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FALL2 NEURO > INTRO TO HEALTH PROMOTION > Flashcards

INTRO TO HEALTH PROMOTION Flashcards

1
Q

Nearly ___ of patients with stroke experience recurrent stroke within __ years and comorbidities CV conditions represent leading cause of death.

A

1/3 within 5 years

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2
Q

Fast twitch fibers are ____ sensitive to insulin
Patients after stroke experience decrease in __ fibers

A

Fast twitch are less sensitive to insulin
Post stroke: more fast twitch due to decrease in slow twitch

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3
Q

Paretic limb fat content is _____, muscle mass is ___%

A

Fat is 25% higher
Mm is 20% lower
Causing increase energy cost of gait
Decreased fitness more than age, sex

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4
Q

What are health behaviors?

A

Actions that are intentional or unintentional, that affect health of individuals or others

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5
Q

Greatest physical activity benefits in mortality risk are in ___hrs a week

A

0-7.5 (20% drop in mortality)
7.5-15 is also good (11% drop in mortality)
Up to 40-75 hours BENEFITS

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6
Q

What is most common way to do a home eval?

A

Give patient/family a worksheet to complete and draw a simple floorplan
*you can do a home eval with the patient and family present ideally

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7
Q

What can patients with tetraplegia use on their wheelchair to prevent rolling backwards?

A

Grade aids

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8
Q

___ people post stroke may prefer to go up backwards on a ramp, pushing with quads

A

Foot propellers, pushing with quads

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9
Q

What is progression for K levels of Wheelchair qualifying process?

A
  1. Standard manual WC
  2. Lightweight WC
  3. Power operated vehicle (scooter)
  4. Motorized WC
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10
Q

Scooters are more or less expensive?
More or less trunk control needed?
Do they have armrests and seatbelts?

A

Scooters are less expensive,
Less stable side-to side
More trunk/upper body control needed for scooter
Scooter seat may or may not not have armrests and seatbelts
Scooter has fewer seating options

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11
Q

For any WC prescription, the person has to sit a min of ___hours per day ___ their home to qualify for Medicare coverage

A

4 hours INSIDE

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12
Q

Motorized wheelchairs are only covered if they are needed to perform

A

ADLs in home/routine! (If patient can’t walk to kitchen to eat)
Need to be required at least 4 hours a day. FACE TO FACE VISIT WITH PHYSICIAN REQUIRED

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13
Q

Will Medicare pay for an electric bed?

A

Fully electric: no not at all
SEMI-ELECTRIC: (ADJUST HEAD AND FOOT OF BED WITH CONTROL, bed height is adjusted MANUALLY at foot of the bed)

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14
Q

When does SCAT6 have good clinical utility/best able to discriminate between concussed and non concussed athletes in acute stages…

A

First 72 hours post injury, up to 5-7 days

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15
Q

Functional balance problems

A

STEADI 4 STAGE, FSST, mini best

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16
Q

MOTOR AND SENSORY STRATEGY PROBLMES ARE

A

REACTIVE POSTURAL CONTROL ISSUES

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17
Q

Anticipatory postural control issues are

A

Ability to recover stability after external perturbations (strategies)

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18
Q

Shifting COM before voluntary movement like stepping-lift leg, arm raise, head turn

A

Sensory organization issue

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19
Q

Individual balance is what 3 things

A

Motor
Sensory cognitive

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20
Q

Task balance is

A
  1. Steady state
  2. Proactive
  3. Reactive
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21
Q

Environment components of balance

A
  1. Support surfaces
  2. Sensory context
  3. Cognitive load
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22
Q

Stages of motor learning for balance in the individual

A

Skill acquisition
Refinement
Retention

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23
Q

Environment balance sensory context

A
  1. Visual conditions
  2. Sensory agreement
  3. Sensory conflict
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24
Q

For patients with PD, ___ when performing concurrent verbal task
CVA/TBI ___ sway with dual task

A

Decreased postural stability
Increased sway

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25
Q

Postural adaptation problems are due to

A

Decreased ability to recruit agonist mm in response to big perturbation (strength)
Decreased modulation of response amplitude to different perturbation sizes (cerebellar)
Increased compensatory sway in opposite direction (anterior cerebellar lesions and MS)

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26
Q

Impaired central set

A

Inability to change movement strategies quickly to adapt to changes in demands

BASAL GANGLIA

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27
Q

Reactive balance retraining

A

Multi directions, different perturbations
Goal: strategies! Hip ankle, step

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28
Q

Anticipatory balance retraining

A

Voluntary sway
Self initiated sway
Wobble board, bosu ball, dyna discs

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29
Q

Treatment of timing problem for balance

A

BWSTT, FES

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30
Q

Treatment of timing problem for balance

A

BWSTT, FES

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31
Q

Treatment of amp problem

A

Start small perturbations then progress to large
Scaling problem: computerized program like balance master

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32
Q

What can we do with patients who have dyssynergia?

