Neurological Conditions Flashcards
Human brain
Cerebrum
Diencephalon
Brainstem
Cerebellum
Brainstemo
Midbrain (ANS), pons, medulla oblongata
Hypothalamus
Homeostasis
Cerebral cortex
80% of brain
Front lobe-executive function, emotional control
Parietal lobe-sensation
Occipital lobe- vision
Temporal lobe-language, hearing
Fissures/sulci
Medial longitudinal fissure: separates hemispheres
Central sylvia fissure: b/n parietal/frontal and temporal
Sulcus: b/n frontal/parietal lobe
Postcentral gyrus in frontal lobe/ primary motor area
Frontal lobe
Personality, behavior, emotion, judgment, planning, problem-solving, Broca’s area (expressive speech), writing, motor strip (movement), intelligence, self awareness, concentration, STM, motor planning
Parietal lobe
Interprets language, words, sense of touch, pain (sensory strip), interprets signal from vision, hearing, motor, and sensory, memory, visuospatial perception (primary sense area)
Occipital lobe
Interprets vision, visual stimuli from optic pathways
Temporal lobe
long term memory, hearing, understanding language (wernicke’s area, receptive), sequencing/organization
Limbic lobe
Emotion and autonomic system
Insula lobe
Gustation, taste, visceral organ sensation, empathy, and self aaare essential
Hypothalamus
Autonomic system, controls hunger, sleep, thirst, secretion of hormones, and sexual response
Pituitary gland
Master gland, endocrine system
Pineal gland
Internal clock, circadian rhythms some role in sexual development
Thalamus
Relay station for all info, plays a role in pain, attention, alertness, memory
Basal ganglia
Caudate and putament glubos, pallidus
Emotional reaction and memory
L hemisphere
Communication, Broca’s/Wernicke’s area
R hemisphere
Attention, concentration, memory, problem solving
Unilateral in attention R parietal
Cerebral arteries
Anterior cerebral artery: medial air face if frontal/parietal lobee
middle Cerebral artery: lateral surface of frontal/parietal lobe, superior temporal, Deep internal capsule and basal nuclei
Posterior Cerebral Artery
Inferior temporal lobe and occipital lobe
Cranial nerves in brainstem
Most originate in brainstem
Midbrain: Oculomotor CN3, Trochlear CN4, trigeminal CN5
Pons: abducen CN6, facial CN7
Medulla oblongata: vagus cn10, hypoglossal CN 12
Cranial nerves
1)olfactory: smell
2) optic: vision
3)oculomotor: eye movement/pupil
4) trochlear: eye movement
5) trigeminal: somatosensory of face, muscles for chewing
6) abducens: eye movement
7) facial: taste of anterior 2/3 of tongue, somatosensory from ear muscles for facial expressions
8)vestibulocochlear: hearing/balance
9) glossopharyngeal: taste of posterior 2/3 of tongue, tonsil, tongue, pharynx, controls some muscle in swallowing
10)vagus: glands, digestion, HR, autonomic
11) spinal accessory nerve: muscles in head movement
12) hypoglossal: muscle of tongues
Cerebellum
Inferior to cerebrum, posterior to brainstem, superior/inferior cerebral peduncles carry fibers from major spinal tracts cerebrum to spinal cord
Pons
Relay center between spinal cord, cerebrum, cerebellum
Midbrain
Autonomic nervous system, reflexive vision, hearing, motor control, level of alertness, body temp control, sleep/wake cycles
Medulla
Sends motor messages from cerebrum to spinal cord, heart rate, BO, rate of breathing, vomiting, coughing, swallowing, sneezinf
Spinal cord anatomt
Begins at foramen magnum, conus medullaris
Ascending tracts (sensory), dorsal horn
Descending tracts (motor), ventral horn
31 pairs of spinal nerve: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, coccygeal
Cervical= hand
Thoracic= hand, abdominal, chest muscles
Lumbar=ankle, hip, knee
Sacral= bowel, bladder, reproductive organs
Age-related neurological changes
Decrease processing soeed
Difficulty attending to more than 1 stimuli, alternating/divided attention
Decreased working memory depended on cog load
Procedural memory increase, difficulty using new method with familiar task
Increase difficulty with age conscious awareness of environment
Less efficient problem solving
Decreased fluid increased crystalized
Long term memory
Declarative and procedural memory
Declarative memory
Verbal based memory
Episodic: memory of every day events (better in young age)
