Neuro Flashcards
T4 complete SCI in a wheelchair. Teach sliding board transfer to a bed.
Patient with Parkinson’s Disease is experiencing difficulty mobilizing with cane. Evaluate their gait and then teach them to use a 4WW.
Rx to promote the return of sensation?
Active and passive ROM
Brushing
Tapping
Approximation and/or traction
Deep tissue massage
Rx to facilitate muscle activity
Quick stretching/tapping
Cutaneous stimulation/light touch
FES & NMES – recruit more motor units
Active-assisted Cycling and BW-support Treadmill Training
Rx for shoulder pain/ subluxation (d/t paralysis)
Pharmaceutical Pain management – NSAID’s, analgesia
Positional correction & support – sling, if appropriate
Educate staff/family
PROM/AAROM
Education on Skin Care (Various conditions: Diabetes, PVD, SCI, etc.) (7 points)
1) Wash daily using lukewarm water (test water temperature with body part that has normal sensation, such
as hands)
2) Dry skin completely. Do not leave skin wet, especially between the toes.
3) Apply moisturiser to skin, but avoid putting lotion between toes.
4) Inspect your skin daily from all sides using a mirror.
5) Always wear shoes and cotton socks to protect feet from injury.
6) In case of injury, cuts or abrasions, make sure they are cared for properly and contact your physician for
sores and wounds that persist after 2-3 days.
7) Avoid extreme temperatures, both hot and cold
Will I ever be able to walk again? (post SCI injury)
- understand this is difficult
- assure we will work together to meet the goals
- Ask if they would like a referral to a support group (escalate to a councillor if needed)
Wheel chair fitting:
Seat Height-
Seat Depth-
Seat Width-
Back Height-
Armrest Height-
Seat Height- heel to popliteal fold (add 2 inches for footrest to clear floor)
Seat Depth- Measure from posterior buttocks fold (subtract 2 inches to prevent the seat from pressing into popliteal fold)
Seat Width- add 1.5-2 inches to each side from the widest aspect of the buttock, hip or thigh (give clearance for chunky clothing if needed)
Back Height- measure from seat height to axilla (subtract 4 inches to all back height to be below inferior scapular angle)
Armrest Height- measure from seat height to olecranon process while elbow is flexed 90deg and add 1 inch
SCI levels of injury differences
Review in other decks
Techniques and prescriptions to relieve pressure sores:
o Wheelchair push-ups
o Leaning to side
o Leaning forward
o Frequency: Every 10-15 min and hold for 10-15 seconds. Incorporate in daily routine throughout the day
Exercise precautions for those with SCI
o HR
o Circulation – no vasoconstriction below lesion, thus, increase pooling, decr SV
Wear support stockings and elevate legs
o Thermoregulation – no SNS or vasomotor control, thus, need well-ventilated areas
o BP – hypotension b/c no mm pump
Progress exs slowly, monitor BP, slow with position changes, monitor dizziness/blurred vision
o Spasticity – slow controlled movement, don’t force thru ROM
o Skin breakdown – pressure relief every 10-15 min
o Watch for overuse injuries
SCI Rx
-DB&C, breath stacking, position changes, increase sitting tolerance
-Prevent atrophy
-Stretching
* Rhomboids, biceps, triceps, psoas, toe flexors, gastrocs, TFL, DF
Mat training ASAP
* Balance re-training – high/long sitting, lateral shifting, hands free sitting, internal perturbations, rhythmic stabilization, external perturbations, change surfaces, decrease BOS
Polio Rx (similar to ALS and GBS)
o Do not over exert!
o AROM/PROM to prevent stiff/painful joints and prevent contractures
o Conservative strengthening of weakened mm and NMES
o Orthopedic supports to allow functional activity, as needed
Post-Polio Rx
o EXS PROGRAM: general body conditioning, non-impact CV exs (cycling, swimming), <60-70% HRmax
o Balance period of rest & activity, do not exs to point of fatigue, exs when less fatigued or most rested
o Lifestyle modifications: pacing, energy conservation, rest time should be 2x activity time
o Assistive devices (orthotics, cane, scooter)
MS Education on Exercise
o Exs, but not to fatigue, OK to be tired for 1 hour after exs, but no more. Exs will not damage your body
o Manage spasticity – can incr with infection/illness, cold/hot, pain, emotions, quick movements
o Energy conservation and stress management techniques
MS Rx
treat vestibular dysfunction
posture, proprioception
core
stretches
exercise will benefit overall fxn
MS Programming
late morning sessions
aggressive stretching (daily!)
moderate exercise
strength (10-20 reps, 3-4x/week)
cardio (15-60 min 3-4x/week, 60-70% HRmax)
PD- why are sensory cues important
task becomes less automatic, so conscious activation of motor cortex can override the lost BG/automatic fxn.
