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Pulmonary > Neuro Conditions > Flashcards

Neuro Conditions Flashcards

1
Q

Apraxia

A

-a neurological disorder that affects the ability to perform movements and gestures
-a motor disorder that affects the ability to perform learned movements or tasks

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2
Q

May I assign two diagnoses?

A
  • The need to do so does not happen often
  • No, if it comes from uncertainty or an incomplete examination
  • Yes, if you are “well-behaved”
  • If the patient has an impairment, but the level of impairment does not meet
    the threshold for a given diagnosis, consider adding it as a descriptor to the
    primary diagnosis.

Multiple, equally impactful impairments= 2 diagnosis

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3
Q

Can a diagnosis change?

A

The Diagnosis is Unlikely To Change If the Exam was complete/Interpreted Correctly

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4
Q

Movement System Diagnosis

A
  • Can be applied to adults and children across the continuum of care
  • Not focused on medical diagnosis
  • Derived from a complete examination of body/structure/function + task
    analysis
  • May have addenda related to other impairments not associated with primary
    impairments
  • Will be used to guide treatment and education
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5
Q

Weakness movement diagnosis

A
  • FPD: good (restorative)
    -FPD: poor (compensatory)
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6
Q

Coordination movement diagnosis

A
  • Movement pattern coordination deficit (restorative)
  • Dysmetria (compensatory)
  • Hypokinesia (compensatory)
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7
Q

Fractionation movement diagnosis

A

Fractionated movement deficit (compensatory)

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8
Q

Sensation and perception movement diagnosis

A

-sensory selection and weighting (restorative)
-sensory detection (compensatory)
-postural vertical deficit (could go either way depending on severity)

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9
Q

Force production deficit key impairments and chief complaints

A

-Key Impairment: Weakness; Range of Severity is Extensive Affecting
Prognosis
-complaints: tripping, fatigue, weak, buckling
-medical dx: can be CNS or PNS

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10
Q

FPD key tests and signs

A

Strength:
* Less than 3+/5 to 4/5 muscle strength throughout a limb or limbs or entire body
* Difficulty moving through full range against gravity or
* Focal weakness at one primary joint or limb
* Deterioration in range of motion/speed of movement with repetition

Patients with significant weakness will need varied levels of assistance (independent to dependent) across a variety of functional tasks

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11
Q

FPD associated signs

A
  • Have fractionated movement
  • Normal to mildly altered muscle tone
  • Normal to mildly impaired sensation
  • Coordination: In more severe forms may be unable to test due to weakness; In
    milder forms, likely to be slow but accurate
  • Possible need for supportive structures
  • Postural control: In early stages of recovery, unable to sit or perhaps stand
    unsupported; would fall without support
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12
Q

Movement Pattern Coordination Deficit (MPCD) key impairments and chief complaints

A

-Key Impairment: Mild Coordination Deficit, improves with cues and practice
Deficits in STS, walking, reaching/grasping
-Complaints: messy, falls, clumsy, unsteady, awkward
-Medical Dx Varied, Tend to be Higher Level Function (includes children with developmental delay)
-Ex: early PD, stroke, MS, down syndrome, autism

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13
Q

MPCD key tests and signs

A
  • Postural Responses are Slow/Inappropriate Amplitude;
  • STS:
  • altered sequence or direction of movement components during execution, e.g. knee
    extension before hip extension
  • posterior rather than anterior translation of tibia over foot
  • ankle sway during termination
  • Gait: variable foot placement/line of progression; slow, guarded steps
  • Reach/Grasp: awkward/slow; difficulty adjusting grip during transport (not age appropriate)
  • Difficulty with transitions as develop in age
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14
Q

MPCD associated signs and outcome

A
  • Little/no muscle weakness
  • Generally fractionated movement
  • No >mild spasticity; No > 2 on Modified Ashworth Scale
  • No > mild sensory loss
  • No >mild non-equilibrium coordination deficits
  • latency/sway; inappropriate amplitude of movement affecting balance