Semantic: long term of words, #s, concepts (better in older age)
Procedural memory
Nonverbal memory, how to do a task, stores information regarding motor skills and behaviors
Prospective memory
Decreased external cues increase complex cognitive process = difficulty with age
Remembering future appointments and planned actions
Working memory
Rehearsal occurs and info is manipulated for saving in LTM
Fluid intelligence vs crystallized
Fluid = Abstract concepts
Crystallized = general knowledfe
Working memory strategies
Organizing/repeating stimuli in STM to transfer to LTM, increased age =increased difficulty with tasks with increased cognitive load
Make checklist/note talking, be aware of pt’s capacity
Procedural memory strategies
More difficult to access with increased cognitive load, such as finding way to MDs office
Decrease cognitive load such as using a navigation system
Prospective memory strategies
Reminders such as calendars, recordings, or 2nd person to remind
Executive functioning strategies
Increase time
CVA
Interruption of blood flow to the brain, impacting brain function
Ischemic: obstructed blood vessel secondary to embolism, thrombus, dissection
Hemorrhagic: bleed into the brain from ruptured blood vessel, ICH in brain/SAH around brain
TIA
Resembles stroke with symptoms no longer than 24 hours
Embolic stroke
Type of ischemic stroke, abrupt onset from embolism forming in a cardiac region or other arterial sources outside the brain
L brain lesion impairmenrs
R side paralysis
Speech and language
Slow/cautious behavioral style
Memory loss
R brain lesion impairment
L side paralysis
Vision impacted
Memory loss
Quick inquisitive behavioral
Style
Anosognosia
Denial/unaware of neurological deficits
Agraphia/dysgraphia
Inability/impaired ability to write
Acalculia/dyscalculia
Inability/impaired ability to perform simple math before stroke dx
Apraxia
Inability/impaired ability to perform skilled movements as desired
Dysarthria
Speech disorder from weakness, paralysis, or incoordination of muscles involved in sound production of speech
Aphasia
Language disorder that results from damage to language center of brain
Expressive
Receptive
Global
Broca injury
Labored speech/problems initiating speech, nonfluent/expressive aphasia
Increased time to speak and periods of silence
MCA
Often pairs with R paralysis
Wernicke’s aphasia
Receptive aphasia, fluent aphasia, do not typically present with R paralysis
May show visual deficits, difficulty comprehending spoken language
use gestures and familiar words, face individual, speak at a slower cadence, context
Contralateral homonymous hemianopsia
Ocular condition where vision is lost in the same field halves if both eyes to the ocular nerve lathway
Neglect spatial inattention
Result of damage to R side of brain
Eye movement disorder
Occurs due to nerves/muscles that become damaged resulting in nystagmus, strabismus, diplopia, oculomotor dysfunction
Assessing chronic stroke
COPM
Fugl-Meyer Assessment of Motor Recovery FMA
Modified Ashworth Scale MMAs
Fugl-Meyer Assessment of Motor Recovery FMA
Based on brunnstrom recovery levels, UE/LE section, completion of both more than 1 hour point scale
Severity of limb impairment
Modified Ashworth Scale
Removes 1+ grade and modified grade 2 from original scale, marked increased tone by catch in middle range and resistance in remainder of ROM, but easily moved
Managing spasticity
Strong evidence for dry needling to reducing spasticity and increasing ROM
Low level evidence for static/dynamic splinting in UE
No evidence for manual stretching in UE, moderate evidence for splinting/stretching in the hand
Motor retraining:NMES
No effect of motor ability, positive effect for improved ADLs
CIMT
Time consuming, 90 minute protocol, increased use of limb during ADLs
Mirror Therapy
Effective in acute/chronic strategies
Moderate evidence for increased motor/sensation, 1-8 weeks home MT improved arm/hand function, 6 week, 2days OT/30 min home MT
X5 days, unilateral training more official
Occupational therapy task-oriented approach OT-TOA
Function based for persons with a stroke based on motor behavior/motor learning/control/concepts, top down approach, focuses of roles/occupational performance
