Neurological Disorders Flashcards
1
Q
Upper motor neuron lesion
A
- occurs in CNS( brain/spinal cord)
- stroke, TBI, SCI
- hypertonia
- hyperreflexia, clonus
- Babinski response
2
Q
Lower motor neuron lesion
A
- occurs in PNS (cranial nerves, spinal nerves)
- polio, GBS, peripheral neuropathy
- hypotonia, flaccidity
- hyporeflexia
- diminished deep tendon reflex
3
Q
Right hemispheric damage
A
RANS
- attention
- neglect
- spatial
4
Q
Left hemispheric damage
A
LIO
- language
- ideas
- organization
5
Q
CVA- neurological deficits
A
Hemiplegia - can result in impaired use of one side of the body, postural difficulties, and decreased bilateral coordination
Visual deficits - visual neglect, decreased environmental awareness
Apraxia - decreased motor control or ability to plan movements
Aphasia - speech deficits that affects receptive and/or expressive communication
Cognitive deficits -decreased executive functioning inhibiting ability to learn new information and skills Sensory deficits - decreased awareness, coordination, and sensitivity
Upper extremity dysfunction- generalized weakness, contractures, pain, neglect, etc.
6
Q
OT eval for stroke
A
- top-down approach
- client-centered throughout the assessment. OTs can observe the client while they engage in ADLs to see their deficits along with using standardized assessments to assess the performance skills needed to engage in ADLs/IADLs
- When answering questions in regards to the evaluation process it’s important to note what the question is telling you that needs to be evaluated or has ALREADY been evaluated. Then choose the right assessment or clinical observation needed to see whether or not the client has the deficits.
7
Q
OT intervention stroke
A
- assist the client in engaging in occupational tasks and address their performance skill deficits
- when answering questions, it’s important to highlight the client factors and what we are tasked with
addressing
8
Q
OT eval TBI
A
- identifying the subtle signs and body functions of the client
- careful observation of changes in vital signs in response to task performance
9
Q
OT intervention TBI
A
- When answering questions, it’s important to understand the level the client is at in order to direct intervention.
- OT intervention can address positioning secondary to postural deficits, sensory deficits, cognition, psychosocial factors, wheelchair positioning, muscle tone/rigidity, etc.
- Depending on the client factors presented in the question, the intervention will need to directly correlate with that problem area in order to increase engagement.
10
Q
eval for lower level Ranchos level (1-3)
A
- arousal level/cognition
- vision
- sensation
- joint ROM
- motor control
- dysphagia
- emotional/ behavioral factors
11
Q
intervention for lower level Ranchos level (1-3)
A
- sensory stimulation
- wheelchair and bed positioning
- splinting and casting
- behavior and cognition
- family and caregiver education
12
Q
eval for intermediate/higher level Ranchos level (4-9)
A
- physical status
- dysphagia
- cognitive, visual, and perceptual skills
- ADLs
- driving, vocational rehab, and psychosocial skills (for advanced-level ranchos)
13
Q
intervention for intermediate/higher level Ranchos level (4-9)
A
- residual neuromuscular impairments
- ataxia
- cognition, vision, perception
- behavioral management
- functional mobility
- transfers
- IADLs
- home safety
- psychosocial skills
- home safety
- community reintegration
14
Q
Ranchos Level I - no response
A
- unresponsive to stimuli
- require total A
15
Q
Ranchos Level II generalized response or general reflex response
A
-majority of responses are delayed
-require total A to engage in ADLs
16
Q
Ranchos Level III localized response
A
- begin to react to specific stimuli inconsistently
- EX. they may turn their head to the side that their loved one is talking to them
17
Q
Ranchos Level IV confused, agitated
A
- show poor information processing and increased activity shown through increased behaviors of agitation
- require max A to perform self-care activities
18
Q
Ranchos Level V confused, inappropriate, non-agitated
A
-have gross attention allowing them to follow very simple commands
- easily distracted requiring redirection and assistance with initiating functional tasks
- max A
19
Q
Ranchos Level VI confused, appropriate
A
- goal-directed behavior (can engage in structured activities up to 30 mins at a time)
- has overall increased awareness with appropriate responses and behaviors compared to level V
- mod A
20
Q
Ranchos Level VII automatic, appropriate
