Final Exam Flashcards
Where would bradykinesia be placed in the ICF model
Structure and function impairment
Where is the PDQ-39 in the ICF model
Participation
What are some PD body structure and function outcome measures
MDS-UPDRS part 1 and part 3
What are some PD activity limitations outcome measures
MDS part 2
Parkinson’s fatigue scale
What are some PD participation outcome measures
PDQ - 8, 39
Nonmotor symptoms questionnaire
What is the general model of PD care
Prevention is better than reaction
Do PT as soon as their is a diagnosis and don’t wait until their is an event
What are some intervention strategies for HY stage 1-2
Increase physical activity
Large body movements
Prevention of inactivity
What are some intervention ideas for HY stage 3-4
Train for gait balance and transfers
Reach and grasp
Sensory queuing
What are some intervention ideas for HY stage 5
Supportive care
Prevention of contractures, pressure sores, pneumonia
Hospital bed as needed
Family training
What are some PD associated motor and nonmotor impairments
Postural hypotension
Bladder infrequency
Sleep disturbances
Depression, anxiety, apathy
Describe shuffling gait
Short step length, decreased foot clearance, flexed knees and hips
rigid trunk, asymmetrical arm swing
bradykinesia that worsens with dual tasking
Describe anteropulsion
COM too far forward, starts to run
Caused by forced through a freeze or walkers without wheels
Describe retropulsion
COM if to far posterior
Cause by backing up, reaching overhead, opening doors, carrying items too close to by body
What are some triggers for freezing gait
Narrow spaces
Stress
Turning
Change in walking surface
What are the 4 S’s to fight festinating a freezing
Stop
Stand tall
Sway
Step long
What AD may help most for freezing
Laser pointers useful for visual que
Ustep walker
What are some ways to implement visual ques
rail road tracks, 24-48 inches apart, 150% longer than normal step length
What are some ways to implement auditory ques
Music while walking
Metronome, 100-125 BPM
Why does cueing work for PD
It bypasses the damaged basal ganglia and brings gait to the conscious level
What is Camptocormia
Extreme involuntary flexion in standing but relieved in supine
What is pisa syndrome
increased lateral flexion
subsides with passive correction in recumbent positions
What muscles need to stretched with PD
Pecs
Extensor muscles
What intensity of cardiovascular exercise is ideal for individuals with PD
150 mins a week of moderate intensity
This can slow or reverse neurodegeneration
What are some ways to manage PD tremors
Stress management
Promote relaxation
Weighted utensils
Large buttons
What is a common PD medication
Levodopa
What is an example of reactive balance training
Perturbation training
Abrupt stops and starts, ball catches
What are some anticipatory balance training activities
Self initiated movements
Gait with head turns
Dual tasking
What are some characteristics of successful PD activities
High repetition, high intensity
Dynamic
Patient enjoys
What is the underlying pathophysiology of PD
Degeneration of dopaminergic neurons in the BG, the pars compacta of substantia nigra no longer produce dopamine
How is DP acquired
Genetics
Exposure to certain environmental toxins
Certain drugs
What underlies hypokinesia in PD
Inhibition of the thalamus by the basal ganglia
Where is dopamine produced specifically in the brain
in the pars compacta of the substancia nigra of the BG
What are the 4 cardinal symptoms of PD
Rigidity
Bradykinesia
Tremor
Postural instability
Do PD patients suffer from primary sensory loss
No
60-80% deal with paresthesia and pain as early symptoms
What are some impairments in PD that may warrant a speech language pathologist
Hypokinetic dysarthria
Degraded vocal quality
Mutism
What are some autonomic symptoms of PD
Hyperhidrosis
Seborrhea
Gi disorders
Describe the HY stage 1
Minimal or absent disability
Unilateral if present
Describe the HY stage 2
Minimal bilateral or midline involvement, balance not impaired
Describe the HY stage 3
impaired righting reflexes, some activities restricted
Describe the HY stage 4
All symptoms present and severe, standing and walking only with assistance
Describe the HY stage 5
bed or char bound
What can chronic dopamine replacement cause
dyskinesias and akinesias
Explain deep brain stimulation
Brain stimulation with implanted device that can eliminate symptoms of PD
What are some specific MS outcome measures
12 item MS walking scale Timed 25 foot walk MS quality of life -54 instrument Expanded disability status scale Fatigue severity scale
