Module 4: Lesson 1: Neurological Rehab Flashcards
1
Q
What types of conditions benefit from neurological rehabilitation?
A
- Ischemic or hemorrhagic strokes
- TIA
- Subdural hematomas
- Infections: Meningitis, polio
- SCI/TBI
- Bells palsy, cervical spondylosis, brain/spinal cord tumors, MD, GB
- Parkinsons, HD, ALS, MS
2
Q
1 in how many deaths in 2018 from cardiovascular disease waws due to stroke?
A
6
3
Q
What percent of strokes are ischemic?
A
87%
4
Q
What percent of stroke cases in the world are associated with modifiable risk factors?
A
90%
5
Q
Men are how many more times likely to be hospitalized when compared to women for TBI.
A
2x
6
Q
People age»_space;> and older had the highest number and rates of TBI related hospitalizaitons and death.
A
75 and older
7
Q
What is the leading cause of death?
A
Brain injury
8
Q
After 5 years: What percent of people with TBI have died?
A
22%
9
Q
After 5 years: What percent of people with TBI became worse?
A
30%
10
Q
After 5 years: What percent of people with TBI stayed the same?
A
22%
11
Q
After 5 years: What percent of people with TBI improved?
A
26%
12
Q
The following symptoms describe someone with a mild, moderate or sever brain injury?
- Small cut in scalp
- Balance issues
- Nausea
- Sleep issues
- Blurred vision
- Tinnitus
- Taste alterations
- Sensitivity to noise and light
- Dizziness
A
Mild
13
Q
What type of hematoma is described below:
Occurs between the skull and dura and usually caused by a direct impact injury that causes deformity of the skull
A
Epidural hematoma
14
Q
What type of hematoma is described below:
Appear between the dura and the surface of the brain and are produced by the rupture of small veins and as blood collects within the skull it compresses the brain and increases the intracranial pressure
A
Subdural hematoma
15
Q
What type of hematoma is described below:
Bleeding in the brain that is caused by injuries to small blood vesels.
A
Intracerbral hematoma
16
Q
What is described below:
Bleeding may occur in a thin layer immediately surrounding the brain.
A
Subarachnoid hemorrhage
17
Q
What assessment for brain injury is described below:
- Most common scoring system used to describe the level of consciousness in a person following TBI.
- Assists in determining the severity of an acute brain injury
A
Glascow Coma Scale
18
Q
What assessment for brain injury is described below:
- Used to describe the cognitive and behavioral patterns found in brain injury patients as they recover from their injury.
- Has 10 levels
A
Ranchos Los Amigos
19
Q
What assessment for brain injury is described below:
- Developed to evaluate cognition serially during the subacute stage of recovery from closed head injury.
- It measures orientation to person, place, time, and memory of events, preceding and following the injury.
A
Galveston Orientation and Amnesia Test (GOAT)
20
Q
Name some assessments used in brain injury population.
A
- Glascow Coma Scale
- Rancho Los Amigos
- Sensory stimulation
- Galveston Orientation and amnesia test
- Agitated behavior scale
21
Q
What are the 4 main characteristic mechanisms of primary injury of traumatic SCI?
A
- Impact + persistent compression (burst fracture)
- Impact alone with transient compression (hyperextension injuries)
- Distraction
- Laceration/transection (i.e. missile injuries)
22
Q
What are the types of non-traumatic injuries?
A
- Spinal metastases/tumors
- Inflammatory spinal cord lesions
- Compressive myelopathy d/t spinal stenosis or disc herniation
- Degenerative spine disease
- Shifting etiologies for SCI as the population grows older
23
Q
More then …% of SCI cases are traumatic and caused by incidences such as accidents, violeence, sports or falls.
A
90%
24
Q
Male to female ratio of SCI
A
2:1 (more in adults then children)
25
In what decade of life are men mostly affected by SCI?
- 3rd
- 8th
26
In what age/stage of life are women at higher risk of SCI?
- Adolescence (15-19)
- 7th decade
27
What type of SCI is described below:
Neurological assessments show no spared motor or sensory function below the level of injury
Complete SCI
28
What type of SCI is described below:
Combination of motor and sensory function below the level of injury
Incomplete SCI
29
What type of SCI is described below on the ASIA scale?
No sensory or motor function is preserved in the sacral segments S4-S5
A - Complete
30
What type of SCI is described below on the ASIA scale?
Sensory, but not motor function is preserved below the neurological level and includes the sacral segments. AND no motor function is preserved more than 3 levels below the motor level on either side of the body.
B - Sensory incomplete
31
What type of SCI is described below on the ASIA scale?
Motor function is preserved at the most caudal sacral segments for voluntary anal contraction OR the patient meets the criteria for sensory incomplete status and has some sparing of motor function more than 3 levels below the ipsilateral motor level on either side of the body.
