Neuro Rehab Exam 2 Flashcards
UE D1 Flexion
Scapula: elevation, abduction, and upward rotation
Shoulder: flexion, abduction, and external rotation
Elbow: flexion or extension while moving or extended throughout
Wrist/fingers: flexion, radial deviation, and thumb adduction
UE D1 Extension
Scapula: depression, adduction, and external rotation
Shoulder: extension, abduction, and internal rotation
Elbow: flexion or extension while moving or extended throughout
Wrist/fingers: extension, ulnar deviation, and thumb abduction
UE D2 Flexion
Scapula: elevation, adduction, and upward rotation
Shoulder: flexion, abduction, and external rotation
Elbow: flexion or extension while moving or extended throughout
Wrist/fingers: extension, radial deviation, and thumb extension
UE D2 Extension
Scapula: depression, abduction, and downward rotation
Shoulder: extension, adduction, and internal rotation
Elbow: flexion or extension while moving or extended throughout
Wrist/fingers: flexion, ulnar deviation, and thumb opposition
LE D1 Flexion
Pelvis: protraction
Hip: flexion, adduction, and external rotation
Knee: flexion or extension while moving or extended throughout
Ankle/Toes: dorsiflexion and inversion
LE D1 Extension
Pelvis: retraction
Hip: extension, abduction, and internal rotation
Knee: flexion or extension while moving or extended throughout
Ankle/Toes: plantarflexion and eversion
LE D2 Flexion
Pelvis: elevation
Hip: flexion, abduction, and internal rotation
Knee: flexion or extension while moving or extended throughout
Ankle/Toes: dorsiflexion and eversion
LE D2 Extension
Pelvis: depression
Hip: extension, adduction, and external rotation
Knee: flexion or extension while moving or extended throughout
Ankle/Toes: plantarflexion and inversion
Bilateral Symmetric Patterns
Movement of both extremities simultaneously; either flexion or extension together
Bilateral Reciprocal Patterns
Reciprocal performance of one diagonal pattern by either both upper or both lower extremities
Movement of both extremities occurs in different directions
One limb flexes while one limb extends in the same diagonal
Bilateral Asymmetrical Patterns
Bilateral performance of the two diagonal patterns by either B UE or LE
Movement of both extremities occurs simultaneously in the same direction
Both extremities extend or flex together
Crossed Diagonal Patterns
Reciprocal performance of the two diagonal patterns by either B UE or LE
Movement of both occurs simultaneously in different directions
One limb flexes in one pattern, one limb extends in the other patterns
Chop
Upper trunk flexion pattern that combines bilateral asymmetrical extension patterns of the UE
Used for trunk stability and to promote trunk flexion
Lift
An upper trunk extension pattern that combines bilateral asymmetrical flexion patterns of the UE
Used for trunk stability and to promote trunk extension
Precautions for Casting
Poor skin integrity/small wounds Fluctuating edema (CHF, dialysis) Decreased sensation Cognitive impairment Agitation
Contraindications for Casting
Uncontrolled HTN Major open wounds External fixator/unhealed fracture Need to access the extremity Recent autonomic dysfunction Impaired circulation Acute inflammation
Glasgow Coma Scale Scores
Range from 3-15
13-15= mild
9-12= moderate
<9=severe
Galveston Orientation and Amnesia Test
purpose and scoring
Purpose: looks at post-traumatic amnesia, guide to severity of damage through impairment of consciousness
Scores:
76-100= normal
66-75= borderline
<66= impaired
O-Log
populations and purpose
For acute/IP-R patients daily tracking of orientation
Scored 0-3
Score of 2 versus 3 depends on cueing the patient needs
Coma Recovery Scale
appropriate populations
Designed to help patients in Rancho levels 1-4
Predictive for where patients will be in a year
Higher score- higher level of functioning
Agitated Behavior Scale (scores)
Grades 1-4
Higher score is worse
Rappaport Disability Rating Scale
Covers a wide range of fxnl areas and is used to classify levels of disability from death to no disability