A
- behaving appropriately
- oriented to both place and routine
- decreased problem solving
- new learning w/ min supervision, carryover is possible
- min A
21
Q
Level VIII purposeful, appropriate
A
- alert & oriented
- shows carryover to learn new tasks
- stand-by assist
22
Q
Glasgow coma scale
A
3= dead
under 8= severe (coma)
9-12= moderate (inpt rehab)
13-15 = mild
23
Q
SCI eval
A
- occupational profile
- sensory function
- ROM
- vision
- cognition
- overall functional engagement in ADLs
When answering evaluation questions, it will be important to understand WHAT you are evaluating (ex, vision, cognition, etc.) to choose the correct assessment or clinical observation
24
Q
SCI intervention
A
acute phase
- preserving mobility
- positioning
- mobilization
- engagement in self-care and family education
post-acute phase
- self-management
- prioritizing attainable goals for the client
25
SCI 1-3 symptoms and adaptive equipment
symptoms
- ventilator dependent
- limited head & neck movement
- dependent with all ADLs
AE
- electric wheelchairs or environmental control units (ECU) allow for engagement with their environment
- mouth sticks
26
SCI 4 symptoms and adaptive equipment
symptoms
- have the diaphragm for respiration, and shoulder movement (able to elevate & depress shoulders
which can be used to access AE),
- still dependent with ADLs
AE
- ECU
- electric hospital bed
- power wheelchair
- elongated straws
- shoulder switches added to AE
27
SCI 5 symptoms and adaptive equipment
symptoms
- biceps innervated for elbow flexion w/ specialized equipment (ex: universal cuff)
- able to self-feed & complete grooming tasks with setup from caregiver
- require total A for bowel/bladder
management
AE
- universal cuff
- scoop dishes
- elongated straws
- mobile arm support
28
SCI 6 symptoms and adaptive equipment
symptoms
- wrist extension activated
- utilize tenodesis grasp
- require some or total A for sliding board transfers
AE
- wrist driven tenodesis splint
- built up utensils
29
SCI C7-T1 symptoms and adaptive equipment
symptoms
C7-T1- extension
C8-T1- hand and finger precision w/ strength
- will assist with depression transfers, completing ADLs with use of AE, mobility (propelling manual
wheelchair), etc.
AE
- adapted/long-handled equipment
- dressing sticks
30
SCI T2-T12 symptoms and adaptive equipment
full use of the upper extremities; as you move to lower levels, lower extremity and trunk
control increases
31
complications w/ SCI
- orthostatic hypotension
- autonomic dysreflexia
- pain
- spasticity
- pressure ulcers
32
orthostatic hypotension
- sudden drop in BP due to positional change (supine to upright)
- recline them back in bed/wheelchair
- want to increase tolerance of sitting upright gradually
33
autonomic dysreflexia
- occurs at T6 and above (T7, T8..etc)
- first, sit them upright
- check bladder/catheter, remove restrictive clothing
34
ASIA levels
ASIA A -complete injury; no motor or sensory fx
ASIA B - sensory incomplete; sensation remains, but no motor control
ASIA C - motor- incomplete; motor fx below injury level, muscles have grade below 3
ASIA D - motor incomplete; same as C but muscles have a grade of 3 or more
35
central cord syndrome
- bilateral loss of pain and temperature
- bilateral loss of motor function, MAINLY UPPER EXTREMITY ARE AFFECTED
- HAS PROPRIOCEPTION AND DISCRIMINATORY SENSATION
36
Brown-Séquard Syndrome
-one side of the cord Is affected usually due to sharp damage from a stab or gunshot wound
- paralysis and loss of proprioception on the same side of damage (ipsilateral)
- loss of the sensation (pain, temperature, and touch) on the contralateral or opposite side (contralateral)
37
anterior cord syndrome
- loss of pain, temperature, and touch sensations along with paralysis
38
posterior cord syndrome
- bilateral loss of proprioception, vibration, and sensations (2-point discrimination, stereognosis)
- preserve motor, pain, touch
39
Conus Medullaris Syndrome
- areflexia in the bowel, bladder and LEs due to injury of the sacral and lumbar nerves
40
Cauda Equina Syndrome
- flaccid paralysis of bladder and bowel
41
MCA stroke
- Contralateral hemiplegia (greater in face and the upper extremity) and sensory loss
- Visual field impairment (homonymous hemianopsia) - Ideational apraxia
- Lack of judgment and organization
- emotional lability and depression
42
ACA stroke
-Contralateral hemiplegia, greatest in foot
- Contralateral sensory loss, greatest in foot
- incontinence
- mutism
- return of primitive reflex (grasp reflex)
- Left unilateral apraxia.
