Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTY3140 > L27: Acute Neurological Management > Flashcards

L27: Acute Neurological Management Flashcards

1
Q

What are the 3 stages of Acute Neurological Rehabilitation?

A
  1. Primary
  2. Secondary
  3. Tertiary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 6 features in the primary stages of Acute Neurological Rehabilitation?

A

ICU, acute wards and inpatient, rehabilitation units

  1. Active initial rehab or preventative management
  2. BIRN rehab, Jasmine unit or Jacana (slow stream rehab)
    1. Max 4-6 months
  3. OPD physio to achieve defined goals
  4. NAB clinic/TRS program
  5. Gym program, more physio later
  6. Not linear, can skip a stage, or return to active rehab when ready
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the primary stage of Acute Neurological Rehabilitation?

A

ICU, acute wards and inpatient, rehabilitation units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the secondary stage of Acute Neurological Rehabilitation?

A

Outpatient, transitional living programs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the tertiary stage of Acute Neurological Rehabilitation?

A

Community integration, return to work, long-term support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 6 features in the subjective examination in the acute stage of primary rehabilitation?

A
  1. Information gained from diagnosis: Charts, relevant past history
    • TBI is young population - usually less comorbidities
  2. Investigations: X-ray, biochemistry, CT scan
  3. Medication
  4. Social background
  5. Family members
  6. Nurses will tell you about patient’s fluctuating consciousness - when to go and talk to patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 7 features in the initial observation in the acute stage of primary rehabilitation?

A
  1. Conscious level: GCS
  2. Appearance
  3. Posture, alignment, deformities
  4. Colour, skin condition, oedema
  5. Movement spontaneous/purposeful
  6. Facial symmetry, expression
  7. Respiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 2 scales for Coma levels in the initial observation in the acute stage of primary rehabilitation?

A
  1. Glasgow Coma Scale
  2. Rancho Los Amigos Scale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the Glasgow Coma Scale in the initial observation in the acute stage of primary rehabilitation?

A
  1. Standardized scale to assess brain impairment and the severity of injury.
  2. GCS givs short term prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 3 determinants of the Glasgow Coma Scale in the initial observation in the acute stage of primary rehabilitation?

A
  1. Eye opening
  2. Verbal responses
  3. Motor response (movement)

Score 3-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 3 features of the Glasgow Coma Scale in the initial observation in the acute stage of primary rehabilitation?

A
  1. Nurses assess GCS. High frequency of GCS checks means high fluctuation. Low frequency of GCS checks means stable condition.
  2. Physios use GCS to guide session planning
  3. Mild GCS 13-15 is 70-85% patients
    • Rarely admitted to hospital
    • Reports of cognitive and behavioural problems 3-6 months.
    • 10-15% remain with post-concussion syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 General Considerations of Acute Assessment?

A
  1. Airway: Prevent hypoxia/hypercapnia.
    • When ventilating aim for CO2 of 30-35 - sensitive cerebral vasoconstrictor.
    • Ascertain whether maintaining own airway: Tracheotomy, O2 needs, saturations
  2. Avoid hyperthermia as it increases use of oxygen - avoid increased metabolic demand
  3. Avoid clustering of cares (a bunch of health professionals seeing them altogether)
  4. Cranial nerves damage
    • Loss of swallow
    • Loss of cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 4 issues with unconsciousness in General Considerations of Acute Assessment?

A
  1. Decreased movement
  2. Decreased somatosensory and vestibular input
  3. Decreased WB
  4. Decrease changes between multiple postures/proprioception
  5. Decreased influence of gravity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 4 features of Acute Positioning?

A
  1. Best position for cerebral perfusion is head F 15-30°with the neck in a midline, neutral position - don’t just sit up!
    • Head down position is contraindicated due to effect on ICP
  2. Allows venous drainage without compromising SBP, thereby maximising CPP
  3. Changing position is not good if ICP is high
    • Changing position may cause an increase in O2 consumption ○ Consider pre-oxygenation
    • Need to know how has they reacted to previous position
  4. Do not lay on bone flap defect, because it is open to external pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is muscle strength in acute rehabilitation?

A

Often assess spontaneous movement noted as they probably cannot move on command.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are 2 features of muscle strength in acute rehabilitation?

A
  1. MRC grades
  2. ROM in particular position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the neurological assessment in acute rehabilitation?

A

Unable to formally assess, therefore need to gain from objective movements, position, response to touch movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are 3 features of the neurological assessment in acute rehabilitation?

