Neuro Flashcards
what are three key things to observe about the neuro patient prior to touching/talking to the patient?
- patient movements
- eye opening
- arousal state
what are two considerations for vitals with regards to neuro patients?
- many have orders to keep BP below a certain level
2. monitor ICP if appropriate
what does lethargic mean
drowsy and may fall asleep without stimulation
difficulty with attention, questions, or tasks
what does obtunded mean
difficult to arouse from a somnolent state and confused when awake
what does stupor mean
response only to strong, generally noxious stimuli and returns unconscious when stimulation ends
what does coma mean
unaroused by any type of stimulation
how should you assess arousal state?
assess changes with different positions such as sidelying and sitting and with different sensory cues
what is selective attention
ability to focus on one source of input
what are the four categories of attention that can be used to describe mental status in patients
selective, divided, sustained, switching
what are two strategies for assessing attention
- read a list of numbers and ask them to repeat back (7 is typical)
- read a list of letters and every time a letter A is read then tap the table
what should be considered before making a judgement about a patient’s cognition?
assess sensory status
related the following words: cognition, awake, and attention
if the patient is not awake, they cannot give you attention. If a patient is awake but doesn’t give you attention then they have poor cognition
when considering mental status, what are the steps to addressing the asleep patient
- gently nudge and if they wake continue and record their quality of awake-ness
- if they remain asleep, provide additional stimulus
when considering mental status in a neuro patient, what are the steps to addressing the awake patient
introduce yourself and then record their quality of awake-ness throughout the session
what is AOx4
who, when, where, why
what is a special sensory consideration for the neuro population?
vision
what is a special motor contribution for the neuro population and how does it impact PT
swallowing and speech - aspiration precautions
where are the five major supine pressure points for ulcers?
occiput, shoulder, elbow, sacrum, and heel
where are the five major sidelying pressure points for ulcers
ear, shoulder, greater trochanter, outer and inner knee, ankle
where are the five major wheelchair pressure points for ulcers?
scapula, sacrum, IT, heel, and ball of foot
T/F: we perform CN exams
true, but not on every patient, every time, and certainly not if its already been done
what are the three categories of sensory integrity
superficial, deep, and combined cortical
what are three superficial sensory integrity tests
pain, touch, and temperature
what are three deep sensory integrity tests
proprioception, kinesthesia, and vibration
what are four combined cortical sensory integrity tests
stereognosis, tactile localization, two-point discrimination, and graphesthesia
what are three important pre-requisites for testing sensory integrity
- pt must be able to follow instruction
- pt must be able to be oriented to the procedure
- need to minimize leading questions
how do you test ROM in the neuro population
visual estimation/gross screen for active range; AAROM usually for treatment and PROM for sensory integration
what are the two major upper extremities DTR’s and what root levels are tested
biceps (C5/6) and triceps (C6/7)
what are the two major lower extremity DTR’s and what root levels are tested
quads (L2-4) and achilles (S1-2)
what are superficial cutaneous reflexes
brief muscle contractions at the level of stimulus
how do you perform a babinski, what roots are involved, and what is a positive result
- stroke from lateral plantar towards the toes and then across the ball of the foot
- S1/2
- toes extend/fan
what is a primitive/tonic reflex we can assess in the lower extremity
flexor withdrawl reflex
what can brainstem reflexes tell you
brain death status
what is tone
resistance to muscle to passive elongation or stretch when an individual attempts to relax
what three things should you do to assess for tone
- observe resting position of the limbs
- palpate the muscle belly
- passively move the joint
what is hypertonicity
increase in muscle contractility due to lesion of CNS or UMN
what is spasticity
a type of hypertonicity characterized by a loss of inhibitory control on LMNs causing VELOCITY DEPENDENT resistance to passive stretch
what is hypotonia
decrease in muscle contractility due to a lesion of a LMN or spinal shock from an SCI
what is dystonia
hyperkinetic movement disorder characterized by disordered tone and involuntary movement
T/F: tone is affected by comorbidities
true: chronic stroke patients can have tone changes if they have the flu or a UTI for example
what are common characteristics of UMN lesions
- spasticity
- heightened tendon reflexes (DTRs)
- clonus
- babinski
- dyssynergistic movement
- fatigue
- paresis
what are common characteristics of LMN lesions
- decreased/absent tone
- paralysis
- atrophy
- decreased DTR
what are three strategies to test strength in neuro patients
- MMT
- ASIA tool for SCI (myotomal assessment)
- functional activities and reps to fatigue
how can you describe motor control clinically
type and quality of movement
how can you describe types of movement
local or general - spontaneous, purposeful, involuntary, reflexive
how can you describe quality of movement
symmetrical, smooth, jerky, coordinated
how is coordination achieved
cerebellum generates a plan, carried by the basal ganglia, and in response to the DCML
how is coordination characterized
speed, distance, direction, and timing
what are goals for neuro patients (6)
- maximize safety and function
- normalize tone
- minimize unwanted movement
- improve trunk control
- prevent loss of ROM
- improve arousal/attention