Practice in natural environment beyond sessions leads to increased paretic UE use, performance, and satisfaction
Task specific training
Use affected UE to complete various tasks for brain to relearn skill
Visual intervention
Visual scanning activities
Balance technique
Spatial awareness
Prisms: change perception by changing direction of light, relaxation, breathing techniques
Pt/ caregiver education as neuro intervention
Moderate to strong evidence for effectiveness
Caregiver experiences negative emotion, employment, finance and physical health=strong evident for CBT and problem solving
Moderate for multimodal ADL training, counseling, community resources, education, and relaxation techniques
Moderate evidence for in hime training and remote training
Inpatient visit strong evidence
Neuro intervention: community reintegration
Return to participation in desired meaningful IADLs, life roles, and community interests, community based care programs
Leisure in neurological conditions
Complicated by types of activities available, individual, stage of life, social/cultural environments, leisure role, satisfaction and use of time
Attend and treat use of time to avoid social isolation
Leisure evaluation
Checklist questinnaires
MOHost
Modified interest checklist
Activity card sort-ID new and existing leisure tasks
Nottingham leisure Questionnaire stroke poo
Leisure intervention
Time management training to incorporate leisure, increased leisure awareness, identify barriers, adapt/modify task
CVA Discharge considerations
Goals setting/flexibility to respond to evolving needs
Includes reintegration, recovery, treatment, adaptation, and end of life care
Transition management goal to facilitate and support seamless movement across continuum
Supported living environment
Discharge disposition: impacts function and mortality, admission to IRF within 90 days of CVA increases mobility and decreases risk of readmission vs d/c home
ABI Acquired Brain Injury
Damage to brain may be traumatic or nontraumatic
Non traumatic ABI: tumor, anoxia, nutritional deficiency, falls, stroke, environmental causes
TBI traumatic brain injury
Caused by falls in higher income countries and traffic incidences in lower income countries
Cognitive reserve is important in managing intervention and discharge recommendations
Younger age increase TBI IQ for better cognition, increase mortality with age
Classification of ABI
4 factors: GCS, time of LOC, presences of post traumatic amnesia and result of neuro imaging
Mild TBI
GCS 13-15
Less than 30 min to 1 hour LOC
Less than 5 min if amnesia
Normal imaging
Moderate TBI
GCS 9-12
Greater than 30 to 24 hour and 6 hours LOC
1-24 hour amnesia
Normal/abnormal imaging
Severe TBI
GCS 3-8
Greater than 24 hours to 76 hours of LOC
Greater than 1 day to leas than 7 days of amnesia
Focal abnormalities on imaging
Glascow Coma Scale
Eye opening: 4 spontaneous, 3 to sound, 2 to pressure, 1 none
verbal response: 5 oriented, 4 confused, 3 words, 2 sounds, 1 none
Motor response: 6 obeys command, 5 moves to localised pain, 4 flex to withdraw from pain, 3 abnormal
Flexion, 2 abnormal extension 1 no response
Ranchos LOS Amigos
Level 1: no response total a
Level 2: generalized response, total a
Level 3: localized response, total a
Level 4: confused agitated, max a
Level 5: confused, inappropriate, nona agitated, max a
Level 6: confused appropriate moderate assistance
Level 7:automatic appropriate, min a
TBI Assessment
Motor: ROM, MMT, muscle torn
Vision: saccades, visual field, oculomotor, near and distant acuity
ADLs: A-One, AMPs 9, Barthel Index, ACS, Performance Assessment of Self-Care
TBI intervention
Internal cuing/strategy training for self-initiation
External cues
Memory Aids
Blocked practice
Random practice
Sensory stimulation
Group based physical activity
Virtual reality
Group based multi-component cognitive progra
Errorless learning
Occupation based tx
Vision therapy
Education/skills training
Goal focused intervention
Caregiver education
TBI intervention: internal cuing and strategy training for self initiation
4 step process-Writer Organize Picture Rehearse several sessions
TBI intervention: external cues
Checklist, timers, memory books
Memory aids: those managed by others vs impaired individual, passive memory aids require pt to develop a habit