A
  1. Stability: rhythmic stabilization/alternating isometrics
  2. Slow reversal/holds for controlled mobility
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33
Q

FRENKEL IS FOR

A

DYSMETRIA

34
Q

Strokes where cause hemiparesis of arm?

A

MCA
BG
Internal capsule
Subcortical white matter
Pyramidal tracts in brainstem

35
Q

Which joint in the shoulder is a major contributor to pain/disability?

A

GH

36
Q

_% of stroke survivors experience at least one episode of shoulder pain within first year of post stroke

A

72%

37
Q

What can cause painful hemiplegic shoulder?

A

Frozen shoulder
Neuropathy traction/compression
CPRS
Shoulder trauma
Bursitis/tendinitis
Rotator cuff tear
HO

38
Q

Inferior subluxation due to

A

Scapula downward rotation (low rotator cuff, Serratus)
Glenoid fossa downward
Humoral internal rotation when elbow extended

39
Q

Anterior GH subluxation due to

A

Down pull of lats
Vertical orientation of glenoid
Scapula elevation on thorax
Humerus hyperextends, internal rotation

40
Q

Superior subluxation is due to

A

Deltoid spasticity/biceps
Scapula rotate down, elevate on thorax
Humoral head internally rotates and pull up under acromion

41
Q

Bad things about shoulder supports

A

Not permanent
Reinforce flexion synergy patterns
Facilitation of contractures

42
Q

Good and bad about FES for shoulder subluxation

A

Good: reduce subluxation, pain immediately
Bad: not permanent changes

43
Q

With frozen shoulder, what are possible treatments?

A
  1. Maximize ROM
  2. Meds for pain
  3. Ice for acute, heat for stretch
  4. STM
  5. Estim
  6. Motor block to sub scap and pecs for spasticity
44
Q

Treatment of brachial plexus injury

A

AROM/PROM avoiding traction
45 degree shoulder abduction sling for night
Shoulder support while walking
Armrest in wheelchair
(Heal 8-12 months)

45
Q

HO usually occurs where in the hemiplegic shoulder?

A

Infrequent but happens
Extensor side of elbow
Gentle mobilization, ETRIDONATE/indomethacin

46
Q

If lateral zone is damaged, what do you see in cerebellum clinical signs

A
  1. Dysdiadochokinesia
  2. Dysmetria
  3. Dyssynergia
  4. Decomposition
47
Q

HYPOTONIA
Oculomotor deficits
Imbalance
Falls
Gait ataxia
*signs of cerebellar __ zone damaged

A

Medial (vermis, fastigial)

48
Q

Flocculonodular lobe damage leads to

A
  1. Nystagmus
  2. Impaired VOR
  3. Imbalance
49
Q

Intermediate zone (spine cerebellum globose and emboli form)

A

Imbalance
Gait ataxia
Tremor
Lack of check
Dysdiadochokinesia
Dysmetria

50
Q

Cerebellar Dysmetria is greatly exacerbated by

A

Multi joint movements
(Graph with elbow movement is fine, elbow and shoulder is hypermetria)

51
Q

Cerebellar tremor is caused by insufficient ____ and excessive _____

A

Insufficient anticipatory effects of movement
Excessive reliance on feedback (SENSORY CONDITIONS)
*reduced when vision is removed, during isometric conditions

52
Q

Individuals with cerebellar damage need to use ___ instead of adaptive motor learning (also called trial and error-sensory prediction error) bc they can’t do it

A

Conscious control strategies (think more, less distractions)
Use dependent motor learning (repeated practice of a movement pattern)
Reward/reinforcement learning

53
Q

Tests for limb coordination in cerebellum

A

Finger to nose
Alternating forearm sup-pron
Hand finger tapping

Heel to knee, foot or toe tapping
*compare both sides, repeat multiple times on same limb
*as fast as possible and SLOW
*compare with or without vision
*

54
Q

When testing limb in coordination, be careful to distinguish from

A
  1. Balance deficits (maybe can’t sit in unsupport sitting)
  2. Vision/diplopia
55
Q

What should you look out for with testing posture/balance in cerebellum patients?

