 SCI?

A

Thoracic abdominal and back Mm

106
Q

Define spasticity

A

Velocity dependent

107
Q

Define tonicity

A

Speed and velocity dependent

108
Q

Can you strengthen motor loss that comes from a SCI?

A

You can strengthen, but not below the level of injury

109
Q

What is motor loss from a SCI?

A

Motor loss below LOI may be complete or partial

Can be tested by MMT

110
Q

What is sensory loss from a SCI?

A

Occurs in dermatomal pattern

ASIA test - light touch and pin prick

Graded normal, impaired, absent

111
Q

What is spasticity from SCI?

A

Spinal shock occurs early after SCI (Mm are flaccid)

Mm spasms occur

The quicker the pt is out of spinal shock = better prognosis - contribute to neuroplasticity

Affect skeletal Mm, b/b, and sex organs

Can increase with pressure ulcers, full bladder or UTIs

112
Q

What is b/b dysfunction after SCI?

A

Lose total or partial voluntary control of b/b

Can be reflexic above S2 or areflexic

113
Q

Define hyperreflexic/spastic b/b dysfunction

A

Pressure inside b/b causes emptying

114
Q

Define nonreflexic/flaccid b/b dysfunction

A

Sacral reflex is not intact so b/b require manual emptying

115
Q

What are ways to void bladder without voluntary control?

A

Catheter
Intermittent catheter
Crede maneuver

116
Q

What is a spastic bladder?

A

No control of urination

117
Q

What is flaccid bladder?

A

Does not empty

118
Q

What respiratory complications can occur with SCI?

A

Respiratory Mm (Intercostals T1-11 and C3-5) will be affected with injury above L1

Cough assist with high T
Functional cough T6
Normal cough T12

Forced vital capacity and inspiratory capacity increases as SCI level descends

119
Q

What occurs to respiratory system when SCI is between C4 and T5?

A

Able to breathe on own, but intercostal Mm may be weak or paralyzed depending on level

C injury: breathing mainly by diaphragm

Need assisted cough to T6

120
Q

What occurs to respiratory system when SCI is between T6 and T12?

A

Injury does not normally affect breathing. Cough may be impaired

Injuries below T12 have normal breathing and cough reflexes

121
Q

What are sx/sx of DVT?

A

Dull ache, pain, calf tenderness, edema, and fever

Early - asymptomatic

122
Q

What are tx options for DVT?

A

Acute - pt on bed rest until sx of inflammation have subsided, elevate extremity

Anticoagulant meds

Exercise contraindicated during acute phase

Amb permitted with stockings after local tenderness and swelling reslove

123
Q

What are preventions/tx for DVT?

A

Elastic hose

Increase mobility

124
Q

What is autonomic dysreflexia?

A

Syndrome of massive imbalanced reflex sympathetic dischage

ONLY occurs in pt with injury at or above T6

Lose ability to maintain homeostasis

125
Q

What are the sx/sx of autonomic dysreflexia?

A 
HTN
Blurred vision
Profuse sweating
Goosebumps (below injury)
Severe HA
Stuffy nose
Flushing of head and neck

MEDICAL EMERGENCY

126
Q

What are the tx of autonomic dysreflexia?

A

Immediately - assist pt to sit or stand

Find and remove cause - check skin, bladder, and bowel

CHECK CATHETER, check tight clothing, look for undiagnosed pressure ulcer

Check BP

Call for help

127
Q

What is ectopic bone?

A

Spontaneous formation of bone in soft tissue - common in hips and knees

128
Q

What is the cause of ectopic bone?

A

Tissue hypoxia to abnormal Ca metabolism

129
Q

What are the sx/sx of ectopic bone?

A

Edema, decreased ROM, and increased temp

130
Q

What is the tx of ectopic bone?

A

Meds: diphosphates

PT and surgery

131
Q

What is decreased bone marrow density?

A

Demineralization occurs within first year with peak at 4-6 months post injury due to NWB

Use stander and orthotics to prevent

132
Q

What is orthostatic hypotension?

A

Decrease BP when you sit or stand

Can cause lightheadedness or fainting

133
Q

What increases the likelihood of orthostatic hypotension?

A

T6 or above SCI

134
Q

What are interventions of orthostatic hypotension?

A

Want to increase BP and get O2 back to brain

Tilt table helpful

135
Q

What are the causes of orthostatic hypotension?

A

After SCI - BV do not decrease in size in smooth Mm around BV cannot vasoconstrict/dilate in response to changes in ANS

Cannot contract to get valves in veins to push blood back to heart - blood can pool

136
Q

How do you prevent orthostatic hypotension?

A

Elastic hose and ab support and come to sitting/standing position gradually

137
Q

What do you look for that can increase risk of pressure ulcers?

A

Thick, rough clothing, lumpy sheets, cushion covers or clothing, moisture, heat, burns, ill-fitting clothes, poor nutrition, orthopedic deformities

138
Q

How do you prevent pressure sores?

A

Relief cushion and mattress

Periodic pressure release
- 15 sec every 15 min, 30 sec every 30 min, or 1 min for every hr

139
Q

What causes spasticity in SCI?

A

Increased internal/external forces

Stress, ulcers, UTIs, b/b obstruction, temp changes, or touch

140
Q

What are the sx/sx of spasticity in SCI?

A

Increased tonic stretch reflexes and exaggerated DTRs

141
Q

What treatment is given for spastic SCI?

A

Meds, surgery, PT

142
Q

What are sx/sx of UTI?

A

Fever, change in urine, sediment in urine, odor change, increase in tone

143
Q

What are the 5 stages of grief?

A 
Denial
Anger
Bargaining
Depression
Acceptance
144
Q

What is MS pain of SCI?

A

Related to mechanical instability, inflammation, Mm spasm, and overuse of Mm and jt

145
Q

What is neuropathic pain of SCI?

A

Sharp, stabbing, burning, or electrical pain associated with painful, hypersensitive response to normally non-noxious stimuli

146
Q

What are components of acute SCI tx?

A 
Positioning
PROM/selective stretching
Acclimation to vertical
Strengthen spared Mm
Improvement of respiratory fxn
147
Q

What is acclimation to vertical?

A

Begin sitting activities ASAP

Watch for orthostatic hypotension - monitor VS

148
Q

What are the components of SCI rehab?

A 
Functional position
Momentum rolling
Sit to/from supine
Protective ext
Balance activities
Transfer training
W/C management and mobility
Pressure relief and reposition in w/c
Standing activities
Gait activities
Complete education and vocational counseling
Sports and leisure education
Community re-integration
Home eval/modification
149
Q

What kind of transfer is needed for SCI C5 or higher?

A

Dependent 2 person/1 person squat

150
Q

What kind of transfer is needed for C5-C6?

A

Sliding board with/without A

No use of triceps

KEEP fingers flexed to keep tenodesis

151
Q

What kind of transfer is needed for C7 SCI?

A

Use triceps with/without slide board

152
Q

What kind of transfer is needed for C8-L2 SCI?

A

Most likely use footboard of w/c

153
Q

What is jack knife?

A

Upper body and head forward of pelvis

Lose standing stability

Can use JK with intention to get back to upright position

Neuro PTA (3 decks)

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