TBI intervention: blocked practice
Repeatedly practicing the same task in the same environment for more severely impaired
TBI intervention: random practice
Practicing task in between other tasks, more beneficial learning of skill
TBI intervention: sensory stimulation
Strong evidence for family delivered multi-modal sensory stimulation to increase arousal and awareness in clients with decreased level of consciousness, moderate for practitioner delivered stim
TBI intervention: physical activity
Moderate evidence for group based physical activity
-aerobic, balance, and strengthening lead to increased mobility
TBI intervention: virtual reality
Moderate evidence for motor
Abilities for mild to moderate aTBI
TBI intervention: Group based multicomponent cognitive program
Strong evidence for problem solving in mild to severe TBI
TBI intervention: occupation based tx
Strong evidence involving clients in IDC tx, CO-OP (goal, plan, do, check)
Mild to severe tbi to solve problems experiencing in daily life
TBI intervention: errorless learning
Moderate evidence to increase ADLs in those who have not emerged from posttraumatic amnesia
TBI intervention: vision therapy
Moderate evidence for outpatient, vision therapy consisting of techniques to increase vergence, saccadic eye movement, visual attntion, visually evoked potentials
TBI intervention: education/skills training
Strong for 1:1outpatient education to improve compensatory strategies with mild to severe TBI
TBI intervention: goal focused intervention
Moderate support for goal focused individual/group treatment to increase emotional control and social interactions
TBI intervention: caregiver education
Individual strong evidence exists for promoting caregiver health and well-being via inpatient and community based caregiver group, may be via phone
Family based strong evidence exists for promotion caregiver health/well being through online/home therapy, group to build skills such as problem solving, communication, and strategy development
Meniere’s Disease
Unknown inner ear dysfunction that causes dizziness, vertigo, ringing in the ear, and hearing loss
No cure, but tx
Increase endolymph in the ear secondary to poor fluid drainage, autoimmune disorder, viral infection, genetics
BPPV
Vertigo, dizziness, nausea, vomiting more prevalent in older adults
Vestibular symptoms
Vertigo
Oscillopsia
Disequilibrium
Spatial orientation deficits
Visual motion sensitivity
Decreased dynamic visual acuity
Decreased ability to concentrate
Limited ability to complete dual tasks
Triggers for vestibular symptoms
Rolling over in bed, getting out of bed, shifting weight during transfer in/out of shower, bending to put shoes on, retrieving from low levels, driving, reading
Vestibular Assessments
Occupational profile
COPM
Task Analysis
Vestibular disorder ADL scale (specific ADLs that are affected)
ABC
Dizziness Handicap Inventory
Ordinal Scales of vertigo intensity
Vestibular activities and participation measure
CTSIB
TUG
Berg Balance
5x STS
Vestibular intervention
Entry-level/generalist: functional mobility training, ADL training, education on symptom management, medication management, environmental modification/adaptation (use of reacher), establish daily routine, incorporate balance of work, sleep, and leisure, stress management/mindfulness technique, relocating objects, reduce triggers
TBI visual deficits
Saccades, pursuits, and convergence insufficiency
Primary visual deficits: acuity, visual field, eye movement, pursuits, saccades
Complex: visual perception, motion vision, visual spatial function
Vestibular system
Inner ear = 3 semicircular canals, 2 otoliths—-peripheral disorder
Central vestibular disorder-brain not integrating, processing information from vestibular system
Components of visual-vestibular convergence
Thalamus, cortex, cerebellum
Sensory Organization Test by NeuroCom
Posturography with complex hardware/software to assess client’s ability to maintain an upright posture in 6 conditions
Similar to CTSIB, CTSIB more affordable and practical
Low sensitivity assessments advised against vestibular disorder use
Head shaking, un-instrumented head impulse test, video lead impulse test