Score= 0-30 (death)
Rancho Levels 1-3
Prevent indirect/secondary impairments (positioning/stretching/ROM)
Sensory stimulation for arousal- rhythmic initiation
Upright activity challenge
Family education
Rancho Level 4
Confused/agitated
More aware of the environment, but also respond to their own internal confusion
Facilitation for movement
Perception/sensory integration
Endurance/activity tolerance
Safety- unpredictable, irrational, and illogical
Rancho Level 5 and 6
Confused but will follow simple commands
Basic mobility and ADLs
Task oriented and meaningful exercises
Motor control- coordination, tone, and movement patterns
Rancho Level 7 and 8
Concussion
Acute management- rest and decreased physical/cognitive exertion
Ongoing symptomalogy will depend on their specific deficits (dual tasks, vocational rehab, self-responsibility)
Concussions:
Immediate Signs and Symptoms
Vacant Stare Delayed motor and cognitive processing Disorientation Slurred Speech Memory Deficits LOC Nausea/vomiting Headache Dizziness
Concussions:
Ongoing Signs and Symptoms
Cognitive Impairment Headache Balance Deficits Dizziness Fatigue Difficulty reading/focusing Photo/Phono-sensitivity Fogginess Amnesia Sleep disturbance(too much or too little) Irritability
Good Prognosis after Concussion
Typically do better, earlier Loss of Consciousness Vomiting Age <13 y/o No previous concussions
Bad Prognosis after Concussion
Age>13 years old
Amnesia
History of: Previous concussions (exponential), Migraines, Anxiety, Ocular deficits (strabismus), Learning disability
Unhappy Triad of Concussions
History of
1) Previous concussions (exponential
(2) Migraines
(3) Anxiety
Peripheral Vestibular Dysfunction
Due to labyrinth or CN 8 problem
Central Vestibular Dysfunction
Due to brainstem, pons, medulla problem
Examples of Peripheral Vestibular Dysfunction
Vestibular Neuronitis Labyrinthitis Meniere’s Disease Acoustic Neuroma Bilateral Vestibular Hypofunction (BVH) BPPV- mechanical problem of otoconia
Examples of Central Vestibular Dysfunction
Vestibular Migraine MS TBI Cerebellar degeneration Cerebellar or vertebral artery infarct Arnold-chiari malformation
ALS Clinical Signs and Symptoms
Early symptoms may include twitching, cramping, stiffness of muscles, weakness of an arm or leg, slurred and nasal speech, difficulty chewing or swallowing
Symptoms may affect one leg, contributing to awkwardness when walking, or more frequent tripping or stumbling; in the arm, individuals may have difficulty in simple manual dexterity tasks like buttoning the shirt, using a key
These general complaints then develop into more obvious weakness or atrophy
Abnormal reflexes may emerge, as well as fasciculations – both UMN and LMN involvement
Stages of ALS
Early stage–>ALS manifests as a variety of signs and symptoms recognized by the pt as abnormal – they may or may not cause some fxnl limitation
Middle stage–> Increasing signs and symptoms and increasing number and severity of impairments – min to mod fxnl limitations
Late stage–>Numerous and increasingly severe impairments, becomes dependent, requires a ventilator
Guillian Barre Syndrome Clinical Signs and Symptoms
Typical presentation is ascending symmetric weakness, tingling (LE > UE)
These symptoms increase in intensity and can lead to total paralysis
Involves PNS, so LMN signs
Direct Approach to PNF
Application of exercise techniques and elements to an affected area
Indirect Approach to PNF
Application of exercise techniques and elements to an unaffected area to gain overflow excitation or relaxation effects to an affected part
Three pieces of the PNF Procedure
(1) Activity- any developmental posture and the movements occurring within that posture
(2) Technique- type of contraction used
(3) Element- type of sensory input used in the treatment to facilitate/inhibit a response
UE flexion is associated with …
External rotation
UE extension is associated with …
Internal rotation
Bilateral UE flexion facilitates…
Trunk extension
Bilateral LE extension facilitates…
Trunk extension
Traction
What is it used for?
