Neuro Flashcards
Presenting condition
> What brings them to see you - will depend on setting and stage of illness
also consider what the patient considers to be a problem
- Possible communication issues
: Expressive/receptive dysphasia
: language difficulty
: hearing difficulty
: confusion (delirium/ dementia)
- May have to get info from other sources (consent):
: Notes
: family members/carers
: MDT members
History of presenting condition
> When did it happen?
Initial symptoms?
What has happened since?
How did it happen? (fall/crash/gradual/sudden)
Previous treatments
Previous tests
Previous physio - beliefs/expectations?
Past Medical History
DON’T USE THREADS - consider systems
> Neurological system - previous strokes/ neurological events
> Musculoskeletal system - arthritis/ osteoporosis/ fractures/ soft tissue injuries/ pain
> Respiratory system - Chronic (COPD, asthma) or Acute (pneumonia, surgery)
> Cardiovascular system - heart disease/ myocardial infarction/ surgery (linked to stroke)
> Urinary system - kidney disease
> Endocrine system - diabetes (linked to stroke)
drug history
Parkinsons - dopamine agonists (madopar/sinemet)
CVA- antiplatelets (thrombotic stroke)
- anti-coagulants
- cholesterol reducing statins (ischaemic stroke)
- bp medications
- antispasmodics
MS - antispasmodics (reduce tone)
- anti- inflammatories (reduce inflammation flare ups)
Traumatic Brain Injury - antispasmodics
Spinal cord injury - antispasmodics
Social History
> Home environment - difficulties/adaptations e.g stairs/toilets/cooking/bedrooms > Hobbies > Work > Drive? > Support network: dependants/carers - their health levels > Previous mobility vs now > Expectations/hopes/goals > General mental state + emotions
Special Questions:
> Falls - when + how often - why? - loss of consciousness? - fear of falling - confidence scale > Fatigue - excessive? - aggs/eases - sleep/diet/exercise/stress - measure on fatigue scale > Pain - where - type of pain - SIN factor - Numerical score
Creating goals
> Important to patient
what they want to achieve - when by
realistic
short + long term - SMART
Communication considerations
> Speech - expressive + receptive dysphasia
eyesight - glasses/ homonymous hemianopia (loss of part of field of vision)
Hearing - hearing aid
Cognition - can they follow instructions
Consciousness - glasgow coma scale
- alert + orientated
Language ?? english 1st language?
Problem list
Create problem list next to objective assessments + outcome measures
Outcome measure lists
Strength - oxford scale/dynamometer Increased tone - Modified ashworth scale Decreased RoM - Goniometry Pain - NPRS/VAS CV fitness - 6m walk test Balance - Berg balance scale/ 180 degree turn gait - 10m walk test
Objective assessment
1. Observation - informal/formal (posture/position, alertness, facial expressions) 2. palpation (muscle tone, wasting, swelling) 2. Active RoM 3. Passive RoM 4. Strength 5. Sensation 6. Co-ordination 7. Function - rolling/sitting/standing/stairs
Cerebrovascular accident (CVA) / stroke
Ischaemic (clot) or haemorrhagic (burst) > Damage to = symptoms - frontal lobe = behaviour/motor/speech changes - parietal lobe = sensory deficit - temporal lobe = speech/hearing - occipital lobe = sight - brainstem = sensation/motor/respiratory/cardiac - thalamus/hypothalamus = ANS/sensation - limbic system = emotions/memory - cerebellum = co-ordination + balance
Outcome measures
- NIH stroke scale: 15 level, loss of visual field/ataxia/consciousness etc.
- individual aspects e.g glasgow coma scale, nine-hole peg test, berg balance, 10 metre walk
Spinal cord injury
Tetraplegia - all 4 limbs
Paraplegia - legs/trunk/pelvis depending on level
Complete/incomplete - 65% incomplete now
Traumatic (84%) - crash/fall/sports
Non-traumatic = disc disease, infarct, tumour
Outcome measures
- ASIA impairment scale - motor and sensory capabilities of left and right sides
- Spinal cord independence measure (SCIM) - self care/ respiratory/ bowel control/mobility capabilities (30 mins)
Multiple Sclerosis
Demyelinating disease of CNS
- inflammatory process + degeneration of CNS
> Relapsing Remitting - inflammatory episodes will likely lead to secondary progressive MS
> Primary progressive - gradual worsening of symptoms with no remitting
> Secondary progressive - relapsing remitting MS is advanced with more symptoms continuing through remitting episodes
(+benign = few episodes not really causing harm)
Outcome measures \:depending on areas affected - balance - co-ordination - functional - fatigue - sight
Parkinson’s disease
lack of dopamine produced in basal ganglia
- tremor
- disturbance of voluntary movement/posture/balance
signs
- tremor
- rigidity
- bradykinesia (slow movement)
Outcome measures
- Lindop scale (gait + bed mobility)
- parkinsons disease questionnaire (PDQ-8) - quality of life
