Neuro Scales

Question 1

Modified Ashworth Scale

Answer 1

The Modified Ashworth Scale (MAS) is a clinical scale

used to assess muscle spasticity- (0 1 1+ 2 3 4)

5 point scale using PROM to evaluate resistance to movement. It has poor interrater reliability

Question 4

Deep Tendon Reflexes

Answer 4

Graded on a 0-5+ system.

0=Absent, no response

1+= Slight Reflex, present but depressed, low normal

2+= Normal, typical reflex

3+= Hyperreflexia. Brisk Reflex, possibly but not necessarily abnormal

4+= Strong muscle contraction with 1 to 3 beats of clonus. Reflex spread to contralateral side may be noted

5+= Strong muscle contraction with sustained clonus. Reflex spread to contralateral side may be noted.

Question 5

ASIA Scale Sensory Level

Answer 5

Sensory Level- Test for Light Touch Sensation and Pinprick

Sensory Grading 0 = Absent 1 = Altered, either decreased/impaired sensation or hypersensitivity 2 = Normal NT = Not testable

*Find the LOWEST LEVEL with intact light touch and pinprick bilaterally

Question 6

ASIA Scale Motor Level

Answer 6

Lowest level of anti-gravity strength 3/5 or greater bilaterally. HAS to have 5/5 strength above the level and motor sensation.

0 = total paralysis

1 = palpable or visible contraction

2 = active movement, full range of motion (ROM) with gravity eliminated

3 = active movement, full ROM against gravity

4 = active movement, full ROM against gravity and moderate resistance in a muscle specific position

5 = (normal) active movement, full ROM against gravity and full resistance in a functional muscle position expected from an otherwise unimpaired person

5* = (normal) active movement, full ROM against gravity and sufficient resistance to be considered normal if identified inhibiting factors (i.e. pain, disuse) were not present

NT = not testable (i.e. due to immobilization, severe pain such that the patient cannot be graded, amputation of limb, or contracture of > 50% of the normal ROM)

Question 8

ASIA Scale Neurological Level of Injury

Answer 8

Lowest level intact sensation- with 2/2 bilateral sensation and 3/5 bilaterally.

Question 9

ASIA Scale Zone of Partial Preservation

Answer 9

Lowest Level with at least 1/2 on sensory OR* >0 on muscle testing. This is typically given as 1 level.

THIS ONLY REFERS TO PATIENTS WITH A COMPLETE INJURY

Question 10

ASIA Scale Complete (a)

Answer 10

Complete injury means there is NO Anal Contraction, Sensation, or Deep Pressure at S4-S5

Question 11

ASIA B Sensory Incomplete

Answer 11

Sensory preserved below level, but no motor more than 3 levels below injury

Question 12

ASIA C Motor Incomplete

Answer 12

Less than half muscles below have 3/5 grade. ALSO there is some sparing of motor function MORE than 3 levels below the NLI.

Question 13

ASIA D Motor Incomplete

Answer 13

Half or more muscles below having >3/5 MMT. ALSO there is some sparing of motor function LESS than 3 levels below the NLI.

Question 14

ASIA E

Answer 14

Normal

Question 15

APGAR Score

Answer 15

Appearance

Pulse

Grimace

Activity

Respiratory

2 points of each possible. Typically checked at 1 minute and 5 minutes after birth.

Question 16

APGAR Score Scale

Answer 16

Score 7-10: no interventions, baby doing good, just needs routine post-delivery care
Score 4-6: some resuscitation assistance required. Oxygen, suction, stimulate the baby, rub baby’s back
Score 0-3: need full resuscitation

Appearance, Pulse, Grimace, Activity, Respiration

Question 17

Monofilament Testing

Answer 17

Those who should be tested are those who may recieve LE compression treatments, and those who have a diagnosis of peripheral neuropathy, diabetes, and/or arterial disease.

PROTECTIVE SENSATION=Semmes-Weinstein Monofilaments

HOW TO: Monofilament is applied to skin until it bends. Patient then reports when they feel the monofilament.

NORMAL SENSATION is 4.17 monofilament (1 g of force)

PROTECTIVE SENSATION is 5.07 monofilament (10 g of force)

Without protective sensation, the individual cannot sense trauma to the foot, which leads to foot ulcers. Special footwear is indicated.

Question 18

Glasgow Coma Scale

Answer 18

1- Eye opening (4)

2- Verbal Response (5)

3- Movement (6)

So the total is 15 (Max) and minimum is 3

Mild- 13-15 Moderate- 9-12 Severe- <9

Question 19

Ranchos Los Amigos Levels

Answer 19

Level 1: No Response • Level 2: Generalized Response • Level 3: Localized Response • Level 4: Confused + Agitated • Level 5: Confused + Inappropriate • Level 6: Confused + Appropriate • Level 7: Automatic + Appropriate • Level 8: Automatic + Purposeful

Question 20

Goals of Early Intervention if RLA Level 1-3

Answer 20

• Increase arousal • Prevent complications/impairments • Improve function • Educate patient/family regarding the injury

Question 21

Goals with Level 1 RLA-No response

Answer 21

Patient appears to be in a deep sleep and is completely unresponsive to any stimuli. • Intracranial Pressure • 5 – 15 mmHg is considered normal • Increased Intracranial Pressure (>20) • Avoid cervical Flexion • Avoid vibration/percussion • Avoid coughing • Avoid head down positions

