exam pt 3 Flashcards
after a TBI to the dorsolateral aspect of the prefrontal area, what deficits would you expect?
impaired concentration, possibly decreased motivation & problem solving
after a TBI to the premotor aspect of the frontal lobe, what characteristics would you expect a patient to display?
apraxia or motor planning deficits
If a patient is displaying unstable emotions and/or unpredictable behaviors, you may suspect damage to..
the orbitofrontal aspect of the frontal lobe
If a patient sustains damage to the SMA, what characteristics would you expect them to display?
loss of b/l control of posture
If a patient sustains damage to teh primary motor cortex during a TBI, what characteristics would you expect them to display?
contralateral paralysis and paresis, most pronounced in distal parts of limbs and lower part of face
if, after a TBI, a patient has difficulty with conjugate eye movements to the right, you would expect an injury to..
the LEFT middle frontal gyrus of the frontal lobe
after a concussion, a patient will have impaired functioning of the ..
brainstem reticular activating system
To be classified as a severe TBI, a patient will have lost consciousness for..
>24 hours (GCS score of <9)
If, after a TBI, a patient demonstrates visuospatial or body scheme disorders, they most likely have a lesion in the..
R hemisphere of the parietal lobe
LOCF =
Rancho Los Amigos Level of Cognitive Functioning
If after a TBI a patient has an impairment of taste in the contralateral side of the tongue, they most likely have a lesion..
in the gustatory cortex of the parietal lobe
a lesion where would cause a patient to have profound memory loss of recent events & no new learning?
parahippocampal region of the temporal lobe
If a patient is at LOCF IV-VI, what would be your focus and emphasis for their care?
- provide structure, avoid overstimulation if agitated/confused
- use daily schedules & memory logs
3. provide consistency, give clear feedback
- 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
what is the most severe ASIA level?
ASIA A - complete, no motor or sensory function is preserved in the sacral segments S4-5
the level of an SCI indicates..
the most distal uninvolved nerve root segment with normal function
-muscles MUST have at least a grade of 3+/5
a C6 ASIA C patient would p/w..
Motor function below C7 is preserved but most ms have <3/5 grade
what type of SCI is considered a LMN lesion?
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
what is the result of Brown-Sequard syndrome?
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
with a central cord lesion, what is preserved?
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)
what nerves innervate the diaphragm?
C3-5 (ie if a lesion is above C4, respiratory insufficiency or failure occurs)
If a patient with an SCI p/w increased spasticity/spasms, what could be the likely cause?
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)
what are the symptoms of autonomic dysreflexia?
1. paroxysmal HTN 2. bradycardia 3. HA
4. sweating (diaphoresis) 5. flushing 6. diplopia
- convulsions
- FIRST: elevate head, check & empty catheter
what is spinal shock
a transient period lasting anywahere from several hours to 24 weeks; involves reflex depression & flaccidity
for patients with high cervical lesions, the most ideal w/c would be:
electric w/c w tilt in space OR reclining seat back,
-microswitch OR puff-and-sip controls
-possibly a portable respirator
