Neuro Interventions Flashcards
RLA level 1
No response
Coma
RLA level 2
Generalized response
Non-purposeful, whole body, vocal, inconsistent
RLA level 3
Local response
Purposeful
Local and specific
Inconsistent
Inconsistently follows simple commands (close eyes, squeeze hand)
RLA 1-3 management
Positioning - neutral head, prevent ulcers, upright position if possible
Gentle PROM (intense will cause myositis ossificans): joint and skin integrity
Respiratory care - postural drainage, percussion, vibration
Family education: what to expect, how to be involved
RLA level 4
Confused and agitated
Behavior:
- heightened activity, just out of coma
- aggressive, doesnt cooperate, incoherent verbalization, confabulations
No selective attention, easily distracted
No long or short term memory
*think like waking a baby from a nap, dream state
RLA level 4 treatment
Confused:
- Consistency of PT/staff/family. Make introductions daily. Establish routine.
- Orient pt to time/place/situation
Memory:
- no carryover
- provide visual reference for pt to see progress
Agitated
- calm behavior - do not confront
- closed environment to prevent harm to others
- distract, change activity, provide options
- no open ended or yes/no questions
RLA level 5
confused inappropriate
Behavior
- consistent response to simple commands
- inconsistent response to complex commands
- able to perform short periods of structured socialization
Memory:
- cont. impairment
- inappropriate use of objects
- unable to learn new task
RLA level 6
confused appropriate
Behavior
- follows simple instruction consistently
- goal oriented behavior w/ external input
Memory:
- carryover of previous skills present (self-care)
- begins to return
RLA level 5-6 treatment
Continue goals from RLA 4
Avoid complex commands and complex open environments
RLA level 7
automatic appropriate
Oriented in home and hospital
Daily routine - automatic but robotic
Judgement impaired
Able to initiate social or recreational activity with structure
RLA level 8
Purposeful appropriate
Carryover of new skills present
Impaired judgement in emergency situation, abstract reasoning,
Reduced tolerance for stress
RLA level 7-8 treatment
Focus on re-entry to work/community
Emphasize skills related to problem solving, social interaction
Trial periods of independent living
Adaptation at work or school to return to normal life
UE D1 Flexion
Making an “X”
Functions
- eating
- drinking
- applying makeup
UE D1 Extension
Breaking “X”
UE D2 Flexion
Making “Y”
UE D2 Extension
Merging/crossing “Y”
Returning sword
Reaching to opposite pant pocket
LE D1 Flexion
Kicking soccer ball or crossing leg
LE D1 Extension
Winding up to kick soccer ball or push off to skateboard
LE D2 Flexion
Getting into low car
LE D2 Extension
Ballerina position
Facilitatory techniques
LMN - flaccid mm.
Joint approximation
Light manual resistance
Quick icing
Light touch
Tapping, brushing, hacking
High frequency vibration
Quick stretch
Fast spinning or rolling
Inhibitory techniques
UMN - spastic mm.
Deep pressure
Prolonged stretch
Neutral warmth and prolonged cold
Maintained touch
Rhythmic swinging
Low frequency vibration
Slow stroking
Slow rocking or rolling
Spasticity management
Early mobilization
Daily prolonged stretching
Inhibitory techniques
Facilitate antagonist mm. (FES)
10-20 min ice pack or ice massage (effects short-lived 20-30 min)
Pusher syndrome
Postural disorientation
Ipsilateral pushing (strong side pushes to weak)
Reduction of self correction
Treatment:
- active shift/self correction
- visual/verbal cues (mirror)
- if using cane > use on strong side but cane is shorter than usual