Vestibular ocular motor screening tool
Sports related concussion, integrate effects of cognitive load, evaluate gaze stabilization
Model of multisensory integration
Separates process of motor planning and motor control with praxis at the center
Necessary for sensorimotor adaptation
Vestibular system is critical for body’s position in space, midline, spatial awareness, navigational skills, body schema/internal representation, and environmental awareness
Perceptual awareness can be altered by cognitive input
Sensory organizational dysfunction
Apraxia
Motor apraxia, ideomotor apraxia, ideational apraxia
Vestibulo-ocular Hierarchy model
Visual integrity (peripheral field, activity, ocular motor skills) —>visual efficiency (accommodation, pursuits, saccades, fixation, convergence, gaze stabilization) —>visual perceptual processing (visual attention, scanning, visual memory, spatial orientation, pattern recognition, discrimination)-> cognitive-perceptual—> occupational performance
Imbedded in multisensory models
Occupatuonal performance from
Environmental and sensory feedback
Diffierentiates ocular motor function and oculomotor skills
Brock string
Assess binocularity and suppression
Reflexive saccades
Stimulated by movement in peripheral field, parietal eye field
Intentional saccades
Follow command to focus on target frontal field
Central nervous problem demo’s normal reflexive saccade and difficulty with intentional saccades
Incremental VOR training
Improve vestibular function
Advance level therapist vestibular intervention
Habituation, balance training, and gaze stabilization
Persistent postural-perceptual dizziness
Describes long term problems experienced by clients with vestibular problems, chronic functional vestibular disorder
Exacerbated by visually complex or dynamic visual simti
Sx: visual hypersensitivity, unsteadiness, imbalance, avoidance of environment with dynamic visual stimuli
Visual vertigo
Visually induced dizziness experienced by people who use vision to compensate for vestibular problems
Triggers: riding as a passenger in the car, walking across lines in crosswalk, coping with children’s spinning brightly colored toys, walking past people
Treatment for visual vertigo
Visual/vestibular activities
Promote desensitization
AVOR app to educate clients on vestibular system
Brain tumor
Top 10 Ca related deaths
90% primary tumor s/p 20 y.o, onset average 57 y.o., highest incidence 85+
Black people more likely to develop primary brain Ca and non malignant tumors
White people more likely to develop malignant brain tumor
Primary tumor
Originates in the area tumor is indentified
Secondary tumor
METs from primary tumor
Grade=reflects appearance
Stage= size and progression from original site
Meningioma
Tumor of meninges, 20-30% of brain tumors, benign
Schwannoma
Cranial nerve VIII, acoustic neuroma, hearing loss, tinnitus, imbalance, incoordination, facial weakness
Common Brain Tumor symptoms
Deficits in sensation, motor, vision, visual perception, cognition, and emotional coping interfering with occupational performance and QOL
Assessment if Brain Tumor: ADLs
Section GG, Barthel Index, Katz ADL scale, AMPAC (acute care)
Assessment of brain tumors: cognition
EFPT, Kettle Test, multiple errands test, functional cognition
Assesment of fatigue with brain tumors
Brief fatigue inventory
Assessment of brain tumors: QOL
Functional assessment of Cancer Therapy (FACT)
Interventions for brain tumors
CBT
Compensatory skills training
Meaningful functional activities
Lifestyle redesign
Remediation/restoration of skill
Psychosocial Intervention for Brain Tumors
CBT for
Body image
Loss of role
Depression
Relaxation
Mindfulness
Stress management
Multiple Sclerosis
Chronic reoccurring demyelinating disease if CNS impacting communication between brain and spinal cord
Body’s immune system attacks myelin sheath
3 types of MS
Relapsing/remitting MS
Secondary progressive MS
Primary Progressive MS
Relapsing and Remitting MS
Most common dx, exacerbations followed by periods of remission, partial or complete recovery of symptoms
Secondary progressive MS
Starts out as relapsing/remitting and transitions into a more progressive course as the remission period does not allow for recovery of symptoms resulting in disability over time
