Neuro: General Comprehensive Flashcards
The patient is awake and attentive to normal levels of stimulation. Interactions with the therapist are normal and appropriate.
Alert
The patient appears drowsy and may fall asleep if not stimulated in some way. Interactions with the therapist may get diverted. Patient may have difficulty in focusing or maintaining attention on a question or task.
Lethargic
The patient is difficult to arouse from a somnolent state and is frequently confused when awake. Repeated stimulation is required to maintain consciousness. Interactions with the therapist may be largely unproductive.
Obtunded
The patient responds only to strong, generally noxious stimuli and returns to the unconscious state when stimulation is stopped. When aroused, the patient is unable to interact with the therapist.
Stupor (semi-coma)
The patient cannot be aroused by any type of stimulation. Reflex motor responses may or may not be seen. There are no sleep wake cycles.
Coma (deep coma)
Return of irregular sleep–wake cycles and normalization of the so-called vegetative functions (respiration, digestion, and blood pressure control). The patient may be aroused, but remains unaware of his or her environment. There is no purposeful attention or cognitive responsiveness.
Minimally conscious (vegetative state) - Persistent if present after 1 yr following TBI - Persistent if present after 3 months following anoxic brain injury
Glasgow Coma Scale: 8 or less
Severe Brain Injury
Glasgow Coma Scale: 9 - 12
Moderate Brain Injury
Glasgow Coma Scale: 13 - 15
Mild Brain Injury
Sustained contraction and posturing of the upper limbs in flexion and the lower limbs in extension. - The elbows, wrists, and fingers are held in flexion with shoulders adducted tightly to the sides while the legs are held in extension, internal rotation, and plantarflexion.
Decorticate Rigidity - Indicative of damage to the corticospinal tract lesion at the level of diencephalon (above the superior colliculus).
Sustained contraction and posturing of the trunk and limbs in a position of full extension. - The elbows are extended with shoulders adducted, forearms pronated, and wrist and fingers flexed. - The legs are held in stiff extension with plantarflexion.
Decerebrate Rigidity - Corticospinal lesion in the brainstem between the superior colliculus and vestibular nucleus.
Noted Impairments: - Inability to plan motor tasks (apraxia) - Difficulty in initiating, sequencing and processing a task - Difficulty in producing or comprehending speech - memory impairment - perseveration of speech or motor behaviors
Left hemisphere damage
Noted Impairments: - Poor judgement and safety awareness - Unrealistic expectations - Denial of disability or deficits - disturbances in body image - irritability -lethargy
Right Hemisphere damage
- Allows for processing of information sequentially, logically for analysis. - Language production - Recognize words and comprehend what has been read - Mathematical calculations - Sequence and perform movements and gestures - Expression of positive emotions
Left Hemisphere
Major motor pathway - Origonates in the frontal lobe in the primary and premotor cortices->internal capsule->synapse on anterior horn cells in the spinal cord
Corticospinal tract
Rancho LOCF: Patient appears to be in a deep sleep and is completely unresponsive to any stimuli.
Level I: no response
Rancho LOCF: Patient reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner. Responses are limited and often the same regardless of stimulus presented. Responses may be physiological changes, gross body movements, and/or vocalization.
Level II: generalized response
Rancho LOCF: Patient reacts specifically but inconsistently to stimuli. Responses are directly related to the type of stimulus presented. May follow simple commands such as closing eyes or squeezing hand in an inconsistent, delayed manner.
Level III: Localized Response
Rancho LOCF: Patient is in a heightened state of activity. Behavior is bizarre and nonpurposeful relative to immediate environment. Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts. Verbalizations frequently are incoherent and/or inappropriate to the environment; confabulation may be present. Gross attention to environment is very brief; selective attention is often nonexistent. Patient lacks short- and long-term recall.
Level IV: Confused Agitated
Rancho LOCF: Patient is able to respond to simple commands fairly consistently. However, with increased complexity of commands or lack of any external structure, responses are nonpurposeful, random, or fragmented. Demonstrates gross attention to the environment but is highly distractible and lacks ability to focus attention on a specific task. With structure, may be able to converse on a social automatic level for short periods of time. Verbalization is often inappropriate and confabulatory. Mem- ory is severely impaired; often shows inappropriate use of objects; may perform previously learned tasks with structure but is unable to learn new information.