Subtypes of MS
Progressive relapsing
Secondary progressive
Primary progressive
Relapse remitting
Relapse remitting
Primary progressive
What are some MS exacerbating symptoms
Stress Affective disorders Disease of major organ systems Viral or bacterial infection Pseudoexacerbation
What is uthoff’s symptom
Adverse reaction to heat
What are some clinical considerations for MS
Avoid overheating
Exercise and activity should be a challenge, but never a struggle
Progression is generally slower
What are some exercise contraindications for MS
Do not exercise them to the point of fatigue
Do not exercise RRMS during an exacerbation
Describe fatigue as it relates to MS
sudden severe sleepiness, excessive tiredness, sense of weakness
What are some energy effectiveness strategies for MS patients
Activity diary
Energy conservation techniques
Activity pacing
What is the underlying cause of MS
Inherited susceptibility to immune system dysfunction
These people are then exposed to a viral agent and MS may develop
What is the pathophysiology of MS
an abnormal immune response attacks oligodendrocytes and the nerve root fibers themselves in the CNS
Describe relapse remitting
Most common form of MS
Attacks followed by remission
Describe primary progressive
continued worsening of the disease
Describe progressive relapsing
Progressive decline with attack
What is considered a MS relapse
Symptoms longer than 24 hours
What are some secondary deficits with MS
numbness
paresthesia
What are some cognitive issues associated with MS
Short term memory loss
Dual tasking issues
Lower attention
Lower executive function
What are some eye movement defecits with MS
Nystagmus
Diplopia
What cerebellar symptoms may be present in MS
Ataxia
Tremors
Hypotonia
Truncal weakness
What is cognitive motor interference
Impairments with gait due to inability to dual task
What is dysarthria
Poorly articulated speech
What is pseudo bulbar affect
Sudden laughing or crying when it is inappropriate
Describe Dawson’s fingers
Seen in coronal MRI
Indicated MS
What medications can manage spasticity
Oral baclofen
Botulin toxin
What interventions are bets for early / mid MS stages
Regular exercise
Community classes for socialization
Education
Determine need for assistive device
What are some fatigue based OM for MS
MFIS
FSMC
What is the MSWS-12
Self assessment on walking function
What is the ideal exercise frequency for MS patients
3-5 days per week
Describe the activity diary for MS patients
Document how they sleep
Daily activities by the hour
How costly those activities were
What are 2 ways to limit ataxic movements
Proprioceptive loading
Light resistance
Define ataxia
Loss of muscle coordination
What does the midline of the cerebellum control
Titubation
Truncal ataxia
Orthostatic tremor
Gait imbalance
What does the hemispheres of the cerebellum control
Limb ataxia
Dysarthria
Hypotonia
What does the posterior of the cerebellum control
Posture
Gait
Eye movement disorders
What side of the body does the cerebellum control
ipsilateral side
Define dyssynergia
impaired synergistic actions with decomposition of movement
How does stroke affect eccentric and concentric strength
Affects concentric more
40-60% less torque
What are some characteristics of post stroke exercise
Prevent stiffness
Strengthen muscles over short lengths
Eccentric strength preservation
What is the exercise dosing post stroke
1 set of 10-15 reps
40-50% 1RM
2-3 days per week
48 hour rest
What type of power training should be conducted post-stroke
Emphasis on fast concentric and slow eccentric
This helps with fall prevention and reactionary balance
Describe CIMT, who made it
Technique of treatment intended to increase the use of the affected limb in post stroke patients
Taub
What are the 4 main components of CIMT
repetitive and intense training
Shaping
Transfer package
Physical restraint of uninvolved limb
What is the dosing of CIMT
3 hours per day
5 days per week
2-3 weeks
How do you shape tasks
Slowly make the task harder
What is the main goal of CIMT
reverse learned nonuse and increase the use of the patients affected limb
What is the goal of the transfer package
Transfer what the patient has learned into the real world
What are the minimum ROM requirements to begin CIMT
45 shoulder abduction
20 elbow extension
10 wrist extension
10 finger flexion
What are the major OM used in CIMT
Wolf motor function test
Motor activity log
What are the most consistent predictors of adherence to physical activity in older adults.