Less then half of key muscle functions below the single NLI have a muscle grade greater than or equal to 3
C - Motor incomplete
32
What type of SCI is described below on the ASIA scale?
Motor function is preserved at the most caudal sacral segments for voluntary anal contraction OR the patient meets the criteria for sensory incomplete status and has some sparing of motor function more than 3 levels below the ipsilateral motor level on either side of the body.
At least half or more of key muscles functions below the single NLI have a muscle grade greater than or equal to 3.
D - Motor Incomplete
33
What level of injury and dysfunction is described below:
- Involves C1-T1
- Loss of sensation, function, or movement in head, neck, shoulders, arms, hands, chest, pelvic organs and legs
Tetraplegia (formerly called quadriplegia)
34
What level of injury and dysfunction is described below:
- Injury involving T2-S5
- Loss of sensation, function, or movement in chest/trunk, stomach, hips, legs and feet
Paraplegia
35
What is the most common incomplete SCI?
Central cord syndrome
36
What syndrome is described below:
- Most common incomplete SCI
- Injury is caused by hyperextension of the neck leading to compression of the cervical spinal cord, causing damage primarily to the center of the cord.
- Weakness affecting the UE more then LE
- Prognosis varies: Younger do better
Central Cord Syndrome
37
What is central cord syndrome?
- Most common incomplete SCI
- Injury is caused by hyperextension of the neck leading to compression of the cervical spinal cord, causing damage primarily to the center of the cord.
- Weakness affecting the UE more then LE
- Prognosis varies: Younger do better
38
What syndrome is described below:
- Compromise in blood flow from anterior spinal artery
- Bilateral injury to the spinothalamic tracts = bilateral loss of pain and temperature below the level of injury
- Bilateral injury to corticospinal tracts = weakness or paralysis below the level of injury
- Dorsal columns are unaffected, tactile sensation, proprioception and vibratory sensation remain intact.
Anterior cord syndrome
39
Describe anterior cord syndrome
- Compromise in blood flow from anterior spinal artery
- Bilateral injury to the spinothalamic tracts = bilateral loss of pain and temperature below the level of injury
- Bilateral injury to corticospinal tracts = weakness or paralysis below the level of injury
- Dorsal columns are unaffected, tactile sensation, proprioception and vibratory sensation remain intact.
40
What syndrome is described below:
- Infections, toxic or metabolic etiology
- Damage to dorsal columns = loss of tactile sensation, proprioception, and vibratory sensation
- Pain and temperature sensation, motor function are preserved
- May exhibit profound ataxia due to loss of proprioception
Posterior cord syndrome
41
What is posterior cord syndrome?
- Infections, toxic or metabolic etiology
- Damage to dorsal columns = loss of tactile sensation, proprioception, and vibratory sensation
- Pain and temperature sensation, motor function are preserved
- May exhibit profound ataxia due to loss of proprioception
42
What syndrome is described below:
- Injury to the terminal aspect of the spinal cord, proximal to the cauda equina.
- Loss of sacral nerve root functions and Achilles tendon reflexes; bowel and bladder dysfunction, and sexual dysfunction may be observed.
Conus medullaris syndrome
43
Describe conus medullaris syndrome
- Injury to the terminal aspect of the spinal cord, proximal to the cauda equina.
- Loss of sacral nerve root functions and Achilles tendon reflexes; bowel and bladder dysfunction, and sexual dysfunction may be observed.
44
What syndrome is described below:
- Injury results from right or left sided hemisection of the spinal cord
- Ipsilateral loss of motor function, tactile sensation, proprioception, and vibratory sensation below the level of injury
- Contralateral loss of pain and temperature sensation below the level of injury
Brown sequard syndrome
45
Describe Brown Sequard syndrome
- Injury results from right or left sided hemisection of the spinal cord
- Ipsilateral loss of motor function, tactile sensation, proprioception, and vibratory sensation below the level of injury
- Contralateral loss of pain and temperature sensation below the level of injury
46
The ASIA scale uses what to help determine classification of injury in the spinal cord
- Zone of partial preservation
- Neurological level of injury
47
What percent of patients with SCI suffer multisystem trauma?
80%
48
Describe functional performance of someone of C1-4 SCI in the following areas: feeding, grooming, UE and LE dressing, bathing, bed mobility, transfers, w/c propulsion and driving.
- Dependent in all areas
- Unable to drive
- Can be independent with weight shifts and w/c propulsion with power equipment
49
Describe functional performance of someone of C5 SCI in the following areas: feeding, grooming, UE and LE dressing, bathing, bed mobility, transfers, w/c propulsion and driving.