- changes in behavior (confusion, disorientation, perservation)
43
PCA stroke
- Both sides Homonymous hemianopsia
- VISUAL AGNOSIA (visual object agnosia, prosopagnosia, color agnosia).
- contralateral sensory loss
- Occasional contralateral numbness.
- thalamic pain (burning or tingling)
- memory impairment
44
frontal lobe damage
Ideation, planning, executive functions in general, organizing, problem solving, selective attention, speech (left: Broca’s area), motor execution, short-term memory, motivation, judgment, personality, and emotions.
45
temporal lobe damage
Emotion, memory, visual memory (right), verbal memory (left), interpretation of music (right), receptive language (left: Wernicke’s area), auditory
46
occipital lobe damage
Visual reception, visual recognition of shapes and colors.
47
parietal lobe damage
Visual-spatial functions (right), reception and recognition of tactile information, praxis (left), sensation (pain, temperature, touch, proprioception), tactile
48
medulla oblongata function
- control of head movements and gaze stabilization (balance, vestibular)
- voluntary movement control
- cardiac, respiratory, vasomotor function
49
spastic CP
either increased muscle tone or increased intensity of reflex responses
50
dyskinetic CP
- fluctuations in muscle mvmt
- dystonia
- athetosis (more distal than proximal)
- chorea ( more proximal than distal)
51
ataxic CP
lack of stability, cerebellum, hypotonia and ataxic mvmts
52
monoplegia
one extremity
53
hemiplegia
- same sided paraylsis
- ex. L arm and L leg
54
paraplegia
involves LE
55
quadriplegia
all 4 limbs involved
56
diplegia
more leg impairment than UE
57
complications with CP
- seizures
- language and cognition
- visual
- feeding disturbances
- diminished sensation (common in spastic CP)
58
Interventions for CP
assistive tech, NDT, CIMT, physical exercise, orthotics, positioning and seating devices, serial casting, AE
see tmpot notes also
59
Parkinsons disease symptoms
postural instability, bradykinesia, resting tremors, rigidity
60
Parkinsons disease stages 1 symptoms and intervention
symptoms
- unilateral tremor, rigidity, akinesia
- min or no functional impairment
- can still complete ADLs
- fatigue
intervention
- work eval
- HEP
61
Parkinsons disease stages 2 symptoms and intervention
symptoms
- bilateral tremors w/ rigidity
- decreased executive functioning
intervention
- energy conservation
- task sequencing skills
62
Parkinsons disease stages 3 symptoms and intervention
symptoms
- decreased balance and righting reactions
- continued difficulty w/ sequencing
intervention
- environmental modifications (adaptive equipment to compensate)
- compensatory strategies (visuals to assist w/ sequencing)
63
Parkinsons disease stages 4 symptoms and intervention
symptoms
- decreased mobility
- ESPECIALLY FINE MOTOR AND ORAL MOTOR
intervention
- modifications for self-care due to motor control
64
Parkinsons disease stages 5 symptoms and intervention
symptoms
- dependent (wheelchair or bed bound)
intervention
- environmental control units
- positioning
65
Parkinsons eval
- OT is most often required during stages 3-5
- brief history
- occupational performance deficits
66
Parkinsons intervention
decrease isolation and communication issues
- TIME ACTIVITIES WITH MEDICATION
- leisure activities
- writing modifications (ENLARGED FELT-TIP PEN AND WRITE WHEN RESTED)
- HEP to maintain facial movement and expression
safety
- avoid walking in crowds, narrow spaces, corners (for "freezing" movements)
- USING RHYTHMIC BEAT AND COUNTING TO MAINTAIN MOMENTUM
- home modifications (reduce clutter, raised toilet seat, grab bars, walking aids for festinated gait)
independence and participation
- REDUCE NEED FOR FINE-MOTOR CONTROL
