Neurological Disorders Flashcards
Primary vs. Secondary TBI
Primary: at the moment of impact
Secondary: several days to many weeks after injury
Decorticate rigidity
UE: spastic flexed position with internal rotation and adduction
LE: spastic extended position, internally rotated and adducted
Decerebrate rigidity
UE and LE: spastic extension, adduction and internal rotation
Wrist and fingers: flexed
Plantar portion of feet: flexed and inverted
Trunk: extended
Head: retracted
Frontal Lobe functions
Motor planning, motor control, higher order cognition
Precentral gyrus: primary motor cortex for voluntary muscle action
Prefrontal cortex: emotions, judgments, higher-order cognitive functions (ideation, abstraction)
Premotor cortex: planning of movements
includes Broca’s area for motor aspects of speech
pg. 206 Therapy Ed
Parietal Lobe function
Body sensation for opposite side of body
Postcentral gyrus: primary sensory cortex for integration of sensation
Overall, receives fibers conveying touch, proprioceptive, pain and temperature sensations from opposite side of body
(Think body sensation for opposite side)
Pg. 206 Therapy Ed
Temporal Lobe function
Auditory and language comprehension
Primary auditory cortex: receives and processes auditory stimuli
Associative auditory cortex: processes auditory stimuli
Wernicke’s area: language comprehension
pg. 206 Therapy Ed
Occipital Lobe function
Visual stimuli
Primary visual cortex: receives and processes visual stimuli
Visual association cortex: processes visual stimuli
Limbic system function
Basic functions: feeding, aggression, emotions, endocrine aspects of sexual response and long-term memory formation
Middle Cerebral Artery (MCA) stroke symptoms
Contralateral
Hemiplegia, hemianesthesia (sensation loss), homonymous hemianopsia
Left MCA: aphasia and/or apraxia
Right MCA: unilateral neglect, spatial dysfunction
Internal Carotid Artery (ICA) stroke symptoms
Similar to MCA
Contralateral
Hemiplegia, hemianesthesia (sensation loss), homonymous hemianopsia
Left MCA: aphasia and/or apraxia
Right MCA: unilateral neglect, spatial dysfunction
Anterior Cerebral Artery (ACA) stroke symptoms
Contralateral hemiplegia Grasp reflex Incontinence Confusion Apathy Mutism
Posterior Cerebral Artery (PCA) stroke symptoms
Homonymous hemianopsia
Thalamic pain (burning, tingling, difficulty with temp change)
Hemi-sensory loss
Alexia (inability to comprehend written materials)
Vertebrobasilar system stroke symptoms
Pseudobulbar signs:
- Dysarthria
- Dysphagia
- Emotional instability
Tetraplegia
Left Hemispheric Specialization
- Movement on right side of body
- Processing sensory information from right side of body
- Visual reception from right field
- Bilateral motor praxis
- Verbal memory
- Bilateral auditory reception
- Speech
- Processing of verbal auditory information
Right Hemispheric Specialization
- Movement on left side of body
- Processing sensory information from left side of body
- Visual reception from left field
- Visual spatial processing
- Left motor praxis
- Nonverbal memory
- Attention to incoming stimuli
- Emotional lability
- Processing nonverbal auditory information
- Interpretation of abstract information
- Interpretation of tonal inflections
Modifiable risk factors of stroke
- Hypertension
- Cardiac disease
- Atrial fibrillation
- Diabetes mellitus
- Smoking
- Alcohol abuse
- Hyperlipidemia
Transient ischemic attack (TIA)
Mini strokes causing mild neurological symptoms that resolve in 24 hours
TIAs are often a warning sign for a more significant stroke, about 1/3 of those with TIAs will have an acute stroke at some point in the future
Neurological impairments we may be looking for after an acute stroke include… (general)
- Motor dysfunction (hemiplegia, hemiparesis)
- Trunk and postural control, sitting and standing balance
- Communication impairments (aphasias, dysarthrias)
- Cognitive and perceptual impairments (neglect, apraxia, visual perceptual, problem solving)
- Upper extremity impairment (subluxations, edema)
- Visual impairments (homonymous hemianopsia)
- Psychosocial adjustments (depression is common, anxiety, personality changes)
Global aphasia
Loss of ALL language ability
Broca’s aphasia
Broken speech
Slow, labored speech
Frequent mispronounciations
Wernicke’s aphasia
Impaired auditory reception
Speech may be fluent but meaningless/nonsensical
Dysarthria
Articulation disorder resulting from paralysis of the organ of speech
Motor apraxia
Difficulty completing planned movements
Ideational apraxia
Difficulty with conceptualizing planned, multistep movements
Visual agnosia
Difficulty recognizing objects
Assessment of Motor and Process Skills (AMPS)
Requires additional training
Assessment of ADL task performance
Clients choose 2-3 standardized tasks and the OT observes the person’s quality of performance
Barthel Index Measure
Measure independence in BASIC ADLs
(Therefore high scores does NOT equate ability to live independently)
Direct observation of task performance, interview of individual, medical records
- Feeding
- Transferring
- Personal grooming
- Toileting
- Control of bladder
- Control of bowel
- Bathing
- Dressing
- Walking on level ground
- Negotiating/climbing stairs
Functional Independence Measure (FIM) System
Assesses severity of disability and amount of assistance needed according to 6 performance areas
- Self-care
- Sphincter management
- Mobility
- Locomotion
- Communication
- Social cognition
(OT typically deals with some self-care and mobility such as tub transfer)
Each item on a scale 1-7
1 = Total Assistance
7 = Independent
Contraindicated for patients at C6-C7 spinal cord injury level:
Extended arms with flat palms
Stretches out the flexors, which decreases tenodesis grasp
At the C5 spinal cord injury level, you will typically recommend this adaptive device:
Universal cuff (no wrist movements)