Level V: Confused Inappropriate
Rancho LOCF: Patient shows goal-directed behavior but is dependent on external input or direction. Follows simple directions consis- tently and shows carryover for relearned tasks such as self-care. Responses may be incorrect due to memory problems, but they are appropriate to the situation. Past memories show more depth and detail than recent memory.
Level VI: Confused-Appropriate
Rancho LOCF: Patient appears appropriate and oriented within the hospital and home settings; goes through daily routine automatically, but frequently robot-like. Patient shows minimal to no confusion and has shallow recall of activities. Shows carryover for new learning but at a decreased rate. With structure is able to initiate social or recreational activities; judgment remains impaired.
Level VII: Automatic-Appropriate
Rancho LOCF: Patient is able to recall and integrate past and recent events and is aware of and responsive to environment. Shows carryover for new learning and needs no supervision once activities are learned. May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgment in emergencies or unusual circumstances.
Level VIII: Purposeful-Appropriate
Most common CVA type
Middle cerebral artery
CVA: - Contralteral hemiplegia - Upper extremity greater than lower - loss of sensation primarily in arm and face - Infarction in dominant left hemisphere may produce aphasia and apraxia
Middle Cerebral Artery
CVA: - Rarely involved artery - LE with greater involvement than UE – contralateral hemiplegia and sensory loss - mental confusion - aphasia - contralateral neglect with extensive dominant side involvement
Anterior Cerebral
CVA: - Persistent pain syndrome or contralateral loss of pain and sensory - Homonomous hemianopsia - aphasia - thalamic pain syndrome
Posterior Cerebral
CVA: - Most often results in death from infarct associated edema - “locked in” state with only eye blinking available - vertigo - coma - diplopia - nausea - dysphagia - ataxia
Vertebral Basilar - With pons affected: quadriparesis and bulbar palsy
CVA: - unilateral deafness - contralateral pain and temperature loss - paresis of lateral gaze - unilateral Horner’s Syndrome (ptosis, constructed pupil, loss of sweating) - ataxia - vertigo - nystagmus
Anterior Inferior Cerebellar (AICA)
CVA: - severe ataxia - dysarthria - dysmetria - contralateral loss of pain and temperature
Superior Cerebellar
CVA: - Wallenberg Syndrome: — (vertigo, nausea, hoarseness, dysphagia, and decreased impairment of sensation in the ipsilateral face, contralateral torso and limbs. - Horner’s Syndrome also possible
Posterior Inferior Cerebellar (PICA)
An inability of the patient to produce movement either on command or automatically and represents a complete breakdown in the conceptualization of the task. The patient has no idea how to do the movement and thus cannot formulate the required motor programs.
Ideational apraxia
The patient is unable to produce a movement on command but is able to move automatically. Thus, the patient can perform habitual tasks when not commanded to do so and often perseverates, repeating the activity over and over
Ideomotor apraxia
Synergy: Scapular Retraction and elevation (or hyperextension)
UE flexor synergy
Synergy: Shoulder abduction, external rotation
UE flexor synergy
Synergy: Elbow flexion*
UE flexor synergy
Synergy: Forearm supination
UE flexor synergy
Synergy: Wrist and finger flexion
UE flexor AND extensor synergy
Synergy: Scapular protraction
UE Extensor Synergy
Synergy: - Shoulder adduction,* internal rotation
UE Extensor Synergy
Synergy: - Elbow extension
UE Extensor Synergy
Synergy: - Forearm pronation*
UE Extensor Synergy
Synergy: - Hip flexion,* abduction, external rotation
LE Flexor Synergy
Synergy: - Knee flexion
LE Flexor Synergy
Synergy: - Ankle dorsiflexion, inversion
LE Flexor Synergy
Synergy: - Toe dorsiflexion
LE Flexor Synergy
Synergy: - Hip extension, adduction,* internal rotation
LE Extensor Synergy
Synergy: - Knee extension*
LE Extensor Synergy
