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Neuro Rehab 1 > Intro to Neuro Rehab and Exam > Flashcards

Intro to Neuro Rehab and Exam Flashcards

1
Q

what are the goals of neuro rehab

A
  • restore mobility and functional skills
  • promote recovery via neuroplastic changes
  • compensation/adaptation when recovery not likely
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2
Q

what is the continuum of care

A
  1. exam
  2. eval - synthesize info from exam
  3. diagnosis (PT)
  4. prognosis - POC and length of recovery
  5. intervention
  6. outcomes - did they get better or need to change POC
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3
Q

clinical reasoning vs clinical decisions

A

reasoning - problem solving
decisions - outcomes of reasoning process

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4
Q

what falls under the umbrella of clinical reasoning

A

process info
reach conclusions
determine actions

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5
Q

what influences clinical decision making

A

CLINICIAN: goals, experience, knowledge, values, psychosocial skills

PATIENT: goals, values/beliefs, psychosocial cultural educational physical factors

ENVIRONMENT: setting, resources, payers

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6
Q

what is the evolution of clinical decision making

A

novice > advanced beginner > competent > proficient > expert

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7
Q

how does clinical decision making differ between novice vs expert

A

novice - more skill acquisition driven
expert - reflective practice

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8
Q

what are the 3 major components of PT neuro exam

A

hx and subjective assessment
systems review
exam: BSF, activity and participation

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9
Q

what do the 3 major components of a PT neuro exam inform: (5)

A

eval -> critical analysis, synthesize exam data
PT diagnosis and prognosis
POC and goals
interventions
dc plan / conclusion of care

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10
Q

how are BSF/activity/participation assessed in the exam portion of a neuro exam

A

tests and measures - clinical and standardized

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11
Q

what are 3 components in history taking for a neuro exam

A
  1. PMH & current health status
  2. medical dx, imaging, tests/labs, meds, surgery, prior PT or other interventions
  3. age, gender, ethnicity, language, culture, religion, educational level, work/school hx, social/health habits
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12
Q

why is history important in your neuro exam

A

helps to create patient centered care

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13
Q

why is PMH and current health status important in a neuro exam

A

PMH - is what presenting w new or old, do you address this or focus on other areas

current health status - how does this compare to PLOF

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14
Q

what are 6 things to hit on in your subjective assessment

A
    1. PLOF *
      1. home environment
      2. goals
      3. culture
      4. limitations
    1. family and friend support *
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15
Q

how is a systems review conducted

A

brief screening of systems

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16
Q

what does a brief screening of systems inform (2)

A
  1. used to identify areas of potential dysfunction that warrant further testing
  2. decisions regarding scope of care
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17
Q

why is it important to keep your systems review brief

A

would be too time consuming otherwise

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18
Q

what are the 8 things touched on in a CP systems review

A
  1. HR
  2. heart rhythm
  3. respiratory rate
  4. BP
  5. edema
  6. read a single lead EKG (if available)
  7. dyspnea, orthopnea
  8. cough
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19
Q

why is a CP exam important in neuro rehab

A

lot of neuro insults can be result of underlying CP issues
- while addressing neuro impairments, think ab if can handle intensity

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20
Q

what are examples of neuro insults due to underlying CP issues

A

vascular dementia
stroke

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21
Q

what are 4 things hit on in an integ systems review

A
  1. color
  2. cap refill
  3. integrity
  4. scars
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22
Q

what are 3 examples of how an integ systems review would important for neuro rehab

A
  1. wound could lead to infection
  2. skin breakdown can reduce ability for PT to work w them
  3. calluses on their feet - is that why they can’t feel the ground or is it sensory impairments
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23
Q

what are 5 things hit on in a MSK systems review

A
  1. gross symmetry / posture
  2. gross ROM
  3. gross strength
  4. height
  5. weight
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24
Q

why are height and weight looked at in a MSK systems review

A

can impact how someone moves around
- esp if have a SCI

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25
Q

what are the 3 broad categories looked at in a neuro systems review

A

cognitive
mobility
motor

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26
Q

what is an important thing to look at when looking at movement in a neuro systems review

A

quality of the movement - smooth, precise, accurate

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27
Q

what is looked at in the cognitive portion of a neuro systems review

A

gross cognition
arousal
communication

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28
Q

what is looked at in the mobility portion of a neuro systems review

A

gross movement patterns
function

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29
Q

what is looked at in the motor portion of a neuro systems review

A

motor function
motor coordination

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30
Q

what does a green flag mean when identified in a PT exam

A

go - continue PT (complete exam/eval, determine POC)