Primary progressive MS
Steady declining neurological function from onset without apparent relapse, symptoms gradually worsen overtime
MS Assessment
Multiple Sclerosis intimacy and sexuality questionnaire
COPM
Functional Assessment of Multiple Sclerosis
Fatigue modified Impact Scale
9 hole peg test
Multiple Sclerosis Intimacy and sexuality Questionnaires
MSISQ-19, rate degree of which MS symptoms interfere with sexuality
Functional Assessment of Multiple Sclerosis
FAMS, 58 likert scale response items, self-administered or interview style
Areas: mobility, thinking and fatigue, emotional well being, family/social well being, and MS symptoms
Fatigue Modified Impact Scale
Understand impact of fatigue on daily function of persons with MS, effects if fatigue of cognitive, physical, psychosocial functioning over last 4 weeks
MS Intervention for fatigue
ECT/work simplification (positive response)
Results: improvement in fatigue, feeling less pessimistic, experiencing few positive consequences of MS, improvement in perceiving disparity in social support
MS intervention for Sleep
Moderate evidence for online mindfulness/meditation group for sleep problems
Moderate evidence for individual or group CBT, 90 minute x8 weeks=increase sleep in women with MS
MS intervention of ADLs
Address environment and adaptationspl to increase (I) with ADLs
Home visit focusing on task specific exercise
PEO Model:mismatch of pt’s ability
And environment
intervention for MS: exercise
16-30 minute of HeP bc longer intervals are burdensome, videotape, complete in front of mirror, pictures/words
Interventions for MS: bladder
Moderate to high evidence supporting pelvic floor muscle training to decrease leakage and neurogenic bladder symptoms
MS Intervention: IADLs
PEO Model: address environment in home visits with task specific exercises, mismatch of environment and abilities
MS intervention: falls and functional
Mobility
Moderate evidence for fall/mobility interventions, balance training, exercise program, 6 week protocol for virtual reality balance training
12 week HEP decrease falls targeting balance and LE strength, not strength but balance improvement related to reduced falls
String evidence for Group/ in home fall prevention: 10-12 week 4-10 sessions
MS interventions: sexual function
Strong evidence for OT to address sexual function, 4 weeks, 16-20 minute, community based model, PLISSIT or EXPLISSIT model
Moderate evidence for in person group, 5 full days of meetings to increase quality of relationship
MS Intervention: activity tolerance
Strong evidence for providing educational materials in 4-15 online, newsletters, or DVD material with 7-15 1:1 videos or phone coaching
Leads to increased physical activity and self-reported participation
MS Intervention: Caregiver
In person group caregiver intervention and support during 6-12 week collaborative care or psycho education program
MS intervention: medication management
3-5 week duration using CBT/mindfulness to increase medication adherence
MS intervention: work
Moderate evidence for 4 weeks, educational module to increase confidence in career goals and problem solving work place difficulties in MS
SCI
Can occur as a result of a traumatic or non traumatic event damaging the spinal cord or nerves
Paraplegia: LE/lower part of body, typically resulting from injury to thoracic/lumbar region of spinal cord
Tetra/quadriplegia: involves paralysis of both UE/LE typically resulting from an injury to cervical region of spinal cord
SCI Assessments
SCI QOL FM Functioning
COPM
Assessing client factors: level of injury/completeness, neurological impairment, motor function, cognitive function, sensation, shoulder pain, depression
SCI QOL FM Functioning
SCI functional index, 9 item pt report outcome measure, functional abilities with SCI
Domains: basic mobility, self-care, fine motor, ambulation, wheelchair mobility
Common shoulder injuries with SCI
Impingement
RTC injury
Bursitis
Joint swelling
Glenohumeral joint instability
Assessing Shoulder pain in SCI
Assess with wheelchair user shoulder pain index: 15 item self-report tool
SCI shoulder pain intervention
Exercise, massage, e-stim, neuromuscular retraining, corticosteroid injections, strengthening and stretching
