Neurologic Impairments Flashcards
1
Q
Decorticate Rigidity/Posturing
A
- Upper extremities are in spastic FLEXED position with internal rotation and adduction.
- Lower extremities are in spastic EXTENDED position, with internal rotation and addiction.
- Typical of damage to cerebral hemispheres.
2
Q
Decerebrate Rigidity/Posturing
A
- Upper AND lower extremeties are in spastic EXTENSION, with internal rotation and adduction.
- Wrists and fingers flex, plantar portions of the feet flex and invert, the trunk extends, and the head retracts.
- Typical of damage to the midbrain and/or brainstem.
3
Q
Ataxia
A
- Abnormal movement resulting from cerebellum damage
- Impaired muscle coordination
- Interventions focus on compensatory strategies for control, including weighting of body parts or use of weighted utensils or cups
4
Q
Apraxia
A
- Inability to plan and perform purposeful movements
- May be treated with hand-over-hand exercise to repair damaged neural pathways.
- Client may also compensate by following steps depicted in pictures or written on a card.
5
Q
Coma
A
- Severe disorder of consciousness
- Absence of responses to environmental stimuli
- No evidence of sleep-wake cycles
- No intentional movement
- Eyes do not open to stimuli or spontaneously
6
Q
Vegetative State
A
- Onset within 1 month of TBI
- No awareness or ability to interact with self or environment
- No sustained, reproducible, voluntary, or behavioral responses to sensory stimuli
- No apparent receptive language comprehension or verbal expression
- Sleep-wake cycles of variable length
- Ability to self-regulate temperature, breathing, and circulation for survival
- Incontinence of bowel and bladder
- Variable and unpredictable preserved cranial nerve and spinal reflexes
- Condition of past and continuing disability with uncertain future
- Persistent Vegetative State = exceedingly small chance of client regaining consciousness before death
7
Q
Minimally Conscious State
A
- Definite behavioral evidence of awareness of self, environment, or both
- Discernible, reproducible behavior in one or more of the following areas: following commands, gestural or verbal yes/no responses, intelligible verbalizations, purposeful movements.
8
Q
Glasgow Coma Scale
A
- Traditional method to assess levels of consciousness
- Quantifies the severity of TBI and predicts outcome
- Scores range from 3 to 15:
Severe = 3 to 8
Moderate = 9 to 12
Mild = 13 to 15 - Assess three behavioral areas (eye opening, verbal responses, & motor responses)
9
Q
Rancho Los Amigos Scale of Cognitive Functioning
A
- Descriptive measurement of awareness and cognitive function after traumatic injury
- Scored from Level I to Level X
10
Q
RLA - Level I
A
- No response
- Is completely unresponsive to any stimuli presented
11
Q
RLA - Level II
A
- Generalized response
- Exhibits inconsistent and non-purposeful reactions to stimuli
12
Q
RLA - Level III
A
- Localized response
- Reacts specifically to stimuli, though inconsistently
13
Q
RLA - Level IV
A
- Confused & agitated response
- Has heightened state of activity with severely decreased ability to process information
14
Q
RLA - Level V
A
- Confused, inappropriate & non-agitated response
- Appears alert with fairly consistent reactions, although increased complexity of commands causes more random responses
15
Q
RLA - Level VI
A
- Confused & appropriate response
- Exhibits goal-directed behavior but is dependent on external input for direction
16
Q
RLA - Level VII
A
- Automatic, appropriate responses
- Behaves appropriately and is oriented to place and routine, but frequently displays shallow recall
17
Q
RLA - Level VIII to X
A
- Purposeful and appropriate responses
- Is alert and oriented
- Able to recall and integrate past and recent events
- Each level represents a decreasing need for assistance with routine daily living skills:
VIII = Stand-by assistance (SBA)
IX = SBA on request
X = Modified Independence (Mod I)
18
Q
Acute Phase of TBI
A
- Initial interventions for severe disorders of consciousness occur in the intensive care and acute care units of hospitals.
- Interventions involve both preventive and restorative approaches.