A
  1. Sensation
  2. Proprioception
  3. Coordination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 8 aims of acute neurological management?

A
  1. Optimise respiratory function
  2. Prevent complications
  3. Decrease effects of tonal presentations
  4. Optimal musculoskeletal alignment
  5. Prevent adaptive muscle shortening
  6. Provide normal postures and proprioception - minimising the effects of static postures and inactivity
  7. Facilitate alertness and awareness of normal postural alignment.
  8. Determine the potential for rehabilitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is sensory stimulation in acute rehabilitation?

A

Proprioceptive, cutaneous, vestibular, visual, auditory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 7 features of sensory stimulation in acute rehabilitation?

A
  1. Handling: Provide movement control and input to guide normal movement
  2. WB stimulation: Compression, approximation, weights, bandaging
  3. Traction/stretch
    • Facilitatory: Sweep tapping
    • Inhibitory: Prolonged slow lengthening
  4. Stroking/brushing variable textures
  5. Thermal
  6. Vestibular: Position changes, rocking, swaying, rolling
  7. Auditory: Verbal cueing, talking through what you are doing, what you want them to do, vary tone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 4 features of postural control in acute rehabilitation?

A
  1. Choice of posture
  2. Use of gravity
  3. Size of base of support
  4. Key points for movement - stability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are 4 movement strategies in acute rehabilitation?

A
  1. Head-on-body & body-on-body perceptions: Segmental movements, not enbloc
    • Cervical, thorax, pelvis mobility, bed mobility
  2. Start challenges against gravity to facilitate muscle activity
  3. ROM techniques: Inhibitory mobilisation, rotation, distraction, functional patterns of movement.
  4. Muscle elongation/mobilisation, contract-relax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 10 general considerations of movement in acute rehabilitation?

A
  1. Specific ward program/communication
  2. Engage family in exercises
  3. Formalise structure, frequency and duration
    • Sitting
    • Wheelchair
    • Transfers
  4. Give patient time to process request
  5. Use signs: e.g. Thumb up/down, eye movement
  6. Use humour
  7. Look closely for signs of recognition/understanding
  8. Pick up on non-verbals
  9. Clear concise instructions
  10. Imagine what is going on in patient’s mind
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are 5 assessment of TBI for primary rehabilitation?

A
  1. Mindful of concomitant problems - more awareness of associated MSK problems
  2. Get an idea of posture, movement quality, fitness, skill level and previous injuries
  3. Movement analysis
  4. Tailor assessment according to stage of rehabilitation and severity of injury
  5. Mindful of patient’s tolerance of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are 7 assessment tools of TBI for primary rehabilitation?

A
  1. Neurological assessment
  2. Descriptive movement strategies, postural sets
  3. Clinical outcome variable scale (COVS)
  4. Tone
  5. MAS
  6. Coordination
  7. High level skills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are 5 features of Post Traumatic Amnesia in the Severity of Injury & Prognosis for primary rehabilitation?

A
  1. 12 questions daily
  2. Orientation to name, place, time and short and long memory
  3. Must get 12/12 for 3 days with the 3 memory cards changing each day - “emerged from PTA”
  4. Time from injury to “emerged from PTA” is the length of PTA
  5. PTA gives long term prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are 5 managements of Post Traumatic Amnesia in the Severity of Injury & Prognosis for primary rehabilitation?

A
  1. Short sessions
  2. Frequent task changes
  3. Simple and functional activities
  4. Manual handling
  5. Limit setting for behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are 3 outcome measures for primary rehabilitation?

A
  1. Disability measures
  2. Localised measures
  3. Clinical outcome measures
30
Q

What are disability measures as outcome measures for primary rehabilitation?

A

FIM, COVS, MAS

31
Q

What are localised measures (3) as outcome measures for primary rehabilitation?

A
  1. Tardieu Scale for spasticity
  2. Joint ROM
  3. Movement return
32
Q

What are clinical outcome measures (2) as outcome measures for primary rehabilitation?

A

Clinical outcome measures using timed tests and rating scales

  • Specific tests: e.g. Walking speed, balance parameters ○
  • Higher level skills: e.g. UL function, 4 limb coordination, dynamic balance
33
Q

What are 4 features of Cognition & Memory for primary rehabilitation?

A
  1. Attention & concentration: Problems with sustained, selective or sequential focus on a task
  2. Memory: Problems with input, storage or retrieval of information
  3. High level skills: Planning, problem solving, mental flexibility, insight and judgement problems
  4. Neuropsychology & OT required
34
Q

What are 6 types of communication problems with people with neurological issues?