Self efficacy
Perceived barriers
How do you break down objective and subjective obstacles
Objective - environment and task adaptation
Subjective - confidence building, problem solving, refuting beliefs that hinder activity
What is use-dependent neural reorganization
Happens after overuse is overcome use of that extremity is learned
What activities may require “mit off both hands”`
Dressing
Bathing
What is the difference between home skills and home practice
Home skill - encourage patients to try ADL’s that they may not have tried with the more involved limb
Home practice - Patients performing 15-30 mins of specific UE tasks
What side to “pushers” push toward
Weak side
Opposite the lesion
What OM can be used to determine if the patient is a pusher
Scale for contraversive pushing - SCP
Burkle Lateropulsion scale - BLS (more sensitive)
What is the hallmark sign that someone has Pusher’s syndrome
resistance to passive coercion
What characteristics mark a higher incidence of pusher syndrome?
Severe hemiparesis / plegia
Severe sensory loss
Neglect
Right CVA compared to left
What system is affected with pusher syndrome?
impaired gaviception
What is the prognosis of individuals with Pusher syndrome?
Good prognosis
Most resolve in 3 weeks
Generally 80% resolve in 3 months
Rare presence by 6 months
Which hemisphere is push most evident in
Right
What area of the brain will most likely underlie contraversive pusher
Posteriolateral thalmus
Parietal lobe
What is a lacunar stroke
Caused by small vessel disease deep in the cerebral white matter
Why is dysphagia a worry among stroke patients
happens to 1/3
Can lead to aspiration, pneumonia and death
Where is short term memory stored
Limbic system in the temporal lobes
Damage to which hemisphere is associated with a more cautious, anxious, disorganized behavior?
left
Perceptual deficits are frequently the result of lesions to what area(s) of the brain?
Right hemisphere
What are the SS for PE
Chest pain Tachypnea Tachycardia Anxiety Restlessness Apprehension Persistent cough
What is central post-stroke pain?
Pain arising as a direct consequence of a lesion or disease affecting the central somatosensory system, happens in about 10% of strokes
What is selective capacity
Ability to isolate movement
A selective loss in what type of fibers is present post-stroke?
type 2 fast twitch
When performing rolling during bed mobility with an individual with hemiparesis, which direction would be the most difficult?
Onto the good side will be more difficult
What should early sitting balance training focus on in the acute/sub-acute stages post-stroke?
symmetric posture with proper spine and pelvic alignment
In a patient with hemiparesis which direction is lateral flexion more prominent
Lateral flexion to the affected side
Define TBI
Alteration of brain function by an external force
What is the leading cause of TBI
Falls
Then MVA
What population is most affected by TBI
Elderly
What is a Primary TBI
The brain contacting another object or rapid acceleration and deceleration of the brain
What is the most predominant mechanism of injury in most individuals with moderate to severe TBI
Diffuse axonal injury
Caused by acceleration and deceleration shear forces
What is Blast TBI
When the shockwave from a black causes compression to the brain
Describe secondary TBI injury
The subsequent events after an initial trauma Hypoxemia Ischemia Edema Elevated ICP
Define a vegetative state
awake
non powerful movements
withdrawal from noxious stimulus
Define minimally conscious state.
Inconsistent ability to mediate behaviors
some evidence of self and environmental awareness
What is dysautonomia?
Pathologically increased sympathetic nervous system activity
Which outcome measure is most often used for TBI severity? Provide the value corresponding with a severe TBI.
GCS
<8 = severe
The duration of what predicts TBI recovery
Post traumatic amnesia
PTA
Length of time from injury to when patient can remember events
What is normal intracranial pressure
5-20 mmHG
What are some methods used to treat elevated ICP
Moderate head up position Osmotherapy Hypothermia Surgical decompression Barbiturates
What are contraindications for early mobilization with TBI patients
Unstable spine
Increased ICP
Describe the Community Balance and Mobility Scale
Activity
Ambulation
High level patients
Describe the Community Integration Questionnaire
Participation
Home integration, social activities, productive activities
For home health and outpatient settings
What kind of practice shedule is good for TBI
Distributed