Aging with SCI concerns
Health literacy
Perceived quality and satisfaction with healthcare services
Lack if collaboration between provider and pt
Functional changes due to aging process (energy level, memory, sleep, bowel/bladder, comorbidities)
Increased falls
Change in level of participation in activities
Reassess environment
Treatment of Aging concerns in SCI
Active engagement with health literacy
Practice and discussing problem solving
Educate on strategies to continue meaningful life role
Balance activities to reduce falls later in life
Modifying existing leisure activity to allow for participation
Increase professionals participation after DC
Tx co-occurring medical conditions
Co-occurring Medical Conditions of SCI
Secondary health conditions in first 6 months greater chance of LT disability
Want to treat co-occurring conditions with 2.5 years post injury
Leg spasms, constipation, back pain below level of injury and shoulder pain
Higher level of impairment leads to constipation, UTI, and headaches and back pain= greater disability at 18 months
Difficulty coughing = more significant disability at 30 months
SCI intervention
Bowel/bladder management
AD
Adaptive techniques
Safety training
ADL training
Transfer training/functional mobility
Fall prevention
Pressure ulcer (80% will have a sore, 30% more than one)-pressure relief tech
VR, AT, splinting,
strengthening
caregiver education
Modalities
Spasticities management
Medication management
Health promotion/prevention
Adaptive sports
ROM exercise/contracture prevention
Educate sexuality concerns
Pressure Ulcers risk factors in SCI
Prolonged sitting
Shearing forces
abrasions
Bumps
Falls
Loss of muscle mass
Extreme temps
Wet skin
Under/overweight
Decrease circulation
Swelling DN
Increased BP
Alcohol/drug use
Depression
Aging
Pressure relief techniques
Weight shifting in wheelchair 15-30 minute for 30-90 seconds
Inspect skin 2x/day
Padding/positioning
Turning in bed
Avoid elevating HOB while sleep secondary to increase pressure on buttocks/low back areas
SCI pressure relief program
Program consisting of didactic lectures, group discussions, and practice sessions to increase benefits on 5 skin care belief scales
Domains: susceptibility to pressure ulcer, barriers to skin, skin check belief, benefit to wheelchair pressure relief, barriers to turning/positioning belief, and self-efficacy
Reaching forward during computer use to redistribute pressure compared to upright sitting
Amyotrophic Lateral Sclerosis
Nerve cells breakdown break down which reduces functionality in muscles
Sx: muscle twitching, weakness in arm/leg, trouble swallowing, slurred speech
ALS Assessment
COPM
Amyotrophic lateral sclerosis functional rating scale
Client factors: shoulder pain (visual analog scale to monitor pain), dysphagia, pain, strength/ROM
ALS shoulder pain intervention
Scapular mobilization, ROM, caregiver education research shows increase ROM and reduce VAS score for pain
ALs intervention
HEP of stretching/resistive exercise- moderate evidence
Use of wheelchair, limited evidence, PWC did not increase community participation
Home modification with participants reporting satisfaction with use of elevated toilet seat, toilet rails, shower seats, grab bars, slip on shoes, transfer board (not satisfied with button hooks/long handled tools)
OT related to improved perceived fatigue, manual dexterity, fall prevention, and improved cognitive aspects (memory, communication, depression, QOL)
Functional t/f and mobility: power wheelchair features frequently tilt in space, reclining, power elevating leg rests, joystick control, air/gel cushion, height adjustable armrests, soft headrests, and seatbelts
Bowel/bladder management
Fall prevention/safety training
AD/adaptive techniques
ADL training
Caregiver training: increase communication between client and caregiver, family members did not understand mental, social, and emotional state of each other
Home Health care
Catherine Bergego Scale
observational, functional, performance based assessment. There are 10 items, Each item is scored from 0-3. The minimum total score is 0 (indicating no neglect), and the maximum total score is 30 (indicating severe neglect)
Assesses spatial neglect