A
  1. Aphasia
  2. Dysarthria: Weakness of muscles of speech Speech may be slurred or the voice may be soft, monotone or hoarse.
  3. Dyspraxia: Motor programming deficit with no muscle weakness Speech can sound jumbled, effortful and difficult to understand.
  4. Dysphasia
  5. Receptive language: Problems understanding spoken or written words
  6. Expressive language: Difficulty producing words/sentences or problems writing (dysgraphia)
35
Q

What is dysarthria as a communication deficit?

A

Weakness of muscles of speech. Speech may be slurred or the voice may be soft, monotone or hoarse.

36
Q

What is dyspraxia as a communication deficit?

A

Motor programming deficit with no muscle weakness Speech can sound jumbled, effortful and difficult to understand.

37
Q

What is receptive language as a communication deficit?

A

Problems understanding spoken or written words

38
Q

What is expressive language (dysgraphia) as a communication deficit?

A

Difficulty producing words/sentences or problems writing

39
Q

What are pragmatic deficits as a communication issue?

A
  1. Poor eye contact
  2. Inability to take turns in conversation
  3. Verbosity: Speaking too much
  4. Perseveration: Getting stuck on a topic - prompt them that they already asked it
  5. Invading personal space
  6. Limited facial expression.
  7. Reduced ability to initiate a conversation
  8. Reduced awareness of personal space
  9. Reduced awareness of these changed behaviours and interactions
  10. They do not pick up social cues - be concrete and direct about social cues
40
Q

What are 5 psychosocial problems as a communication issue?

A
  1. Decreased drive and motivation
  2. Disinhibition and low frustration tolerance
  3. Emotional extremes
  4. Poor insight and unrealistic expectations
  5. Self-centered
41
Q

What are 11 general consideration of management for primary rehabilitation?

A
  1. Patient’s readiness to therapy • Impact of cognitive impairment, part of brain injured
  2. Family support (or lack of it)
    • Over-anxious family
  3. Personality before the accident: e.g. Risk taking behaviour, dependencies, drug use
  4. Patient’s own insight (or lack of it)
  5. Must work with patient’s goals (modify if necessary)
  6. Youth - neuroplasticity
  7. Bilateral problems
  8. Brainstem involvement
  9. Behavioural problems
  10. Cognitive problems
    • Quiet gym
    • Set program time
    • Short session
    • Written exercise sheets if verbal problems
    • Short direct commands
    • Limit behaviour
    • Need constant supervision
    • Introduce yourself every time you see them
42
Q

What are 8 cognitive problems for primary rehabilitation?

A
  1. Quiet gym
  2. Set program time
  3. Short session
  4. Written exercise sheets if verbal problems
  5. Short direct commands
  6. Limit behaviour
  7. Need constant supervision
  8. Introduce yourself every time you see them
43
Q

What are 6 characteristics of agitated patients for primary rehabilitation?

A
  1. Influences training in acute/early rehab
  2. Use a relevant, functional program
    1. Task training + simple verbal cuing
    2. Automatic & cognitive strategies
  3. Identify cause of agitation, liaise team member, educate family
  4. Remain calm, offer verbal reassurance, orient to time/place
  5. Frequently change the motor task or method of practising the same task
  6. Quiet environment
44
Q

What are 11 managements of TBI for primary rehabilitation?

A
  1. Early movements provide neuroplasticity
  2. Consider sensory, vestibular, proprioceptive, gravity, pain, nausea, effects of prolonged static positioning, headache, fear, anxiety
  3. Consult with treating team
  4. Stable ICP, CV, agitation
  5. Arousal
    1. Change in position, rolling, sitting etc.
    2. Sensory stimulation
  6. Progressively load postural system: Begin with rolling > supported sitting & head control > transfers, mobilisation etc
  7. Motor control
    • Re-establish head/trunk control as a basis for motor tasks (e.g. Rolling, prone on elbows, sitting, stand) ○
    • Establish eye follow & integrate eye-hand coordination
  8. Establish focal gaze
    • Integrate with head movement
    • Use a range of positions (e.g. Supine, sitting, prone on elbows)
  9. Develop gradual tolerance to gravity (e.g. Sitting/standing using tilt table), rotational movement
  10. Improve orofacial control to minimise aspiration pneumonia (with speechies)
  11. Use strategies that consider the behavioural/cognitive ability of each patient
45
Q

What are 7 aims of primary rehabilitation?