A
  1. Nausea/vertigo
  2. Observe for postural tremor=TITUBATION
  3. Lack of check
56
Q

Why is endurance in CV and MSK system for cerebellum so important?

A

Movements are often exaggerated and effortful, so they need good endurance for safe ADLs

57
Q

What two scales are used for cerebellar ataxia?

A

ICARS
SARA

58
Q

How often to schedule interventions for cerebellum dysfunction

A

Frequent 10 hours/week
Long: 6 months

59
Q

What compensations help cerebellum dysfunction?

A

Slow
Wide BOS
Visual cues
Maybe AD? Could be too hard to coordinate
NO DISTRACTIONS

60
Q

GG codes

A

6: independent
5: set up/clean up
4: supervision
3: partial/mod assist
2. Substantial/max assist
1: dependent

61
Q

TBI outcome measures

A

JFK
GCS
Goat
Ranches
FIM
DRS

62
Q

Orpington Prognostic Scale for stroke

A

Less than 3.2 mild
Over 5.2-6.8 severe (dependent)

63
Q

Organization of movement for MCML and task analysis:
Individual: 3 parts
Task: 3 parts
Environment: reg/non reg

A

Individual: perception, action, cognition (PAC)
Task: mobility, manipulation, stability (MMS)
Environment: stationary or MOTION

64
Q

Task categories 1-4

A

Closed
Variable motionless: stationary objects, but different sizes/shapes
Consistent motion (escalator)
Open

65
Q

Task categories 1-4

A

Closed
Variable motionless: stationary objects, but different sizes/shapes
Consistent motion (escalator)
Open

66
Q

7 commandments of PNF

A
  1. Manual contacts
  2. Commands
  3. Stretch
  4. Traction: movement, approx: stability
  5. Max resistance
  6. Normal timing
  7. Reinforcement (timing for emphasis)
67
Q

Elements of postural control

A
  1. Trunk
  2. Midline orientation
  3. Weight shift over BOS
  4. Head control
  5. Limb function
68
Q

Predictors of walking post stroke

A

80% do walk! 98% walked at 6 months IF
1. Independent sitting first 3 days
LE strength 1/5 hip flex, knee extension, ankle DF in 3 days

69
Q

If BBS below 20 and FIM 1-2, then

A

20x more likely to be home bound

70
Q

Recovery for UE post stroke

A

Shoulder and mid finger in first 3 months

71
Q

Essential neuroanatomy for walking

A
  1. Mm and peripheral nerves
  2. SCPG
  3. Medullary reticular formation: decision to walk, driving center *symmetrical and gait speed!
  4. Mesencephalic locomotor region: cats! Modulate speed
  5. Subthalamic locomotor region: goal
72
Q

Core outcome measures post stroke

A

BBS
FGA
ABC
10meter walk
6MWT
5xSTS

73
Q

MAS

A

0 none
1 slight increase, catch and release
1+ more increase, catch and more tone
2 more increase but easily moved
3 difficult PROM
4 CONTRACTURE

74
Q

TARDIEU SCALE

A

V1,2 3 (VELOCITY 1 slow, 2, gravity 3 fast)
X: 0 no resistance 4 unfatigable clonus
Y: angle R1, R2

75
Q

Adverse effects of baclofen pump

A

Sedation
Respiratory depression
Decreased cardiac function
Hypotonia
Mm weakness
Confusion, disorientation
Nausea/vomit
Coma

76
Q

Signs of sympathetic storming

A

Agitation
Diaphoresis
HTN
High heart rate, breathing
Posturing
Dilated pupils

*15-33% of patients with severe TBI

77
Q

DRS scale is for

A

Coma to community
BFS, disability/activity and participation
0 -29 (high disability: vegetative state)

78
Q

___ is normal score for O log (progress out of PTA)

A

25/30

79
Q

1 hour-1 day PTA is considered

A

Moderate
1-7 days severe
0-60 min is mild

80
Q

Verbal apraxia

A

Aphemia

FALL2 NEURO (8 decks)

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