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31
Q

what does a red flag mean when identified in a PT exam

A

STOP
emergency - call 911 or send to ED

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32
Q

what does a yellow flag mean when identified in a PT exam

A

wait
- referral to MD for non-life-threatening scenarios

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33
Q

what are 6 neuro s/sx that are RED FLAGS

A
  1. altered mental status - new onset or exacerbation
  2. prolonged sz activity or status epilepticus
  3. acute infection w/ associated neuro signs
  4. RAPID onset of focal or global deficits
  5. evidence of spinal column instability
  6. non-responsive autonomic dysreflexia (SCI pop)
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34
Q

what overall are the red flag neuro s/sx indicating

A

something might be evolving at that moment

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35
Q

what could cause an exacerbation of an altered mental status

A

infection
bleed
additional neuro insult

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36
Q

how can sz present and how can you assess this

A

pt might not be responding

look at VS (super high HR or BP), incontinent episode

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37
Q

how can you assess if there is a rapid onset of focal or global deficits

A

difference in ms strength

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38
Q

what might be evidence of spinal column instability

A

not having sensation in certain areas

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39
Q

what are 7 yellow flags in neuro s/sx

A
  1. progress/exacerbation of pre-existing neuro signs
  2. evidence of new NM dz not in PMH
  3. new onset of involuntary movement, tremor
  4. change in autonomic status
  5. constant HA that worsens over time
  6. vertebral artery insufficiency
  7. slow, insidious changes in neuro function that are not consistent w known PMH
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40
Q

how should evidence of new NM dz present if yellow flag

A

not presenting quickly

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41
Q

HA that is red flag vs yellow flag

A

red flag - dramatically pounding, can’t focus

yellow flag - bothers them, constant

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42
Q

what could vertebral artery insufficiency present as

A

dizziness

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43
Q

what are the 2 approaches for a neuro PT exam

A

body structure & function-oriented
activity oriented

44
Q

what factors influence your choice in the approach to a neuro PT exam

A

practice setting
pt status
level of expertise

45
Q

what are components of a body structure/function approach

A

how strong
can they feel
cranial nerves
can they see

46
Q

what are components of an activity approach

A

based on performance
- how they do something

47
Q

what is the focus on in the ICF components

A

getting them to be able to participate

48
Q

what are the 4 steps typically used in an activity-oriented exam

A
  1. activities first
  2. hypothesized contributing factors (HCFs)
  3. select appropriate tests/measures to perform based on hypothesis
  4. develop treatment interventions that improve function and address impairments
49
Q

what is the pro to an activity based approach

A

can be more efficient
- can knock out a bunch of different things

50
Q

when do you usually see a BSF approach to exam

A

less experienced PTs
- will become more efficient and move toward activity oriented exam

might also use this approach if PT isn’t moving how you would have hoped

51
Q

describe interventions used in an activity-oriented exam

A

in a functional context
- LAQ vs stairs

52
Q

what are 9 things assessed in an activity oriented neuro exam

A
  1. balance
  2. trunk control
  3. reaching and grasp
  4. bed mobility
  5. transfers
  6. amb and gait
  7. wc mobility
  8. stairs
  9. ADLs and IADLs
53
Q

what is the general process in conducting a BSF oriented exam

A

impairments common to neuro dx
primary/direct impairments
secondary/indirect impairments

54
Q

what is an important part in looking at impairments common to neuro dx when doing a BSF oriented exam

A

identify normal vs abnormal

55
Q

primary vs secondary impairments (BSF oriented)

A

primary = result of health condition
secondary = result of adaptive changes

56
Q

what are the components to the tests and measures part of exam? how does this differ for BSF vs activity?

A

no difference between BSF vs activity

SELECT - appropriate tests determine/confirm presence & extent of dysfunction

PERFORM - exam procedures correctly to ensure accuracy and validity

OBSERVE - even if unable to formally assess due to cognitive, communication, or time limitations

57
Q

what are ex of clinical tests and measures

A

sensory
muscle function - MMT
assist needed - asking them or feeling it yourself

58
Q

what makes standardized tests and outcome measures different from clinical tests

A

standardized tests/outcomes have age related norms to compare to other individuals

59
Q

what are ex of standardized tests

A

BERG
DIG (dynamic gait index)
Tinetti

60
Q

what do standardized tests look at

A

impairment, activity, participation level

psychometric properties

61
Q

what should be considered w standardized tests

A

confounding factors

62
Q

what specifically is assessed for impairments in a BSF oriented neuro exam (11)

A
  1. level of arousal/consciousness
  2. cognition, mental status, communication screen
  3. sensation
  4. motor planning
  5. motor control / ACOM
  6. muscle tone
  7. ROM
  8. reflexes
  9. coordination
  10. vestibular function
  11. cranial nerve integrity
63
Q

what are 6 reasons why screening attention, cognition, perception, and communication are important