- Feeding: Independent w/ AE after setup
- Grooming: Min assist w/ AE after setup
- UE dressing: Requires assist
- LE dressing: Dependent
- Bathing: Dependent
- Bed mobility: Assists
- Weight shifting: Assists unless in power w/c
Transfers: Max assist
- W/c propulsion: Independent in power, to some assist with manual
- Driving: Independent w/ adaptations
50
Describe functional performance of someone of C6 SCI in the following areas: feeding, grooming, UE and LE dressing, bathing, bed mobility, transfers, w/c propulsion and driving.
- Feeding: Independent w/o AE
- Grooming: Some assist to independence with AE
- UE dressing: Independent
- LE dressing: Requires assistance
- Bathing: Some assistance to independence w/ AE
- Bed mobility: Assists
- Weight shifts: Independent
- Transfers: Some assist to independent on level surfaces
- W/C propulsion: Independent - manual w/ coated rims on level surfaces
- Driving: Indeendent with adaptations
51
Describe functional performance of someone of C7 SCI in the following areas: feeding, grooming, UE and LE dressing, bathing, bed mobility, transfers, w/c propulsion and driving.
- Feeding: Independent
- Grooming: Independent w/ AE
- UE dressing: Independent
- LE dressing: Some assist to independent with AE
- Bathing: Some assist to independence with AE
- Bed mobility: Independent to some
- Weight shift: Independent
- Transfers: Independent w/ or w/o board for level surfaces
- W/C propulsion: Independent except for curbs and uneven terrain
- Driving: Car with hand controls or adapted van
52
Describe functional performance of someone of C8-T1 SCI in the following areas: feeding, grooming, UE and LE dressing, bathing, bed mobility, transfers, w/c propulsion and driving.
- Independent for all, needs equipment for bathing.
- Can drive with hand controls or adapted van
53
What are acute complications with SCI?
- Neurogenic shock
- Cardiovascular and pulmonary complications
- Thromboembolism
- Pressure ulcers
- Heterotropic ossification
- Bowel/bladder issues
- Musculoskeletal
- Anxiety/depression/adjustment disorders
54
What are chronic complications with SCI?
- Respiratory failure
- Orthostatic hypotension
- Autonomic dysreflexia
- Bowel/bladder issues
- Spasticity/contractures
- Pain
- Osteoporosis
55
What percent of people with SCI develop a pressure ulcer during their lifetime?
85%
56
Symptoms of autonomic dysreflexia?
- Sudden increase in both systolic and diastolic BP
- Systolic BP elevation > 15-20 mmHg above baseline
- Pounding headache
- Bradycardia
- Sweating
- Pilorection
- Cardiac arrhymias
- Flushing
- Seeing "spots"
- Nasal congestion
- Anxiety
- No symptoms
57
What to do for autonomic dysreflexia?
- Help patient sit up if they are lying down (to lower BP)
- Look for cause:
- Full bowel/bladder (twisted cath)
- Fix tight clothing
- Check skin for pressure sores, cuts, bruises or ingrown nails
58
What are some neurodegenerative diseases?
- MS
- Parkinsons
- ALS
59
What disease is described below:
An acquired idiopathic, inflammatory demyelinating disorder of the central nervous system, in which the myelin sheath is disrupted.
MS
60
Are men or women more likely to have MS?
Women: Twice as likely
61
What is the role of the blood brain barrier?
- Myelinating cells
- Protects the brain
- Homeostasis
62
In an MS brain their is an impaired what that leads to demyelination, oligodenrocyte and axonal loss and inflammation
Blood brain barrier
63
What tests should be given if considering MS?
- MRI
- CSF examination looking for oligoclonal bands
64
Describe percentage of MS subtypes.
- Relapsing remitting: 85%
- Primary progressive: 10%
- Progressive relapsing: 5%
65
What form of MS is described below:
- Initial episode of neurological dysfunction followed by a remission period of clinical recovery
- Recurring bouts of relapse and remission
- Improvement during each remission wanes as disability accumulates
Relapsing remitting MS
66
Name some differential diagnoses for MS
- Sjogrens syndrome
- CNS lupus
- Sarcoidosis
- Behcets diease
- CNS syphilis
- Lyme disease
- HIV
- Vitamin B12 deficiency
- Copper deficiency
- Leukodystrophies
- Stroke
- CNS lymphoma
67
Describe the clinical presentation of MS
- Gradual onset of symptoms
- Optic neuritis
- Sensory and motor impairments for UE and LE
- Lhermittes sign: electical tingling triggerd by neck flexion
- Fatigue
- Cognitive decline
68
What are some things OT should focus on in MS patients?