19
Q
Interventions for Acute Phase of TBI
A
- Wheelchair positioning
- Bed positioning
- PROM (to prevent development of secondary impairments)
- Splinting and casting (if spasticity interferes with functional movement AND/OR soft-tissue contractures are possible)
- Sensory stimulation
- Management of agitation (e.g., behavior management strategies to avoid reinforcing inappropriate behaviors while allowing medically necessary treatments to occur)
- Family and caregiver education (so can assist with sensory regulation, positioning, & ROM needs)
21
Q
Inpatient Rehabilitation Phase of TBI
A
- Inpatient rehabilitation settings for TBI provide intensive rehabilitation for clients who are able to demonstrate stimulus-specific responses.
- Clients in inpatient rehabilitation are generally at Rancho Level V or higher.
21
Q
Interventions for Inpatient Rehabilitation Phase of TBI
A
- Optimize motor function (with focus on motor learning, skill acquisition& exercise, through occupation-based activities)
- Optimize visual abilities (e.g., through environmental adaptation, vision correction, & intro of compensatory strategies such as contrasting colors)
- Optimize visual-perceptual function including compensatory and rehabilitative strategies (e.g., Neglect may be treated by encouraging use of neglected side during functional activities, and environmental modifications)
- Optimize cognitive function (emphasis is on self-awareness of deficits, attention, memory and executive function through functional activities)
- Optimize voice and speech function (e.g., conversation exercises for aphasia and compensation with communication devices or pictures if gains not made)
- Restore competence in self-maintenance tasks including: dysphagia & feeding, bed mobility, wheelchair management, functional ambulation, community mobility, transfers, home management, & community reintegration
- Contribute to behavioral & emotional adaptation (focus on decreasing or mediating problem behaviors utilizing both environmental & interactive interventions)
- Support family caregivers
22
Q
Post-acute Rehabilitation Phase of TBI
A
- As clients prepare to reenter the community, rehabilitation transitions from an inpatient setting to one of a variety of post-acute rehabilitation settings
- Possibilities include: home-based therapy, a residential program, a day treatment program, or an outpatient community reentry program
- Client’s family often need to provide long-term assistance depending on the severity of the TBI
23
Q
Interventions for Post-acute Rehabilitation Phase of TBI
A
- Optimize cognitive function (focus on residual cognitive deficits such as memory problems & executive function deficits)
- Optimize visual and visual-perceptual function (focus on environmental adaptations & compensatory strategies)
- Restore competence in self-maintenance roles (continued focus on skills not fully acquire in inpatient rehab; emphasis on behavioral intervention with repetitive practice through errorless leaning, fading cues, and positive encouragement; homemaking tasks addressed first, then money management, shopping skills, & community mobility)
- Restore competence in leisure and social participation (e.g., social skills groups using behavior contracts, role-playing, self-reflection thru video-feedback, and role modeling)
- Restore competence in work once client is competent in self-maintenance (includes skill development for work-appropriate behaviors, and vocational rehabilitation)
- Contribute to behavioral and emotional adaptation (focus on increasing self-awareness and coping skills)
24
Q
Spinal Shock
A
- Initial stages of SCI
- May last between 24 hours and 6 weeks
- Can result in the absence of reflexes below the level of injury
- If the injury results in paralysis and reflex activity ceases, spasticity can result
25
Q
Functional ability in SCI - Level C1 to C4
A
- Respiratory assistance REQUIRED
- Total assistance for personal and domestic care
- Limited head and neck movement; tetraplegia
- SNS compromised (autonomic dysreflexia possible)
- No bowel or bladder control
- Mobility with power wheelchair with sip and puff possible
26
Q
Functional ability in SCI - Level C5
A
- Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
- Total assistance for personal and domestic care
- Full head and neck movement; able to raise arms and flex elbows (** Arms should be positioned with elbows extended and forearms in supination to prevent contractures **)
- SNS compromised (autonomic dysreflexia possible)
- No bowel or bladder control
- Mobility with power wheelchair with hand controls possible
27
Q
Functional ability in SCI - Level C6
A
- Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
- Moderate assistance for personal care
- Total assistance for domestic care
- Full head and neck movement; able to raise arms and flex elbows; some wrist extension (tenodesis)
- SNS compromised (autonomic dysreflexia possible)
- Little bowel or bladder control
- Mobility with power wheelchair with hand controls; manual wheelchair for short distances; may drive a vehicle with hand controls
28
Q
Functional ability in SCI - Level C7
A
- Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
- Limited assistance for personal care