A
  1. determine ability to participate in exam/treatment
  2. ability to provide informed consent
  3. plan effective instruction / communication methods
  4. screening / detecting dz
  5. identify person needing referral to psych, neuropysch, SLP, OT, etc.
  6. dc planning
64
Q

what are 4 components of cognition that are looked at

A

awareness
memory
reasoning/judgement
executive functioning

65
Q

what are two pieces of awareness as part of cognition

A

orientation and attention

66
Q

orientation vs attention

A

ORIENTATION
- time, person, place, events/situation
- ex: birthday, date, time of day, why are you here

ATTENTION
- ability to attend to & process info of themselves and their environment
- ability to concentrate dual task
- ex: neglect side of room, letting hand hang off bed

67
Q

what is memory

A

register, retain, and recall info

68
Q

what is the relationship between memory and learning

A

memory is a separate process from learning

69
Q

short term vs long term memory

A

short term - recent or working memory
long term - remote

70
Q

how can amnesia be graded

A

partial, total, transient or permanent

71
Q

anterograde vs retrograde amnesia

A

anterograde - can’t form new memories
retrograde - can’t remember old memories

72
Q

what is a pt population that anterograde amnesia is typically seen in

A

dementia
alzheimers

73
Q

what is short term memory

A

memory of events that have just occurred

74
Q

what type of attention and events are associated w short term memory

A

active attention to events lasting seconds

75
Q

describe the brain’s capacity when it comes to short term memory

A

limited capacity
7 items +/- 2

brain accepts new info, but loses short term memory as new info is added

76
Q

what are two types of long term memory

A

explicit memory
implicit memory

77
Q

explicit vs implicit memory

A

EXPLICIT
- acquisition, retention, and retrieval of info that can be intentionally recollected
- declarative memory

IMPLICIT
- procedural / nondeclarative memory
- recalled thru unconscious systems (ie movement)

78
Q

what type of instances do you see explicit memory utilized in

A

required to complete multiple steps in a task
remember events

79
Q

what is an example of implicit memory

A

tying shoelaces
- happens automatically

80
Q

what are two standardized tests/measures for cognition

A

mini mental state exam (MMSE)
Montreal cognitive assessment (MoCA)
- more common

81
Q

what does the MMSE look at

A

orientation
recall
calculation
attention
language
visual construction

82
Q

what are the benchmarks for MMSE and MoCA

A

MMSE - 24/30
- <24 indicates cog impairment

MoCA - 26/30 and above indicates norm
- <26 indicates cog impairment

83
Q

if you score below MMSE and MoCA benchmarks, what does this mean

A

cognitive impairment

could mean that you need to do another test

84
Q

what is executive functioning

A

higher order cognition

85
Q

what does executive functioning encompass (6)

A

awareness
reasoning
planning
judgement
intuition
decision making

86
Q

what are 2 ex of executive functioning

A

preparing a meal

knowing what to do in case of an emergency such as a fire

87
Q

what are 4 levels of arousal identified in a clinical exam

A
  1. alert
  2. delirious or obtunded
  3. lethargic
  4. stupor or semicoma
88
Q

what is an alert level of arousal

A

awake
attentive
interactive

89
Q

what is a delirium level of arousal

A

confused
hallucinating

90
Q

what is an obtunded level of arousal

A

difficult to arouse
confused when alert

91
Q

what is a lethargic level of arousal

A

drowsy
drifts to sleep when not stim
brief response to stim & poor attention

92
Q

what is a stupor/semicoma level of arousal

A

not self alerting
responds to vigorous/noxious stim

93
Q

what are the 3 DOC levels

A

coma
VS
MCS

94
Q

VS vs MCS in broad terms of what it means for PT

A

VS - can’t participating
MCS - they are emerging

95
Q

what are characteristics of a comatose state of consciousness

A

complete loss of arousal
no sleep-wake cycles

96
Q

what are the characteristics of a VS state of consciousness

A

irregular sleep-wake cycle
can be aroused but no awareness of environment
wakeful unconsciousness

97
Q

what are characteristics of a MCS state of consciousness

A

severely altered consciousness
minimal and inconsistent
evidence of self or environmental awareness
purposeful movement

98
Q

what are standardized tests and measures for consciousness/level of arousal

A

glascow coma scale (GCS)
coma recovery scale - revised (CRS-R)
rancho los amigos scale level of cognitive function (LOCF)

99
Q

why is communication an important thing to assess in a neuro exam

A

critical to validity of PT exam

100
Q

what parts of assessing communication are within our scope of practice

A

screen
consult w SLP
review medical records

101
Q

what are 2 main barriers to communication

A

aphasia
dysarthria

102
Q

what are two types of aphasia

A

receptive
expressive

103
Q

receptive aphasia

A

fluent or Wernicke’s

inability to understand info

104
Q

expressive aphasia

A

non-fluent or Broca’s

inability to get words out

105
Q

dysarthria

A

poor articulation
- weakness in mouth or tongue

know what is being said and how to get words out, but have difficulty saying it

Neuro Rehab 1 (27 decks)

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