- modify eating routine
- USE VISUAL CUES AND RHYTHMIC MUSIC IN NONDISTRACTING ENVIRONMENT
- SPEAK SLOWLY W/ SIMPLE INSTRUCTION
67
spina bifida
- Spina bifida occulta
- 1-2 vertebrae, probably no symptoms
- Meningocele/myclomeningocele
- involves spinal cord
- S2-S4 bowel and bladder affected
- LE paralysis/loss of sensation is common (sensorimotor issues)
- Hydrocephalus is common
68
tethered cord
- end of the spinal cord is stretched from compression or trapped with scar tissue- bowel/bladder, gait disturbances, deformities of feet, scoliosis
- hair, mole, red mark, deformities of feet= sign of it
69
shunt not working (spina bifida)
1st year= soft spot on head and head growth
2nd year= headache, vomiting, irritability
70
Muscular Dystrophy symptoms
- low muscle tone and weakness
- difficulty w/ oral motor feeding
- deformities of extremities and spine due to weakness
- difficulty w/ breathing
71
Huntinington's chorea
- choreiform movements and progressive intellectual deterioration
72
ALS symptoms
- muscle weakness and atrophy
- cramps and fasciculations
- signs usually begin in the hands
- dysarthria and dysphagia
- sensory systems, eye movements, and urinary sphincter are intact
73
ALS Eval
- Assessments should be based on clearly defined levels of function and the individual’s needs and priorities.
- Because of disease progression, reevaluation at each visit is required.
74
ALS early-stage intervention
optimizing strength and ROM using HEP, maintaining function in ADL and IADL using assistive or adaptive devices, decreasing fatigue in the neck and extremities through use of splints and orthotics, managing pain and energy using joint protection and work simplification techniques.
Early stages- most appropriate interventions are WORK SIMPLIFICATION AND ENERGY CONSERVATION
75
ALS late-stage intervention
- home evaluations and in-home therapy. Intervention focuses on enabling the caregiver to assist the client safely and effectively.
- Optimize safety and positioning, perform safe transfers, and maintain skin integrity; use augmentative communication equipment, assess and manage dysphagia, optimize social participation, identify and obtain equipment (such as a hospital bed), modify the environment to enhance participation, safety and comfort.
76
ALS stages
1= some weakness, ind with ADLs
2= moderate weakness, difficulty climbing stairs, and lifting arms
3= severe weakness, respiratory system is impacted
4= power w/c dependent, some A with ADLS
5= dependent for ADLs
6= tube feeding
77
brachial plexus and Erb's palsy, Klumpke's palsy
Brachial plexus
- C5, C6, C7, C8, T1
- Splint = injury flail arm
Erb’s Palsy-
-C5-C6
- waiters tip—splint = elbow lock
Klumple's palsy
- C7-T1
- paralysis of hand and wrist
78
peripheral neuropathy symptoms
- syndrome of sensory, motor, reflex and vasomotor symptoms
- symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve
79
GBS symptoms
- acute, rapid progressive disorder
- musuclar weakness
- distal sensory loss/parathesias
- affects distally more than proximally
- fatigue
- swallowing problems
80
GBS phases
acute= weakness in 2 extremities, mechanical ventilation
plateau= symptoms worsen, communication (paralysis of muscles in the head and neck) & hypersensitivity
initially= lose sensation in legs and goes up to head (starts bottom to top)
recovery= recovery goes top to bottom
affects distally more than proximally
81
GBS eval
acute phase
- oral motor and dysphagia issues
- effects on engaging in ADLs on blood pressure
plateau phase
- enter phase when they are stable
- continue to evaluate for pain and dysphagia
- document MMT (IF STRENGTH HAS INCREASED, THIS MEANS THEY ARE READY FOR RECOVERY STAGE)
recovery phase