o Need verbal, auditory, tactile stimulation – try music, rhythmic initiation
PD- Why is gait affected? And what are some treatment tips
loss of arm swing and reciprocal trunk movements, shuffling gait, festinating gait (an abnormal and
involuntary increase in the speed of walking) shorter steps, narrow BOS
o Tx for festinating gait: use toe wedge to help displace COG backwards
o Treadmill may improve gait rhythm & stability
Exercise Rx for PD
ROM:
Postural Correction:
Balance Re-training:
Aerobic exercises:
Strength exercises:
Exercise when Meds are at their peak
o ROM: full ROM, exs that promote reciprocal movement, stretch flexors (prone lying), slow rhythmic rotational repetitive movements, massage
o Postural correction: decr kyphotic posture w/ back extensor strengthening exercises, AROM into horacic/lumbar extension, cervical retraction, axial extension, scapular retraction
o Balance re-training:
o Aerobic exs – use recumbent bike if balance impaired, incr duration slowly (every 4-5 wks), use rhythmical, rotational, reciprocal activities, 3-4x/week, 45-60 min, 50-70% HRmax
o Strength exs – can improve gait/ performance
ALS Rx-
Resp:
ROM/ Contracture prevention:
Pain:
Muscle Weakness:
Shoulder:
Spasticity:
Assistive Devices:
Circulation:
Education:
o Resp: chest clearance, breathing exs, DB, huffing/coughing, breath stacking, assisted cough, suctioning, percs & vibes, education re: S&S of resp infection, HOB at 30deg and above, suppl O2
o ROM & contracture prevention – prophylactic stretching, splints, AAROM/PROM, strengthen antagonist
o Pain d/t stress on joint capsules/lig b/c of mm weakness. AROM/PROM, support joints, cold/heat, NSAIDs, position changes, symptom relief, pt comfort
o Muscle weakness - facilitate mobility, continue to use what pt has to maintain function
o Shoulder – positioning, slings, arm rests, teach correct transfers, scap mobs in side lying, scap setting/retraction, ROM at elbows, wrist and hand
o Spasticity – stretching, positioning, WBing, trunk rotations
o Assistive devices – AFO’s walking aids (cane, walker, w/c), raised toilet seat, sliding board, mechanical lift
o Circulation – elevation & compression stockings to prevent dependent edema, layers (d/t cold)
o Education – energy conservation
GBS Rx
Early stages:
Sub-acute:
Late stages:
Early stages: progresses over 10-12 days before plateau. prevent atelectasis, DVT, ulcers, contractures, malalignment; proper positioning, maintain ROM/strength; monitor chest status; Educate pt/family on
Sub-acute: gentle strengthening & mobility, gastrocs stretching, sitting balance exs
Late stages/ Rehab: Monitor for over-exertion, continue to strengthen and increase mobility/function; use
TENS, PROM, ice, etc to treat neurogenic pain from jt immobility
Educate the Spouse of a patient with Alzheimer regarding the patients function and managing his fatigue. Patient lives in care-home with support.
Managing Fatigue: prioritize(tasks he wants to do), pace (allow sufficient time for doing the tasks), proficiency (allow the in home support to help as much as possible) , plan( Patterns for his fatigue complete the most important tasks first – know when help will be around to know when he can take rest breaks).
Consistency with routine and environment. If agitated – making sure to keep a calm demeanor and avoid arguing with him (guiding/leading to new activity) Sundowning.
Slow and progressive disease – troubles with walking/speaking/swallowing in later stages
Resources for caregivers – support group availability
Side effects of medication – discuss with care team
Do a SLR test and myotomes of LE. Verbalize findings to examiner. F/U what would a cross sign indicate during this test (having pain on contralateral side when SLR) and based on your diagnosis, which exercises would you tell the pt to avoid. (Patient had a lumbar disc herniation.
SLR: Supine – unaffected side first. But do both. Instruct “don’t help me (raise the table up) keeping the knee In full extension and moving slow – asking the patient what they are feeling as they go.
- Cross Sign: raising the unaffected side produces symptoms in the involved side. Indicative of a central disc herniation (major nerve root impingement).
LE Myotomes in supine: L1/2: Hip flexion. 3: knee extension 4: DF 5: Great toe Ext S1: plantar flexion S2 Hamstring (knee flex)
Based on findings – avoiding flexed forward positions to avoid symptom aggravation. Exercise Rx: Repeated prone, prone on elbows to hands – eventually in standing. (Mckenzie method)
Differential Dx: muscle spasm, cauda equina, peripheral nerve entrapment (sciatic)
Patient with ALS – educate them how to use a 4-wheel walker and teach sitting with the 4-wheel walker.
ALS – motor neuron disease (UMN and LMN)
Safety – brakes, gait belt, footwear,
4WW fitting – GT floor.
Demo walking and sitting.
Guard
Talk to patient with C6 spinal cord injury. What will they be able to do functionally with this level of spinal cord injury, Patient ask will her legs ever work again, as doctor told her the function wouldn’t return.
C6 SCI – Best case – independent with breathing, have wrist extensors (allow for tenodesis grip)
- Able to drive with adapted controls, I to min with SB t/f, live independently – pressure relief and manual cough
- best case scenario of level of function ADLs and Leisure
- emphasize what they typically will have and the positives
- Could discuss adaptive equipment if they bring up certain activities
too early to tell, need time for injury to stabilize before we can form a timeline, but there are a few positive factors working for you, such as … eg. young age, health before injury, etc. (Q2) Likely won’t be the same level of function before injury, likely will need assistive devices eg. walker, forearm crutches, KAFO; (Q3) address danger of reading from internet, probe what patient has read from the internet, can mention the basic mechanisms for FES – but will require some time before team can determine if patient is a good candidate for FES;
Your patient has Parkinson disease and experiences freezing of gait.
Assess gait and state 5 findings to the examiner.
- Freezing – competing stim or stress
- Stooped Posture – looking down
- Shuffling small steps
- No arm swing
- Trouble with turning
- Slow
Gait Analysis – Observe, Return to seated, State Findings
Teach 2 strategies to the patient to overcome freezing of gait
- Auditory Cues: rhythmic music, clapping, counting
- Visual Cues: Stepping over lines
- Tactile Cues: tapping to get out of freezing
- Cognitive cues: mental image of big step