What are the contraindications?
Used to promote movement with pulling or antigravity movements and decrease pain
Contraindications: increased pain, lig injury, unstable joints
Approximation
What is it used for?
What are the contraindications?
Used to promote stability
Contraindications: increased pain, fracture, joint replacements, and inflammatory conditions
Appropriate Resistance
What are the contraindications?
Increased pain, fracture, valsalva, tendon surgeries, muscle flaps, and reconstructions
Quick Stretch
What is it used for?
What are the contraindications?
Used to trigger the stretch reflex to facilitate initiation of motion or enhance the muscle contraction
Used to facilitate voluntary movements and increase the strength of voluntary contraction
Contraindications: increased pain, fracture, joint instability, and creating dominant reflexes
Rhythmic Initiation
Unidirectional technique to enhance initiation and promote motor learning
Used to promote relaxation initially and treat people having difficulty initiating motion due to hypertonia
“Let me move you” or “Help me move you”
Rhythmic Stabilization
Isometric technique used for stabilization of an unstable joint/posture by facilitating co-contraction at a joint
“Hold and don’t let me move you”
Slow Reversal
Utilizes slow, rhythmical, concentric contractions of the total agonistic patterns and then the antagonistic pattern without relaxing
Used to promote increased strength, ROM, coordination, and power; also facilitates contraction of the antagonist
“Pull or Push”
Repeated Contractions
Utilize stretch reflex to promote initiation of muscle activity to reinforce and strengthen an existing contraction
Agonistic Reversals
Alternates between concentric and eccentric contractions of the agonistic movement pattern
Does NOT facilitate opposing muscle group
Used to increase strength and ROM
Hold/Relax
Isometric technique to increase ROM due to muscle tightness or pain
Contract/Relax
Combo of isometric and isotonic contractions to increase ROM due to muscle tightness
Not good for pain because the build up of tension is immediate and release is aburpt
Define concussion
Trauma-induced alteration in mental status that may or may NOT involve a loss of consciousness
From a direct OR indirect blow
Acute management of concussion
Any signs or symptoms shown from the previous page warrants an immediate removal from activity
NO athlete diagnosed with a concussion should be returned to sports participation on the day of the injury d/t second impact syndrome
Cognitive and physical rest
No exertion until all signs and symptoms resolve (symptoms > 7-10 days require additional treatment)
Concussion RTP Protocol
Light aerobic Sport Specific Non-contact training Full contact training RTP **Need 24 hours within each stage to account for rebound potential
Concussion RTW Protocol
Partial duty Lower productivity Slow return to machinery and heights Reduced screen time RTW
Optokinetic Reflex
Functions during movement of visual images (smooth pursuit or saccades)
Cervico-ocular Reflex (COR)
Functions during movement of head relative to the body
Vestibulospinal Reflex (VSR)
Generates appropriate tone to maintain upright position
Vestibulo-ocular Reflex (VOR)
Functions during movement of head relative to gravity
Stabilizes images on the retina during head movement
Produces eye movement in opposite direction of head movement to maintain image
What is the gain?