- Do not push clients to fatigue, because it will cause recovery to be prolonged and fatigue may slow
the rehabilitation process
- continue to evaluate for pain and dysphagia
82
GBS intervention
acute phase
- PROM
- prevention of contractures with positioning
- caregiver education
plateau
- PROM
- prevention of contractures with positioning
- caregiver education
- monitor strength
recovery
- continue to increase their strength
- energy conversation
- engagement in ADLs as tolerated
83
myasthenia gravis
weakness in voluntary muscles (eye, facial expressions)
84
post-polio syndrome symptoms
- new onset of weakness
- easily fatigued
- muscle pain
- joint pain
- cold intolerance
- atrophy
- loss of functional skills
85
multiple sclerosis
- slow progressing CNS disease
- early stages= LE weakness, fatigue mgmt
- later stages= vision and cognition
86
considerations for MS
- AVOIDING OVERFATIGUE
- COOLER TEMPERATURE is generally better (AVOID HOT WATER)
- SENSORY LOSS (AVOID SHARP OBJECTS) and possible heat intolerance so USE HEAT MODALITIES WITH CAUTION
- be aware of fluctuations in level of independence, and monitor safety due to loss of postural control and cognitive impairment
87
MS eval
- history
- cognition
- REST PERIODS MAY BE NECESSARY IF THE PATIENT BECOMES FATIGUED OR THE EVAL MAY BE BROKEN UP INTO MULTIPLE SESSIONS
- ADLs
- Client factors include strength, muscle tone, sensation, coordination, ROM, endurance, balance, vision, and cognitive functions.
88
MS intervention
- ADL and cognitive training
- energy conversation, education about disease
- work/home modifications
- mobility aids/ AT
- safety awareness
- stress management training (diaphragmatic breathing)
- splinting
89
OT Eval for neurological disorders
- occupational profile
- ADLs and IADLs
- determine sensory/motor dysfunctions
- determine cognitive/perceptual dysfunctions
- determine psychological dysfucntions
90
OT Intervention for Neurological Disorders
- Use a COMPENSATORY approach for progressive disorders (ALS and muscular dystrophy)
- Use combination of RESTORATIVE/REHABILTATIVE approach for nonprogressive disorders (TBI, SCI)
91
OT Intervention for pain
- educate about contributing factors of pain
- assist in identifying and adapting to pain behaviors
- assist in developing strategies and using techniques to manage pain
- create individualized daily activity program
- provide assistive devices
- educate family members
- refer to other professionals
92
hyperresponsive (sensory avoider)
tactile defensiveness
- unable to tolerate various tactile sensations
- results in daily tantrums in morning routine to avoid the sensation
- use DEEP PRESSURE (HEAVY PILLOWS)
- activities should be CHILD-DIRECTED (LET CHILD CHOOSE, SELF-INITIATE, ADMINISTER INPUT)
- START WITH LESS BOTHERSOME TEXTURES combined with vestibular and/or proprioceptive input to help the child remain calm
93
gravitational insecurity
-child avoids their feet leaving the ground or activities that change head position in space
- EX. avoids playground jungle gym resulting in
isolation during recess
- avoids swinging, climbing, and slides
- START WITH GRADED, SLOW, CHILD DIRECTED ACTIVITIES
- (allow child to choose equipment that is on or close to the floor so feet stay in contact with the ground)
-
94
hyporesponsive
- exhibits less of a response to the sensation
- Ex. unable to notice when food or drool is on the
face resulting in a dirty face or clothing
- DOES NOT RECOGNIZE, NOTICE OR RESPOND
- USE LIGHT TOUCH (playing dress up with a feather scarf or being in a ball pit with various textures)
95
Intervention for seizures
- remove dangerous objects
- if person is in hospital bed, raise bed rails
- turn person on their side
- allow seizure to happen, protect head and extremities
-
96
