Neuro Scales Flashcards
Modified Ashworth Scale
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
Deep Tendon Reflexes
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.
ASIA Scale Sensory Level
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
ASIA Scale Motor Level
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)
ASIA Scale Neurological Level of Injury
Lowest level intact sensation- with 2/2 bilateral sensation and 3/5 bilaterally.
ASIA Scale Zone of Partial Preservation
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
ASIA Scale Complete (a)
Complete injury means there is NO Anal Contraction, Sensation, or Deep Pressure at S4-S5
ASIA B Sensory Incomplete
Sensory preserved below level, but no motor more than 3 levels below injury
ASIA C Motor Incomplete
Less than half muscles below have 3/5 grade. ALSO there is some sparing of motor function MORE than 3 levels below the NLI.
ASIA D Motor Incomplete
Half or more muscles below having >3/5 MMT. ALSO there is some sparing of motor function LESS than 3 levels below the NLI.
ASIA E
Normal
APGAR Score
Appearance
Pulse
Grimace
Activity
Respiratory
2 points of each possible. Typically checked at 1 minute and 5 minutes after birth.
APGAR Score Scale
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
Monofilament Testing
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.
Glasgow Coma Scale
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
Ranchos Los Amigos Levels
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
Goals of Early Intervention if RLA Level 1-3
• Increase arousal • Prevent complications/impairments • Improve function • Educate patient/family regarding the injury
Goals with Level 1 RLA-No response
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
Goals Level 2 RLA
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
Goals Level 3 RLA
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
For the above responses, apply tone-inhibiting techniques
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)
Goals of Level 4 RLA
- 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
With an overstimulated patient…
• 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
Which of the following is the best course of action if a patient is confused and agitated…
Attempt to calm the patient by reducing extraneous stimuli
Goals of Level 5 RLA
- 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
Heterotropic Ossification
- 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.
Goals of Level 6 RLA
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
Motor Learning for Patients with TBI
- 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
What is Constraint-Induced Movement Therapy?
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
BWSTT (Body-Weight Supported Treadmill Training)
Good for patients who are overweight, high risk for falls, or difficulty weight-bearing. Over-ground training is JUST AS EFFECTIVE
Goals of Level 7 RLA
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
Goals of Level 8 RLA
Purposeful and Appropriate:
Significant return to premorbid levels, but may have slow processing and impaired judgement.
Uthoff’s Sign
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
MOST APPROPRIATE NEXT STEP for spastic diplegia is…
Serial casting. Then botox.