Outcome: favorable

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15
Q

MPCD treatment

A

Focus is Restoration/Remediation: need to push these pt’s
* limb use and refining movement strategy
* improving movement speed and amplitude
* improving coordination of anticipatory and reactive postural responses relative to balance demands
* generating consistency, flexibility, and efficiency of motor behavior during changing environmental demands

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16
Q

Dysmetria key impairments and chief complaints

A

Key Impairment: Inability to Grade Forces Appropriately for Distance and Speed of a Task
-Complaints: overshooting, clumsy, dyscoordination, cerebellum, wide BOS
-Medical Dx-Most Commonly Those Affecting the Cerebellum

17
Q

Dysmetria key tests and signs

A
  • Non-equilibrium coordination: Notable under or overshooting;
    Abnormal rhythm and incoordination that does not improve with practice; This is a key impairment test that makes the diagnosis, as they tend to have moderate to severe deficits with this
  • Able to move against gravity
  • During function: Needs wide base of support; Under or overshoots; Excessive postural sway (and postural responses);
  • Difficulty grasping small or light objects
  • Because they overshoot, have most difficulty with termination phase of movement
18
Q

Dysmetria associated signs and outcome

A
  • Often needs UE support to sit safely (more severely impaired)
  • Wide base of support/high guard
  • Variable foot placement
  • Generally requires assistance

Outcome: variable with compensation (less favorable)

19
Q

Dysmetria treatment focus

A
  • Compensatory
  • AFO: suggested so pt will only have to control 2 segments instead of 3
  • slowing down
  • decompose mvmt: move one segment at a time
  • assisted device
20
Q

hypokinesia key impairments and chief complaints

A
  • Key Impairment: Slowness in Initiating and Executing Movement; May be Associated with Stopping of Ongoing Movement.
    -complaints: slow, rigidity, unsteady, tremor, festination, retropulsion (fall back when standing), shuffling, freezing
    -Medical Dx-Most Common is Parkinson’s Disease (BUT not all ppl with PD have hypokinesia)
21
Q

Hypokinesia key tests and signs

A
  • Able to move against gravity
  • Difficulty initiating movement
  • Delayed timing of postural adjustments
  • Lack of preparatory movements; may use repeated movements/momentum
    strategy
  • Assistance required especially with transitional movements
  • Loss of balance posteriorly and with termination (retropulsion)
  • Can have poor (delayed or absent) postural responses
  • Parkinson’s-later in disease, some can develop freezing of gait (FOG) and/or gait
    festination
22
Q

Hypokinesia: Associated Signs and outcome

A
  • Rigidity (increased muscle tone)
  • Non-equilibrium coordination- undershoots target; slow reciprocal movement
  • Peds: Delayed “integration” of early/primitive reflexes

Outcome: variable with compensation (poor)

23
Q

Hypokinesia treatment

A

Treatment Focus Is Primarily Compensatory but Can Have Restorative/Remediation Components
- slow turns, big steps, assisted devices

24
Q

Fractionated Movement Deficit (FMD) Key Impairment and chief complaints

A
  • Key Impairment: Inability to Fractionate Movement
    -complaints: stiff, contracture, rigid, slow, synergy
  • Medical Dx: always related to CNS (hypertonicity)
25
Q

FMD key tests and signs

A
  • Non-fractionated movement* (No dissociation of movement from one joint to the other)
  • Unable to generate quick movements
  • Moderate to severe hyperexcitability
  • Grade 3-4 on the Modified Ashworth Scale
  • SCALE scores of <5 for either LE would indicated FMD
  • May exhibit abnormal reflexes e.g. ATNR, STNR
26
Q

FMD associated signs and outcome

A
  • Associated reactions with effort
  • Lacks dissociation of muscle groups during activities; stereotypical patterns
  • Compensatory gait signs
  • Stiffness of gait
  • Scissoring
  • Assistive devices and AFO commonly needed
  • Reach limited, minimal hand movement in grasp
  • Asymmetrical postural control is frequent

Outcome: Dependent on the Amount of Anti-Gravity Strength (Tends to Be Poor); They DO NOT have the capacity to “move normally”; So, don’t expect improvement with cues to incorporate essential components