A
  1. Optimise respiratory function and prevent complications
  2. Decrease effects of tonal presentations
  3. Optimal musculoskeletal alignment
  4. Prevent adaptive muscle shortening
  5. Prevent shoulder damage
  6. Provide normal posture and movement experiences
  7. Determine the potential for rehabilitation
46
Q

What are the positioning (prone, supine, sitting, standing, step-standing) and the features for primary rehabilitation?

A
47
Q

What is the length for Post Traumatic Amnesia (PTA) for primary rehabilitation (very mild, mild, moderate, severe, very severe, extremely severe, ongoing memory problems)?

A
48
Q

What are the Clinical Outcome Variables Scale for primary rehabilitation?

A
  1. 13 item scale, scored out of 7, total 91 points
  2. Rolling x2
  3. Sitting to supine
  4. Sitting balance
  5. Horizontal/vertical transfer
    • Ambulation
    • Performance
    • Aids
    • Endurance
    • Velocity
  6. Wheelchair mobility
  7. Arm function R & L
49
Q

What are 6 features of tone management in primary rehabilitation?

A
  1. Must be documented objectively
  2. Splints, ROM, positioning of limbs
  3. Recruit family to assist as required
  4. Consideration of early serial casting to prevent physiological changes in muscle and joints
  5. Excessive tone increases metabolic demand and oxygen consumption - adverse effect on respiration and neurological recovery
  6. Tone within the chest wall can adversely affect respiratory dynamics
50
Q

What are 6 features of inhibitory casting in primary rehabilitation?

A
  1. Early or late stages (better prognosis earlier)
  2. Correct alignment & WB decreases tone
  3. Serial casts decreases contracture
  4. Baseline and reassessment measures of tone, ROM and function
  5. Used in conjunction with other techniques
  6. Follow-up orthosis
51
Q

What are 5 managements of heterotrophic ossification in primary rehabilitation?

A
  1. Diagnosis by X-ray or bone scan
  2. Prevention better than cure
  3. NSAIDS
  4. Gentle active exercise to maintain ROM & pain relief
  5. Surgical removal in later stages
    • Cannot surgery in early inflammatory stage because it will regrow
52
Q

What are 4 features of heterotrophic ossification in primary rehabilitation?

A
  1. Prevalent in TBI
  2. Calcium deposits in the muscles and joints > ankylosis of joints
  3. Maturity 3 months - 5 years (average 6 months)
  4. S&S
    • Decrease ROM +/- pain
    • Solid end-feel to passive movement
    • Local oedema and erythema in early stages
    • Low grade temperature, raised white cell count
    • Increased spasticity/muscle spasm
53
Q

What are 5 features of SS in heterotrophic ossification in primary rehabilitation?

A
  1. Decrease ROM +/- pain
  2. Solid end-feel to passive movement
  3. Local oedema and erythema in early stages
  4. Low grade temperature, raised white cell count
  5. Increased spasticity/muscle spas
54
Q

What are 5 features of suspected vestibular involvement for the vestibular system?

A
  1. Balance deficits exceeding presenting neurological impairments
  2. Fixation of gaze and head/neck, upper trunk
  3. Cannot hold conversation with >1 person
  4. Head shake when moving from one position to another
  5. Avoidance of busy places
55
Q

What are 4 vestibular deficits for the vestibular system?

A
  1. Peripheral
    • 8th cranial nerve
    • Vestibular apparatus
  2. Central
    • Vestibular nuclei
    • Cortical projections
  3. Orientation to midline
    • Decreased sense of upright in AP & lateral planes
    • Pusher syndrome
  4. Asymmetrical vestibular function > sensory mismatch > symptom provocation
56
Q

What are 4 assessments for the vestibular system?

A
  1. History
  2. Subjective: VAS, disability scale, Dizziness Handicap Index
  3. Oculomotor tests: HT, DVA, Dix-Hallpike
  4. Postural stability tests
    • Static balance
    • Gait pattern, gait deviations
57
Q

What are 4 managements for the vestibular system?

A
  1. Reprogramming of eye movements and postural responses to movement
  2. Requires movements and exposure to stimuli that challenge the system
  3. Vestibular system can adjust VOR according to the demands
  4. Stimulus to induce vestibular changes is the movement of the image across the retina (retinal slip).
58
Q

What are 2 adaptation exercises for management for the vestibular system?