Question 22

Goals Level 2 RLA

Answer 22

Patient reacts inconsistently and non- purposefully to stimuli in a nonspecific manner. Same old response • Positioning is key to prevent secondary complications • Goal should be try and reduce tone by positioning out of synergy such as putting them in- Semiprone & Sidelying

*Decorticate and decerebrate tone

*Position change every 2 hours to prevent skin breakdown and pneumonia

Question 23

Goals Level 3 RLA

Answer 23

Patient reacts specifically but inconsistently to stimuli. May follow simple commands but inconsistently and delayed • Positioning is still a key intervention • Range of motion activities • Passive ROM or even AAROM if applicable • Static stretching • Air cast/splint • Serial Casting

Also need to apply:

Upright sitting at edge of bed which Assists with BP regulation • Positional tolerance • Prevents secondary complication • Progresses function in preparation for standing

Question 24

For the above responses, apply tone-inhibiting techniques

Answer 24

Slow rhythmic rotation • Work proximal musculature/joints first! • Approximation & weight-bearing through extremity • Prolonged ice application • Static stretch with pressure to the tendon or muscle belly • Air splints (38 - 40 mmHg)

Question 25

Goals of Level 4 RLA

Answer 25

• Patient is in a heightened state of activity •Bizarre & non-purposeful behaviors •Unable to cooperate with treatment
• Overstimulation is a major problem at this stage •One person should interact at a time •Dim lights •Reduce noise level
• Patient will have difficulty with short term & long term recall •Unable to learn new information • Memory book or calendar use • Consistency is key • Provide structure (same therapist, time, place) • Scripts and daily routine
• Flexibility and control • Must come with numerous activities that could be performed •Give control to the patient when it’s safe & appropriate • Give options like, “Would you like to walk” or “Would you like to sit on the ball”
• Behavioral Interventions •Positive reinforcement • Provide rewards or praise when an appropriate response is exhibited •Ignoring times when inappropriate behavior is exhibited (Within reason) •Redirection

Question 26

With an overstimulated patient…

Answer 26

• Remove stimulus • Decrease the demands of the activity • Redirect the patient to another task • Remove the patient from the area • Continue to offer emotional support • After a crisis, patient should be allowed to rest

Question 27

Which of the following is the best course of action if a patient is confused and agitated…

Answer 27

Attempt to calm the patient by reducing extraneous stimuli

Question 29

Goals of Level 5 RLA

Answer 29

• Responds to simple commands fairly consistently but is unable to complete complex commands •Highly distractible and still unable to learn new information • Able to converse for short periods but verbalization is often inappropriate and confabulatory
• Memory book or calendar use is important to help show progress •Don’t expect much carry-over • Focus on improving awareness, orientation, mobility, and previous learned tasks with structure

Question 30

Heterotropic Ossification

Answer 30

• When bone is deposited into soft tissues including muscle or tendon which restricts joint range of motion • Common post TBI with patient’s who have been immobilized. • Patient usually develops: • Palpable mass • Tenderness • Warmth • Limitation in ROM
• Most commonly found at the hip, knees, shoulders, or elbows •Develops as a reactive hyperemia to the location of bone deposition and progresses rapidly over 4-6 weeks

Radiographs can visualize this condition in 4-6 weeks but bone scans can visualize at 2-4 weeks • The PT responsibility to contact the physician immediately and perform basic mobility training if cleared.

Question 31

Goals of Level 6 RLA

Answer 31

Confused and appropriate:

•Demonstration of goal-directed behaviors but requires cueing •Able to relearn and retain (carryover) •Continues to have memory deficits but able to recall more in detail

Question 32

Motor Learning for Patients with TBI

Answer 32

• Motor learning principles are a huge part of progressing your patient. •Understanding what stage of learning the patient is currently in • Extrinsic feedback is beneficial in the early stages to assist the patient in activity performance
• Practice should be distributed with ample rest • Blocked and serial practice are good initially but randomized practice is superior for retention • Extrinsic feedback should be provided initially as opposed to intrinsic feedback

Question 33

What is Constraint-Induced Movement Therapy?

Answer 33

Used primarily for patients who have had a stroke. When one UE is impaired significantly and the patient is not using it appropriately • Patient is forced to use affected extremity in task oriented training for 6 hours/day for 2-3 weeks

Question 34

BWSTT (Body-Weight Supported Treadmill Training)

Answer 34

Good for patients who are overweight, high risk for falls, or difficulty weight-bearing. Over-ground training is JUST AS EFFECTIVE

Question 35

Goals of Level 7 RLA

Answer 35

Automatic and Appropriate-

Minimal to no confusion • Alert, Oriented, Automatically follows daily routines • Learns but at a decreased rate •Judgment remains impaired

Frequency • 2-3x per week (strength) • 3-5x Alternate days (endurance) • Intensity • 60 – 90% Max HR (aerobic) • 70 - 80% 1RM (strength) • Type • Aerobic & Strength Training • Time (Duration) • 5 – 10 minutes with progression to 20 – 40 minutes

Question 36

Goals of Level 8 RLA

Answer 36

Purposeful and Appropriate:

Significant return to premorbid levels, but may have slow processing and impaired judgement.

Question 37

Uthoff’s Sign

Answer 37

Uhthoff’s phenomenon is the worsening of neurologic symptoms in multiple sclerosis and other demyelinating diseases when the body is overheated. This may occur due to hot weather, exercise, fever, saunas, hot tubs, hot baths, and hot food and drink

Question 38

MOST APPROPRIATE NEXT STEP for spastic diplegia is…

Answer 38

Serial casting. Then botox.