27
Q

FMD treatment

A

Focus is compensation

28
Q

Sensory Selection and Weighting Deficit Key impairments and chief complaints

A
  • Key Impairment: Decreased Ability to Screen & attend to Appropriate Sensory Inputs
    -complaints: dizziness, visual sensitivity, spinning, vertigo, weaving, sensory avoidance, unsteadiness
  • Medical Dx:
  • Stroke
  • Brain Injury
  • Unilateral or bilateral vestibular hypofunction
  • BPPV with postural instability
  • Sensory Integration Disorder
  • Autism Spectrum Disorder
  • Pervasive developmental disorder
  • Rhett’s Syndrome
  • Sensory Processing Disorder
29
Q

Sensory selection and weighting deficit key tests and signs

A
  • Sitting/Standing: Increased sway; greater instability with head movement or changes in sensory conditions (eyes closed; compliant surface)
  • Standing: Hip strategy used at inappropriate times
  • Gait: Variable line of progression with walking; Excessive lateral sway with turns; Deviation with head turning; loss of balance; Dizzy; Worse with increased speed
  • Difficulty making transitions from one sensory environment to another
  • Postural responses may be delayed or exaggerated
  • May improve with modification of sensory needs and practice
  • Symptoms with smooth pursuit or saccadic eye movements
30
Q

Sensory selection and weighting deficit associated signs and outcome

A
  • Movement is fractionated and non-equilibrium coordination is intact
  • May have positive vestibular tests (will cover in Module 6)
  • Sensation/Sensory Behavior:
  • May show signs of gaze aversion
  • May show signs of self stimulation behaviors such as rocking, spinning and
    banging

-outcome: good, independent ambulation with no or mild deficits

31
Q

Sensory selection and weighting deficit treatment

A

restorative

32
Q

Sensory detection deficit key impairments and chief complaints

A
  • Key Impairment: Lack of Joint Position
    Sense or Multi-Sensory Failure
    -complaints: dull, need vison, numb, unsteady
  • Medical Dx Involve Those That Affect JPS, Vision or Bilateral Vestibular Loss
33
Q

Sensory detection deficit key tests and signs

A
  • Sensation: mod/severe loss of JPS; mild or greater loss of JPS and touch sensation
  • STS and Step-up: hyperextension of knees before hip extension during execution
  • Gait: increased BOS; variable foot placement; increased sway; increased knee hyperextension; some improvement with visual guidance
  • Grasp/in-hand manipulation: clumsy; some improvement with visual guidance
  • Needs postural support or has increased sway; worse with eyes closed (or in low light environments) because they can no longer compensate with vision;
  • Limited improvement with practice
34
Q

Sensory detection deficit associated signs and outcome

A
  • Poor timing and coordination of movement
  • Slow and clumsy
  • Some improvement with visual guidance

-outcome: variable with compensation (poor)

35
Q

Sensory detection deficit treatment

A

compensatory

36
Q

Postural vertical deficit key impairments and chief complaints

A
  • Key Impairment: Inaccurate Perception of Vertical Orientation with Resistance of Correction of Center of Mass Alignment
    -complaints: falling, resisting, leaning “off”, pusher
  • Medical Dx: Most Common is Stroke
37
Q

Postural vertical deficit key tests and signs

A
  • Resists correction of center of mass alignment*; fearful/agitated when center of mass alignment is corrected
  • Sensation of “falling” when shifted toward correct vertical alignment
  • May fix extremities and push away
  • Shift COM beyond limits of stability without weight bearing
  • In Medial/ lateral form is associated with disregard, motor planning deficits
  • May have disregard or neglect of involved extremity
38
Q

Postural vertical deficit associated signs and outcomes

A
  • Movement is variable
  • May have motor planning difficulty
  • Sensation may be lacking (light touch and JPS)
  • Behavior may be impulsive or fear avoidant
  • Judgment may be poor or they demonstrate fear avoidance behavior

-outcome: depends on severity cog/behavioral deficits and motor function

39
Q

Postural vertical deficit treatment

A

restorative (compensatory in severe cases)

Pulmonary (2 decks)

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