A
  1. Retinal slip & head movements
    • Object still, head moving
    • Object and head moving in phase
    • Object and head moving out of phase
  2. Progression
    • Duration
    • Velocity
    • Full field vs. focused stimulus
    • Position
    • Target distance
59
Q

What are 15 managements of ataxia?

A
  1. Observe and explore their potential
  2. Do not block their potential due to your own insecurity
  3. Challenge movement
  4. First, use “big” movements with rotation to break the static motor behaviour of fixation
  5. Find out where stability and limits are
  6. Use movement experience to re-learn safety and control
  7. Regain pleasure in movement for long time patient
  8. Take away fixation - let go muscle using breathing or vibration
  9. Rebound reaction in standing position
  10. Box patient - decrease fear and allow motor pattern in automatic way
  11. Variety of postural orientation
  12. Various sequences of movement
  13. Establish movement patterns but do not move in postures with fixation in body parts.
  14. Change of direction
  15. Change of speed
60
Q

What is the balance and gait training (3 examples) for primary rehabilitation?

A

Increase reliance on vestibular rather than visual or somatosensory cues

  1. e.g. Backwards walking, sidestepping, braiding (eyes closed)
  2. e.g. Marching on the spot on foam EO/EC
  3. e.g. Walking moving head & eyes > shopping aisle with objects to avoid
61
Q

What is high level training for primary rehabilitation?

A

Return to work, sport or recreation

62
Q

What are 8 common problem areas for high level training for primary rehabilitation?

A
  1. High level vestibular deficits
  2. Decreased strength from period of inactivity
  3. Fatigue, lack of motivation, low tone
  4. Decreased muscular and CV endurance
  5. Tonal changes (calves, clonus)
  6. High level balance and coordination
  7. Speed, change of direction
  8. Coordination (quality and speed)
63
Q

What are 6 complex tasks for high level training for primary rehabilitation?

A
  1. Simultaneous tasks
  2. Inter-limb coordination
  3. Multi-sequence tasks
  4. Changes in environmental cues
  5. Eye/hand and foot coordination
  6. 4 limb coordination
64
Q

What are 8 running drills for high level training for primary rehabilitation?

A
  1. Criteria for running: Walk on toes x1, descend stairs reciprocally without rail x1, hop on each leg x1
  2. Running on toes
  3. Flick backs
  4. Bounding
  5. Single knee lift
  6. Double knee lift
  7. Skipping
  8. Running backwards
65
Q

What are 6 team approaches for discharge planning for primary rehabilitation?

A
  1. MDT conferences to determine common goals for the patient
  2. Family interviews
  3. Joint treatment sessions with other therapists
  4. Good communication with all team members
  5. Pt and family education
  6. Equipment prescription for MASS, work cover, insurance
66
Q

What are 3assessment before discharge for the discharge planning for primary rehabilitation?

A
  1. Check balance/mobility before discharge
    1. Multiple sensory processing (CSTIB)
    2. Higher level balance/coordination skills (HiMAT)
    3. Speed & agility
    4. Multitask during task execution (TUG cognitive)
    5. Vestibular screening/education
  2. Neuropsych function should also be reviewed
  3. Referral to outpatients follow-up
67
Q

What are 3 assessment before discharge (check balance/mobility before discharge) for the discharge planning for primary rehabilitation?

A
  1. Multiple sensory processing (CSTIB)
  2. Higher level balance/coordination skills (HiMAT)
  3. Speed & agility
  4. Multitask during task execution (TUG cognitive)
  5. Vestibular screening/education
68
Q

What are 6 features of secondary rehabilitation?

A
  1. Same principles as primary rehab but more focus on functional gains
  2. Compensatory skills taught if no motor recovery
  3. Walking aids and orthotics if necessary
  4. Education of family/carers
  5. Increasing focus on skills needed to integrate back into home life
    • e.g. Attending therapy, skill retraining, social activities and hobbies, CVS fitness, gym membership, relationships etc.
  6. May require fine tuning or UL function if the focus as an inpatient was on gait retraining
69
Q

What are 6 features of tertiary rehabilitation?

A
  1. Impairments stable
  2. Will require problem solving skills if deterioration in function
  3. Consultative role
  4. Education of family/carers/friends/employers
  5. New physical challenges as client attempts more
  6. Often teaching patient their own problem solving skills
70
Q

What are 3 community supports of tertiary rehabilitation?

A
  1. ABIOS
  2. Work cover, NDIS, NIISQ
  3. The Guardianship and Administration Tribunal

PHTY3140 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions