Neurological Conditions Flashcards
A ____________________ is an acquired brain injury caused by an external mechanical or blunt force. It is accompanied by loss of consciousness, posttraumatic amnesia, skull fracture, or other unfavorable neurological findings attributed to the event.
Traumatic brain injury (TBI)
Most common cause of death and disability in young people between ages 16 and 30
Results in more than 55,000 deaths and 80,000 severe disabilities per year in the United States
True or false: Motor vehicle accidents cause more TBI’s than falls.
FALSE
Falls (48% of TBI-related emergency department visits)
Motor vehicle accidents (20% of TBI-related hospitalizations)
Striking or being struck by an object (17% of TBI-related emergency department visits)
Intentional self-harm (e.g., gunshot wound to the head; 33% of TBI-related deaths).
What are the 3 associated factors of TBI?
Gender: Young and middle-aged men are 4 times more likely than women to experience a TBI.
Age: After age 65, the discrepancy between genders is less marked.
Substance abuse: More than half of adults diagnosed with TBI report alcohol use near the time of injury.
Factors in positive outcomes:
Client’s age
Preinjury capabilities
Severity of injury
Quality of intervention and support.
What are examples of primary TBI and secondary TBI prevention?
Primary (at moment of impact) TBI can be prevented through safety mechanisms such as safety belts, protective helmets, air bags, and roadside barriers.
Secondary (days to weeks after injury) TBI can be prevented through medical interventions involving control of the client’s blood pressure and oxygenation, management of intracranial pressure, nutrition, and seizure prevention.
_____________ is a sudden deceleration of the body and head (e.g., from a motor vehicle, bicycle, or skateboard accident; a fall from a high surface; or being thrown from a horse or bull).
Multifocal and diffuse brain injury
______________ is the direct blow to the head resulting from a collision with an external object, a fall from standing or sitting, or a penetrating injury. The directly injured area is known as the coup; the site of an indirect injury is the contrecoup.
Focal brain injury
In ______________ rigidity, the upper extremities are in spastic flexed position with internal rotation and adduction.
Lower extremities are in spastic extended position, internally rotated, and adducted.
Decorticate (rigidity)
In _______________ rigidity, the upper and lower extremities are in spastic extension, adduction, and internal rotation.
Wrist and fingers flex, plantar portions of the feet flex and invert, the trunk extends, and the head retracts.
Decerebate (rigidity)
TBI can affect primitive reflexes (righting/equilibrium) and functional endurance. Muscle weakness can lead to postural deficits, limitations in ___________, and ____________.
(limitations in) joint mobility
ataxia
Sensation can also be affected. Signs of absent or diminished sensation including light touch, differentiation between sharp and dull sensations, proprioception, temperature, pain, and kinesthesia. Diminishment of sense of taste and smell with cranial nerve injury
Possible hypersensitivity.
Interventions related to effective positioning in the wheelchair and bed can support a client with TBI to… (name 2 outcomes)
- Prevent skin breakdown and ulcers
- Increase sitting tolerance
- Improve muscle tone
- Improve posture
When spasticity (result from TBI) interferes with function movement or ADL performance, splints can be effective.
Name 2 splints that can be used with this population.
Clients wear a resting splint (20°–30° wrist extension, thumb abducted, metacarpophalangeal joints at 15°–20° of flexion) or functional position splint when not involved in active movement or functional tasks. The wear schedule includes alternating 2-hour periods. Frequent monitoring for skin breakdown is necessary.
Cone splints are worn to keep fingers from digging into or damaging the palmar surface.
Antispasticity splints position the hand and wrist in functional positions and abduct the fingers, decreasing spasticity.
Elbow casts are used for the loss of PROM in the elbow flexors.
Agitation during the medically unstable acute phase of TBI is common.
How can an OT support a client in managing agitation?
Behavior management strategies are useful to avoid reinforcing inappropriate behavior while allowing medically necessary treatments to occur.
Tracking arousal and alertness is important to establish a method of communication. A yes–no system is generally the starting point and is possible using eye blinks, head nods, or discernible motor movements (e.g., thumbs up).
True or false: It is not expected that sensory stimulation will improve the client’s level of consciousness; rather, it helps the occupational therapist identify when a client has emerged from a coma.
True!
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to optimize motor function at this phase?
Interventions that focus on motor learning, skill acquisition, and exercise, generally beginning with gross motor functions.
Occupation-based activities that include motor skill performance may be more effective than motor practice activities alone.
Current evidence does not support the use of neurodevelopmental treatment, Rood techniques, and proprioceptive neuromuscular techniques.
Ataxia may be treated through intervention focused on compensatory strategies for control, including weighting of body parts or use of weighted utensils and cups.
Apraxia may be treated with hand-over-hand exercise to repair damaged neural pathways. The client may also compensate by following steps depicted in pictures or written on a card.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to optimize visual abilities and visual perceptual function at this phase?
Intervention can involve environmental adaptation, vision correction (with an optometrist or ophthalmologist), and introduction of compensatory strategies (e.g., contrasting colors, textured tapes, sunglasses).
Neglect may be treated by encouraging the client to use the neglected side during functional activities.
Environmental adaptation may necessitate interaction with the neglected side, such as moving the television or meal tray.
The client may also compensate by placing all objects in the field of vision to maximize success.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to optimize cognitive function at this phase?
Intervention emphasizes self-awareness of deficits, attention, memory, and executive function through participation in functional activities as much as possible.
Engagement in ADLs and IADLs allows the client to develop problem-solving, planning, organization, concentration, frustration tolerance, sequencing, and categorization skills.
Compensatory approaches to address memory impairment have the most supporting evidence.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to optimize cognitive function at this phase?
Expressive aphasia may be treated with conversation exercises, with occupational therapists recognizing client errors and asking the client to verbalize the words the client meant to say.
Compensation through communication devices, pictures, or charts may be used if significant gains are not found from treatment.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like feeding at this phase?
Feeding instruction may begin in an isolated and quiet area to prevent distraction and then be graded to include social situations.
Adaptive equipment may include a rocker knife, plate guard, and nonspill mug.
Impulsivity may be controlled by requiring the client to place the fork down after each bite to ensure that a full chew-and-swallow routine is completed.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like bed mobility at this phase?
Training in bed mobility skills progresses from scooting up and down in bed to rolling, bridging, and moving from and to supine and from and to sitting and standing positions.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like wheelchair management at this phase?
Ensure proper pelvic and trunk alignment; educate on wheelchair parts and train client on correct wheelchair propulsion.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like functional ambulation at this phase?
High-level activities are provided, including those involving both lower and upper extremities such as advanced IADLs (e.g., sweeping, raking, interaction with children).
Compensatory devices include walkers with bags and baskets, canes, and reachers.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like community mobility at this phase?
NOTE: The ability to negotiate the community environment is client-dependent.
Electric scooters or wheelchairs may be recommended to assist clients with extended mobility requirements.
Determine the client’s safety with mobility devices via clinical practice before they are issued to the client.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like transfers at this phase?
Memory impairments and carryover difficulties necessitate consistent transfer training among all care providers, including family members.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like home management at this phase?
The degree of assistance required is client dependent. Some clients can prepare simple meals in a microwave, and others are able to perform higher-level activities including meal planning and budgeting.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to promote confidence and competence in self-maintenance tasks like community reintegration at this phase?
Reintegration can be accomplished through community trips to practice IADLs in natural environments.
During the inpatient rehab phase of TBI, clients are generally at Rancho level V or higher.
What are some interventions an OT can do to focus on decreasing or mediating problem behaviors?
Environmental interventions: Agitated clients should be provided a quiet, isolated room without a roommate (if possible). Environmental cues are also useful in orienting the client to place and time.
Interactive interventions: Interventionists’ speech should be calm, concise, and deliberate. Behavioral management programs may be necessary to promote appropriate behavior.
Rehabilitation for TBI transitions from an inpatient setting to one of a variety of post-acute rehabilitation settings, including home-based therapy, a residential program, a day treatment program, or an outpatient community reentry program. The client’s family often will need to provide long-term assistance, depending on the severity of the TBI.
During this phase (post-acute rehab) what are some interventions an OT can do to optimize cognitive function?
Residual cognitive deficits remain in the post-acute rehabilitation phase, including memory problems and executive function deficits.
The more stable and consistent environment of the post-acute rehabilitation phase often allows for more emphasis on changing the physical and social contexts and environment to compensate for cognitive deficits.
Increasing the client’s self-awareness is also important in this phase.
Rehabilitation for TBI transitions from an inpatient setting to one of a variety of post-acute rehabilitation settings, including home-based therapy, a residential program, a day treatment program, or an outpatient community reentry program. The client’s family often will need to provide long-term assistance, depending on the severity of the TBI.
During this phase (post-acute rehab) what are some interventions an OT can do to optimize visual and visual-perceptual function?
Focus on environmental adaptations and strategies to compensate for deficits that remain.
Rehabilitation for TBI transitions from an inpatient setting to one of a variety of post-acute rehabilitation settings, including home-based therapy, a residential program, a day treatment program, or an outpatient community reentry program. The client’s family often will need to provide long-term assistance, depending on the severity of the TBI.
During this phase (post-acute rehab) what are some interventions an OT can do to maximize ADL and IADL skills?
Interventions continue to focus on self-care and homemaking tasks if those skills have not been fully acquired in the inpatient phase of rehabilitation.
Emphasis is on behavioral intervention with repetitive practice through errorless learning, fading cues, and positive encouragement.
Strategies from the inpatient setting may need to be adapted for the community setting.
Rehabilitation for TBI transitions from an inpatient setting to one of a variety of post-acute rehabilitation settings, including home-based therapy, a residential program, a day treatment program, or an outpatient community reentry program. The client’s family often will need to provide long-term assistance, depending on the severity of the TBI.
During this phase (post-acute rehab) what are some interventions an OT can do to maximize leisure and social participation?
Intervention should focus on guiding the client in identifying leisure activities that are within the client’s abilities and are important for the individual.
Social skills training groups can be used to focus on social interaction and ability to develop relationships.
Specific techniques include behavior contracts, role-playing, self-reflection through video feedback, and role modeling.
Rehabilitation for TBI transitions from an inpatient setting to one of a variety of post-acute rehabilitation settings, including home-based therapy, a residential program, a day treatment program, or an outpatient community reentry program. The client’s family often will need to provide long-term assistance, depending on the severity of the TBI.
During this phase (post-acute rehab) what are some interventions an OT can do to promote work participation?
Intervention should focus on appropriate job identification, including appropriate skill development that matches the demands of the desired job.
Vocational rehabilitation is useful in this skill development and in identifying appropriate work or volunteer settings.
A _________ is a nontraumatic acquired brain injury resulting in neurological dysfunction caused by a lesion in the brain.
Stroke
Stroke is also called cerebrovascular accident (CVA).
What are the two types of stroke/CVA?
Ischemic stroke: Ischemia may result from a brain embolism from cardiac or arterial sources.
Hemorrhagic stroke: Hemorrhage results from subarachnoid and intracerebral hemorrhages in 13% of strokes.
Cerebral anoxia and aneurysm may result from hemorrhage and have similar treatment strategies.
