Module 15: PFC, Self Regulation, vagal tone & concussion Flashcards
What will be the findings on the side of hemisphericity
- upper limb flexor angulation
- lower limb increase extensor tone & external rotation (tight hamstring/ foot turnout)
- reduced tone small digit mm (strength/ piano fingers)
- reduced tone facial mm (lower lid lag, elongated/flattened nasiolabial fold
- larger pupil (reduced inhibition of sympathetics)
- exophoria (reduced convergence)
- flushing/ sweating
- reduced pursuits to that side
- may have cerebellar signs on opposite side
TOP 5-7 cerebellar tests in a 7 yr old:
- posture
- DDK
- Dysmetria
- gait
- Single leg balance
- Heel - shin
What age do the following Fontanelles close? What landmarks do they become?
- Anterior
- Posterior
- Mastoidal
- Sphenoidal
- Anterior - 12-24 mo = Bregma
- Posterior - 1-2 mo = Lambda
- Mastoidal - 6-18 mo = Asterion
- Sphenoidal - 6 months = Pterion
Homecare to stimulate R cortex:
- L body sensory input
- L cerebellar stim (balancing/ bouncing, tracing)
- R nostril smelling
- Saccades to L (R frontal)
- L auditory (nature sounds)
- Cortex: painting, dancing, puzzles
Homecare to stimulate L cortex:
- R body sensory input
- R cerebellar stim
- Visual = saccades to R
- R ear stimulation w lyrics
- word games, number sequences, trail maker, sudoko
Does the vestibular nerve project to ipsilateral vestibular nuclei in pons & medulla?
yes
Frontal lobe functions:
- Inhibits/integrates primitive reflexes
- Motor Control
- Movement Planning
- Arousal
- Awareness
- Attention
- Understanding Self
- Motivation
- Working Memory (check from young age -remember 3 things)
- Shift Focus
- Inhibition
- Complete a Goal
what part of the brain is being activated by giving saccades/ anti-saccades?
- Frontal
What is the main parasympathetic nucleus in the brainstem?
Dorsal motor nucleus of the vagus
What is concussion?
- traumatic brain injury induced by rapid acceleration / deceleration forces.
- transient disturbance of brain function involving complex pathophysiological process.
- produces chemical inflammatory neurometabolic cascade in the brain & reduces cerebral blood flow = produces the symptoms (short lived impairment of neurological function)
What period of time defines persistent post concussive symptoms?
- clinical post traumatic symptoms existing greater than;
- Adults > 14 days
- kids > 4 weeks
What are risk factors for prolonged concussion symptoms? PPCS
- kids w ADHD
- Female
- pre- existing anxiety
what pathway is affected/ injury in TBI?
Corticoreticular pathway = effecting corticospinal pathway.
- efffets proximal muscles, tone, balance & posture.
Important observations to recognise that indicate concussion:
- Ragdoll = no protective action (loss of consciousness)
- Tonic posturing
- Impact seizure
- Motor incoordination (staggers, ataxia)
- confusion/ impaired memory
What is the ABC concussion assessment?
A = Alert & Awareness
B = Behaviour & balance
C= C-spine & cognition
D = Dizziness
E = exertion
F = Follow up