Need a ratio of one to see clearly
Eye movement/ Head movement
Four rules of vestibular nystagmus
- Clearly defined fast and slow components
- Named for the direction of the fast phase
- Not direction changing or position dependent
- Increased by removal of fixation and gaze in direction of the fast phase
Oscillopsia
Definition
Cause
Patient Complaint
Definition: Illusion of movement of the of the visual environment
Cause: impaired VOR leads to retinal slip (uni or bilat)
Patient complaint: vision is blurry, everything bounces when I move
Unilateral Vestibular Dysfunction (UVH)
Etiology
S+S
Recovery
Etiology: viral infection, trauma, vascular insult, or tumor
S+S: spontaneous nystagmus, constant vertigo, oscillopsia, and impaired balance
Recovery: few days to few months
Acute UVH
Reduction in the neural firing rate on the injured side
The brain perceives this as a rotation to the strong side
Resolves after 1-7 days
Chronic UVH
Impaired VOR creates dizziness with head movements
Decreased dynamic visual acuity
Vestibular Neuritis
Etiology
S+S
Lesion Site
Treatment
Etiology: viral infection of CN 8
S+S: acute onset vertigo (48-72 hrs) , dizziness and oscillopsia with quick head movements for weeks, intense/ constant spinning vertigo
Lesion Site: typically affects the superior vestibular nerve
Treatment: vestibular suppressants and bed rest for 1-3 days, vestibular therapy, exercise
Labyrinthitis
S+S
Treatment
S+S: acute onset vertigo (48-72 hrs) , dizziness and oscillopsia with quick head movements for weeks, intense/ constant spinning vertigo
Treatment: steroids for hearing loss, meds + bed rest for 3 days, vestibular therapy
Meniere’s Disease
Etiology
S+S (during and after attack)
Lesion Site
Treatment
Etiology: Due to anatomic, infections, immunologic/allergic factors
S+S (during): sudden onset of vertigo (>20 min, <2g/d), diuretics or vestibular suppressants, intratympanic gentamycin injections, endolymphatic shunt/labyrinthectomy/vestibular neurectomy, PT for patients with chronic imbalance/dizziness between attacks
Acoustic Neuroma
Etiology
S+S
Treatment
Etiology: tumor from Schwann cells of the vestibular portion of CN 8
S+S: progressive unilateral sensorineural hearing loss, tinnitus, brief vertigo/imbalance, facial paralysis/pain, cerebellar signs (HA, mental status changes, nausea/vom, ocular changes)
Treatment: surgical resection of tumor or gamma knife radiation, monitor for 6 mo, PT for gaze stabilization, habituation, and balance training
BVH
Etiology
S+S
Exam Findings
Treatment
Etiology: ototoxicity (aminoglycosides, aspirin, chemotherapeutic agents), presbystasis, meningitis, autoimmune disease, congenital malformation, otosclerosis, polyneuropathy, tumors, endolymphatic hydrops
S+S: oscillopsia, disequilibrium, and head movement induced dizziness, NO VERTIGO
Exam Findings: rotary chair test, impaired DVA (>2 line loss), increased sway with eyes closed, wide BOS with gait, positive head thrust bilaterally
Treatment: Substitution exercises (recruiting non-vestibular capacities such as COR and proprioceptive and visual control for gaze stabilization, balance and gait), Fall prevention/compensatory strategies, Assistive device, Patient education (time frame for recovery is up to 2 years)
Migraine Associated Dizziness
Symptoms
Etiology
Lesion Site
Treatment
Symptoms: dizziness (true vertigo, motion sensitivity, lightheadedness, imbalance), nausea, HA, fatigue, photo/phono-phobia, motion sensitivity, tinnitus, aural pressure (B), visual fog
Etiology: central (asym activation or deactivation of vestibular neuronal activity through release of NT) or
peripheral (transient change in blood flow to labyrinth due to VC/VD)
Lesion Site: labyrinth, vestibular nuclei, sensory collection, and processing centers of the brain
Treatment: eliminate triggers (stress/anxiety, foods), meds, therapy, aerobic exercise
Canalisthisasis
Vertigo lasts <60 seconds
Otoconia are floating freely through the canals
Cupulolisthiasis
Vertigo lasts >60 seconds
Otoconia have adhered to the cupula
Geotropic
Beating down toward the ground when they’re laying on that side
Ageotropic
Beating down toward the ground when they’re laying on the opp side
Distinguish between vertigo, lightheadedness, and unsteadiness
Vertigo- actual movement/rotation of the room or their head
Lightheadedness- do they feel faint or their head is a “balloon on a string”
Unsteadiness- dysequilibrium