- Occupational engagement
- Fatigue management
- Memory & cognitive training
- Exercise to improve endurance, muscle strength
- Energy conservation
- Splints
- Assistive devices
- Motor
69
Are the following primary or secondary outcomes of MS and rehab?
- Knowledge about disease management
- Self efficacy
- Motor coordination
- Balance
Secondary
70
Are the following primary or secondary outcomes of MS and rehab?
- Fatigue
- Pain
- Functional ability
- Social participation
- QOL
Primary
71
What is the EDSS?
The expanded disability status scale
- A method of quantifying disability in MS and monitoring changes in the level of disability over time.
72
What scale is often used with MS patients?
EDSS - Expanded disability status scale
73
What functional systems are measured in EDSS?
1. Pyramidal - muscle weakness
2. Cerebellar - ataxia, balance, tremor
3. Brainstem - swallowing, speech, nystagmus
4. Sensory
5. Bowel/bladder function
6. Visual function
7. Cerebral functions - memory/thinking
74
What is the exercise recommendations for MS patients?
- Greater than 150 min/wk of exercise and or greater than 150 min/wk of lifestyle physical activity
75
What is the second most common neuro degenerative disorder?
Parkinsons
76
What is the average age onset of parkinsons?
60
77
How many types of parkinsons are there?
2
78
Name the types of parkinsons
- Familial (genetic)
- Sporadic (Braaks hypothesis: caused by pathogen that enters the body via nose, is swallowed and reaches the gut initiating Lewy pathology in the nose and digestive tract).
79
Describe the diagnosis of parkinsons
- History and clinical presentation
- No biological markers
- Motor symptoms
- Bradykinesia
- Deterioration of motor automaticity (arm swing, gait, eye blinking, facial expressions, speech modulation and swallowing).
80
What are some symptoms and signs of parkinsons.
- Bradykinesia
- Rigidity
- Rest tremor
- Postural instability
- Olfactory loss
- Sleep dysfunction
- Autonomic dysfunction (urinary urgency/frequency, BP variability, ED, orthostatic hypotension)
- Psychiatric disturbances (depression, anxiety, apathy, psychosis)
- Cognitive impairment (Attention, EF and visuospatial function)
- Fatigue
- Trouble swallowing
81
How many substypes are there of parkinsons?
3
- Mild motor predominant
- Interemediate
- Diffuse- malignant
82
Describe treatment for Parkinsons
- Medication: for tremor and or bradykinesia
- Levodopa
- Dopamine agonists
- Monoamine oxidase B inhibitors
Advanced treatment:
- Deep brain stimulation
83
What is the purpose of therapy in early parkinsons?
- Consultative and proactive
- Educate on motor and nonmotor symptoms
- Prevet prematurely dropping meaningful activities and occupations
- Increase knowledge to deal with current, future limitations with work, leisure or IADLS
84
Describe rehab for middle/continued parkinsons
- Assess motor/non motor symptoms
- Improve/maintain skills during ADLs
- Address difficulties of ADLS with PD specific strategies
- Modify activities and environment to improve occupational performance
85
Describe maintenace or long term rehab for advanced Parkinson's.
- Assess symptoms as appropriate
- Modify activities and environment to improve occupational performance
- Use adaptations
- Support caregivers
86
Name 2 assessments used in parkinsons
- Modified Hoehn and Yahr Scale
- MDS - UPDRS (Unified Parkinsons Disease Rating Scale)
87
What neurodegenerative disorder is described below:
- Primarily affecting the motor system
- Loss of upper and lower motor neurons: leading to progressive muscle weakness and wasting
- Symptoms include an anticipated decline in: Speaking, swallowing, walking, grasping, moving and breathing
- Cognitive decline
- 3 year life expectancy from diagnosis
ALS
88
How many subtypes of ALS are there?
8
89
UMN signs of ALS:
- Hyperreflexia
- Spasticity
- Slowing of movements
90
LMN signs of ALS:
- Weakness
- Muscle atrophy
- Fasiculations
91
Describe the clinical presentation of ALS
- Progressive muscle weakness (usually focal and typically spreads to adjacent body regions)
- Muscle atrophy
- Fasciculations
- Muscle craps and slowness of movements with muscle stiffness
- UE onset associated with dominate hand
- Bulbar onset ALS presents most commonly with dysarthria or dysphagia
92
What is a scale used for ALS?
- ALS functional rating scale- revised (ALSFRS-R)
12 item scale measuring disease severity and trajectory
93
What are some OT considerations for treating ALS
- Maintaining independence through ADL training, equipment modifications, caregiver and patient education, positioning/splinting, UE training and preventing of complications
94
ALS subtypes may be classified by:
- Regional onset
- Upper Motor vs Lower motor involvement
- clinical presentation varies along with prognosis and disease trajectory
