exam pt 3

Question 1

after a TBI to the dorsolateral aspect of the prefrontal area, what deficits would you expect?

Answer 1

impaired concentration, possibly decreased motivation & problem solving

Question 2

after a TBI to the premotor aspect of the frontal lobe, what characteristics would you expect a patient to display?

Answer 2

apraxia or motor planning deficits

Question 3

If a patient is displaying unstable emotions and/or unpredictable behaviors, you may suspect damage to..

Answer 3

the orbitofrontal aspect of the frontal lobe

Question 4

If a patient sustains damage to the SMA, what characteristics would you expect them to display?

Answer 4

loss of b/l control of posture

Question 5

If a patient sustains damage to teh primary motor cortex during a TBI, what characteristics would you expect them to display?

Answer 5

contralateral paralysis and paresis, most pronounced in distal parts of limbs and lower part of face

Question 6

if, after a TBI, a patient has difficulty with conjugate eye movements to the right, you would expect an injury to..

Answer 6

the LEFT middle frontal gyrus of the frontal lobe

Question 7

after a concussion, a patient will have impaired functioning of the ..

Answer 7

brainstem reticular activating system

Question 8

To be classified as a severe TBI, a patient will have lost consciousness for..

Answer 8

>24 hours (GCS score of <9)

Question 9

If, after a TBI, a patient demonstrates visuospatial or body scheme disorders, they most likely have a lesion in the..

Answer 9

R hemisphere of the parietal lobe

Question 10

LOCF =

Answer 10

Rancho Los Amigos Level of Cognitive Functioning

Question 11

If after a TBI a patient has an impairment of taste in the contralateral side of the tongue, they most likely have a lesion..

Answer 11

in the gustatory cortex of the parietal lobe

Question 12

a lesion where would cause a patient to have profound memory loss of recent events & no new learning?

Answer 12

parahippocampal region of the temporal lobe

Question 13

If a patient is at LOCF IV-VI, what would be your focus and emphasis for their care?

Answer 13

1. provide structure, avoid overstimulation if agitated/confused
2. use daily schedules & memory logs

3. provide consistency, give clear feedback

4. use task-specific training, but limit your activities to well-liked, familiar ones

5. provide freq orientation to time, place, etc

6. emphasize safety, behavioral mgmt

Question 14

what is the most severe ASIA level?

Answer 14

ASIA A - complete, no motor or sensory function is preserved in the sacral segments S4-5

Question 15

the level of an SCI indicates..

Answer 15

the most distal uninvolved nerve root segment with normal function

-muscles MUST have at least a grade of 3+/5

Question 16

a C6 ASIA C patient would p/w..

Answer 16

Motor function below C7 is preserved but most ms have <3/5 grade

Question 17

what type of SCI is considered a LMN lesion?

Answer 17

cauda equina injury (loss of long nerve roots at or below L1)

-flaccid paralysis w NO spinal reflex, also bladder and bowel paralysis

-regeneration is SLOW, often INCOMPLETE; stops after about 1 year

Question 18

what is the result of Brown-Sequard syndrome?

Answer 18

IPSIlaterally :

-loss of dorsal columns w loss of tactile discrimination, pressure, vibration and proprioception

-loss of corticospinal tracts with loss of motor fxn & spastic paralysis below level of lesion

Contralaterally:

-spinothalamic tract loss w loss of pain and temp; b/l loss of pain & temp at level of lesion

Question 19

with a central cord lesion, what is preserved?

Answer 19

proprioception and discriminatory sensation

• loss of spinothalamic tracts with b/l loss of pain and temp
• loss of ventral horn w b/l loss of motor fxn (primarily UEs)

Question 20

what nerves innervate the diaphragm?

Answer 20

C3-5 (ie if a lesion is above C4, respiratory insufficiency or failure occurs)

Question 21

If a patient with an SCI p/w increased spasticity/spasms, what could be the likely cause?

Answer 21

look for nociceptive stimuli that may trigger the increased tone (i.e. blocked cather, tight clothing/straps, body position, environ temp, infection or decubitus ulcers)

Question 22

what are the symptoms of autonomic dysreflexia?

Answer 22

1. paroxysmal HTN 2. bradycardia 3. HA

4. sweating (diaphoresis) 5. flushing 6. diplopia

7. convulsions
   - FIRST: elevate head, check & empty catheter

Question 23

what is spinal shock

Answer 23

a transient period lasting anywahere from several hours to 24 weeks; involves reflex depression & flaccidity

Question 24

for patients with high cervical lesions, the most ideal w/c would be:

Answer 24

electric w/c w tilt in space OR reclining seat back,

-microswitch OR puff-and-sip controls

-possibly a portable respirator

Question 25

If a patient has a cervical lesion SCI with at least shoulder function & elbow flexion (C5), what type of w/c is recommended?

Answer 25

manual chair w propulsion aids

-indep for short distances on smooth flat surfaces

-may choose electric w/e for distance/nrg conservation

Question 26

what w/c is recommended for someone with a C6 SCI?

Answer 26

they still have radial wrist extensors, so a manual w/c with friction surface hand rims (independently)

Question 27

If a patient has a C7 SCI, the w/c recommended is..

Answer 27

manual w/c with friction handrims with increased propulsion

Question 29

what kind of ambulation is expected of a midthoracic lesion SCI (T6-9)?

Answer 29

supervised ambulation for short distances

-req b/l KAFOs and crutches, swing to pattern,

Question 30

what type of gait is expected of a high lumbar lesion SCI (T12-L3)?

Answer 30

**maintained: hip flex, knee ext

independent ambulators on all surfaces and stairss using a swing thru OR four-point gait pattern & B/L KAFOs and crutches

Question 31

what type of gait would you expect from an SCI patient with a low lumbar lesion (L4-L5)?

Answer 31

maintained: DF, g toe ext

independent w b/l AFOs and crutches or canes

typically are indep community ambulators

Question 32

what are CV precautions associated with tetraplegia & high-lesion paraplegia?

Answer 32

1. blunted tachycardia
2. lack of pressor response
3. very low VO2 peak
4. higher variability of responses

Question 33

ABSOLUTE contraindications to exercise with SCI patients

Answer 33

1. autonomic dysreflexia

2. UTI

3. symptomatic hypotension

4. Unstable fx

5. insufficient ROM to perform task

6. severe/infected skin on WBing surface

7. Uncontrolled hot/humid environments

Question 34

what does BWSTT do for a patient with an incomplete SCI?

Answer 34

promotes spinal cord learning/activation of spinal locomotor pools

Question 35

what is the freq/duration of BWSTT suggested for incomplete SCIs?

Answer 35

4x/week x20-30 minutes

(8-12 weeks)

Question 36

some precipitating or exacerbating factors of MS would be..

Answer 36

infections, trauma, pregnancy & stress

Question 37

diagnostic tests for MS =?

Answer 37

1. LP/CSF
2. elevated gamma globulin
3. CT or MRI
4. myelogram
5. EEG

Question 38

what types of sensory differences might be found in a patient with MS?

Answer 38

1. hyperpathia (hypersensitivity to sensory stimuli)
2. dysesthesias (abnormal sensations)
3. trigeminal neuralgia
4. Lhermitte’s sign

Question 39

what’s the EDSS and what patient population is it used for?

Answer 39

expanded disability status scale

-outcome measure for MS

Question 40

what pharmacological intervention is used during an acute flair up

Answer 40

immunosuppressant drugs ie ACTH & steroids

Question 41

what drugs are used in MS to slow the progression of the disease?

Answer 41

interferon drugs