- Partial assistance for heavy-duty domestic care
- Full head and neck movement; able to raise arms; flex and EXTEND elbows; wrist flexion and extension; partial finger movement
- SNS compromised (autonomic dysreflexia possible)
- Little bowel or bladder control
- Independent transfers
- Mobility with power wheelchair with hand controls; manual wheelchair for short distances; may drive a vehicle with hand controls
29
Q
Functional ability in SCI - Level C8
A
- Respiratory assistance NOT required (low stamina, but breathing with diaphragm)
- Primarily independent in personal care
- Partial assistance for heavy-duty domestic care
- Full head and neck movement; able to raise arms; flex and extend elbows; wrist flexion and extension; finger flexion
- SNS compromised (autonomic dysreflexia possible)
- Little bowel or bladder control
- Independent transfers
- Mobility with power wheelchair with hand controls; manual wheelchair for short distances; may drive a vehicle with hand controls
30
Q
Functional ability in SCI - Level T1 to T5
A
- Respiratory capacity and endurance may be compromised
- Independent in personal care
- Partial assistance for heavy-duty domestic care
- SNS compromised (autonomic dysreflexia possible)
- Normal upper-extremity ROM and strength
- Little bowel or bladder control
- Independent transfers
- Mobility with manual wheelchair; may drive a vehicle with hand controls
31
Q
Functional ability in SCI - Level T6 to T12
A
- Respiratory capacity and endurance may be compromised
- Independent in personal care
- Partial assistance for heavy-duty domestic care
- NOT at risk for autonomic dysreflexia below T6
- Normal upper-extremity ROM and strength
- Little bowel or bladder control
- Independent transfers
- Mobility may be with manual wheelchair or may stand in standing frame or walk with braces; may drive a vehicle with hand controls
32
Q
Functional ability in SCI - Level L1 to L5
A
- Normal respiratory system
- Independent in personal care
- Partial assistance for heavy-duty domestic care
- NOT at risk for autonomic dysreflexia below T6
- Normal upper-extremity ROM and strength; only partial paralysis in hips and legs
- Little bowel or bladder control
- Independent transfers
- Mobility may be with manual wheelchair or walk with braces; may drive a vehicle with hand controls
33
Q
Functional ability in SCI - Level S1 to S5
A
- Normal respiratory system
- Independent in personal care
- Partial assistance for heavy-duty domestic care
- NOT at risk for autonomic dysreflexia below T6
- Normal upper-extremity ROM and strength; only some loss of function in hips and legs
- Little bowel or bladder control
- Independent transfers
- Likely able to walk with assistance or aids, though slowly and with difficulty; may drive a vehicle with hand controls and load wheelchair into car independently
34
Q
Impairments in SCI
A
- Sensory loss (also leads to high risk of skin breakdown and decubitus ulcers)
- Decreased vital capacity (breathing difficulty)
- Risk of orthostatic hypotension
- Risk of autonomic dysreflexia (for SCI at T6 level and higher)
- Spasticity (can also lead to contractures without proper positioning)
- Risk of heterotopic ossification (can also be controlled through proper positioning and monitoring/maintaining ROM)
- Risk of deep vein thrombosis (warning signs include asymmetrical lower-extremity color, size and/or temperature)
- Bowel and bladder dysfunction (affected at all levels at and above S2-S5)
- Difficulties with temperature regulation
- Pain (Nociceptive = due to damage to body tissues, such as with muscle overuse; Neuropathic = nerve pain/damage)
- Fatigue
- Sexual function (SCI does NOT alter a person’s sex drive or need for intimacy; however, problems may arise from mobility and impact of functional dependence, altered body image, and other medical conditions/complications)
35
Q
SCI - Acute Recovery Phase (or Acute Phase)
A
Involves short OT sessions limited to 15 minutes and often in the ICU. Focus of intervention is on:
- Client & family support & education
- Allowing environmental control for client (e.g., call button, bed controls)
- Maintaining normal UE ROM and positioning (including splinting if needed)
- Facilitating tenodesis grasp, if appropriate
- Ongoing evaluation of ability to sit upright and begin ADL training
- Evaluation of client’s swallowing ability if needed depending on level of injury
36
Q
SCI - Acute Rehabilitation Phase (or Active Phase of Intervention)
A
Includes providing education and support, and helping the client find meaningful activities that restore a sense of self-efficacy and self-esteem. Focus of interventions is on:
- Continuous education throughout intervention sessions (e.g., on SCI impairments, & pressure ulcer awareness/reduction)
- Caregiver training in ROM, positioning, pressure relief, ADL assistance, equipment use, and SCI impairments (essential for successful discharge)
- Occupational performance interventions to train basic ADLs to level of desired functional independence
- Selection of and training in use of necessary equipment for ADL & IADL performance
- Physical interventions as needed depending on level of injury (i.e., mobile arm supports for C5; tenodesis splint for C6 & C7, etc.)
- Psychosocial adaptation also most prominent in this stage, with focus on developing positive coping skills, problem-solving, making care decisions, being involved in meaningful activities, and group learning.
37
Q
SCI - Transition Rehabilitation Phase
A
- May involve outpatient OT services if the client has been unable to achieve optimal outcomes in acute rehab phase
- Focus of interventions is to maximize strength gains in the first year post-injury, as well as continued training in the use of adaptative devices and equipment, as needed
- Access to support groups and interventions that enhance community integration should also be a focus
38
Q
Ideational Apraxia
A
- Characterized by the loss of ability to conceptualize and plan a SEQUENCE of motor actions
- Breakdown in the knowledge (IDEA) of what is to be done and how to perform specific activities.
- Also, sometimes used interchangeably with term “conceptual apraxia” which describes the loss of the ability to perceive an object’s intended purpose, so client uses tool incorrectly
39
Q
Ideomotor Apraxia
A
- Inability to execute a MOTOR action on demand/request or imitation
- Can conceptualize the action cognitively, so can often execute spontaneous actions such as gestures and one-step tasks (i.e., waving goodbye, brushing hair)
- Intervention focuses on breaking down tasks into separate components to teach and master each individually; requires repetition
40
Q
Dressing Apraxia
A
- Inability to motor plan how to dress UE and/or LE
41
Q
Constructional Disorder/Apraxia
A
- Inability to recognize or assemble parts into a whole
42
Q
Aphasia
A
Neurological language disorder
43
Q
Global Aphasia
A
Loss of all language ability
44
Q
Broca’s Aphasia
A
- Broken speech
- Slow, labored speech with frequent mispronunciations
- Broca’s Area is located in the FRONTAL LOBE of the dominant hemisphere (usually the LEFT) and controls speech production
45
Q
Wernicke’s Aphasia
A
- Aka receptive aphasia
- Impaired auditory reception
- Speech may be be fluent but is often meaningless or nonsensical
- Wernicke’s Area is located in the TEMPORAL lobe of the dominant hemisphere (usually the LEFT) and controls receptive language and language comprehension.
46
Q
Anomic Aphasia
A
Difficulty finding words
47
Q
Dysarthria
A
Articulation disorder resulting from paralysis of the organs of speech
48
Q
Visual Agnosia
A
Difficulty recognizing objects
49
Q
CVA Impairments & Functional Limitations
A
- Motor dysfunction (contralateral hemiplegia or hemiparesis)
- Impairment in trunk & postural control
- Impairment in standing activity that affects weight bearing & weight shifting, etc.
- Possible communication impairment (may include speech production or reception or both)
- Cognitive and perceptual impairment
- Upper-extremity impairment (Note: Subluxation in the glenohumeral joint is a particular concern!)
- Visual impairments possible depending on site of lesion (including visual field deficits such as homonymous heminopsia and hemi-inattention or neglect)
- Risk of depression and other psychological issues (including anxiety, mania, emotional lability, and personality changes)
50
Q
Learning new skills - Transfer
A
- The ability to take a strategy used with one task and apply that strategy to a new task.
- Example: A client with a CVA is taught to dress the weaker side first when donning a button-down shirt. The client then initiates putting the weaker lower extremity into the pant leg first. The client is demonstrating transfer, by using the strategy for donning a shirt and transferring it to donning pants.
51
Q
Learning new skills - Generalization
A
- Generalization occurs when clients transfer a skill learned in one context to another context.
- Example: A client dresses themselves at home in the same way they did in their hospital room.
52
Q
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