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OT EXAM > Neurological Disorders > Flashcards

Neurological Disorders Flashcards

1
Q

Upper motor neuron lesion

A
  • occurs in CNS( brain/spinal cord)
  • stroke, TBI, SCI
  • hypertonia
  • hyperreflexia, clonus
  • Babinski response
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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
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3
Q

Right hemispheric damage

A

RANS
- attention
- neglect
- spatial

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4
Q

Left hemispheric damage

A

LIO
- language
- ideas
- organization

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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.

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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.
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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
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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
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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.
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10
Q

eval for lower level Ranchos level (1-3)

A
  • arousal level/cognition
  • vision
  • sensation
  • joint ROM
  • motor control
  • dysphagia
  • emotional/ behavioral factors
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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
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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)
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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
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14
Q

Ranchos Level I - no response

A
  • unresponsive to stimuli
  • require total A
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15
Q

Ranchos Level II generalized response or general reflex response

A

-majority of responses are delayed
-require total A to engage in ADLs

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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
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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
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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

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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
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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
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21
Q

Level VIII purposeful, appropriate

A
  • alert & oriented
  • shows carryover to learn new tasks
  • stand-by assist
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22
Q

Glasgow coma scale

A

3= dead
under 8= severe (coma)
9-12= moderate (inpt rehab)
13-15 = mild

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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

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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

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25
Q

SCI 1-3 symptoms and adaptive equipment

A

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

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26
Q

SCI 4 symptoms and adaptive equipment

A

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

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27
Q

SCI 5 symptoms and adaptive equipment

A

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

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28
Q

SCI 6 symptoms and adaptive equipment

A

symptoms
- wrist extension activated
- utilize tenodesis grasp
- require some or total A for sliding board transfers

AE
- wrist driven tenodesis splint
- built up utensils

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29
Q

SCI C7-T1 symptoms and adaptive equipment

A

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

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30
Q

SCI T2-T12 symptoms and adaptive equipment

A

full use of the upper extremities; as you move to lower levels, lower extremity and trunk
control increases

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31
Q

complications w/ SCI

A
  • orthostatic hypotension
  • autonomic dysreflexia
  • pain
  • spasticity
  • pressure ulcers
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32
Q

orthostatic hypotension

A
  • 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
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33
Q

autonomic dysreflexia

A
  • occurs at T6 and above (T7, T8..etc)
  • first, sit them upright
  • check bladder/catheter, remove restrictive clothing
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34
Q

ASIA levels

A

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

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35
Q

central cord syndrome

A
  • bilateral loss of pain and temperature
  • bilateral loss of motor function, MAINLY UPPER EXTREMITY ARE AFFECTED
  • HAS PROPRIOCEPTION AND DISCRIMINATORY SENSATION
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36
Q

Brown-Séquard Syndrome

A

-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)

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37
Q

anterior cord syndrome

A
  • loss of pain, temperature, and touch sensations along with paralysis
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38
Q

posterior cord syndrome

A
  • bilateral loss of proprioception, vibration, and sensations (2-point discrimination, stereognosis)
  • preserve motor, pain, touch
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39
Q

Conus Medullaris Syndrome

A
  • areflexia in the bowel, bladder and LEs due to injury of the sacral and lumbar nerves
40
Q

Cauda Equina Syndrome

A
  • flaccid paralysis of bladder and bowel
41
Q

MCA stroke

A
  • 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
Q

ACA stroke

A

-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
Q

PCA stroke

A
  • 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
Q

frontal lobe damage

A

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
Q

temporal lobe damage

A

Emotion, memory, visual memory (right), verbal memory (left), interpretation of music (right), receptive language (left: Wernicke’s area), auditory

46
Q

occipital lobe damage

A

Visual reception, visual recognition of shapes and colors.

47
Q

parietal lobe damage

A

Visual-spatial functions (right), reception and recognition of tactile information, praxis (left), sensation (pain, temperature, touch, proprioception), tactile

48
Q

medulla oblongata function

A
  • control of head movements and gaze stabilization (balance, vestibular)
  • voluntary movement control
  • cardiac, respiratory, vasomotor function
49
Q

spastic CP

A

either increased muscle tone or increased intensity of reflex responses

50
Q

dyskinetic CP

A
  • fluctuations in muscle mvmt
  • dystonia
  • athetosis (more distal than proximal)
  • chorea ( more proximal than distal)
51
Q

ataxic CP

A

lack of stability, cerebellum, hypotonia and ataxic mvmts

52
Q

monoplegia

A

one extremity

53
Q

hemiplegia

A
  • same sided paraylsis
  • ex. L arm and L leg
54
Q

paraplegia

A

involves LE

55
Q

quadriplegia

A

all 4 limbs involved

56
Q

diplegia

A

more leg impairment than UE

57
Q

complications with CP

A
  • seizures
  • language and cognition
  • visual
  • feeding disturbances
  • diminished sensation (common in spastic CP)
58
Q

Interventions for CP

A

assistive tech, NDT, CIMT, physical exercise, orthotics, positioning and seating devices, serial casting, AE

see tmpot notes also

59
Q

Parkinsons disease symptoms

A

postural instability, bradykinesia, resting tremors, rigidity

60
Q

Parkinsons disease stages 1 symptoms and intervention

A

symptoms
- unilateral tremor, rigidity, akinesia
- min or no functional impairment
- can still complete ADLs
- fatigue

intervention
- work eval
- HEP

61
Q

Parkinsons disease stages 2 symptoms and intervention

A

symptoms
- bilateral tremors w/ rigidity
- decreased executive functioning

intervention
- energy conservation
- task sequencing skills

62
Q

Parkinsons disease stages 3 symptoms and intervention

A

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
Q

Parkinsons disease stages 4 symptoms and intervention

A

symptoms
- decreased mobility
- ESPECIALLY FINE MOTOR AND ORAL MOTOR

intervention
- modifications for self-care due to motor control

64
Q

Parkinsons disease stages 5 symptoms and intervention

A

symptoms
- dependent (wheelchair or bed bound)

intervention
- environmental control units
- positioning

65
Q

Parkinsons eval

A
  • OT is most often required during stages 3-5
  • brief history
  • occupational performance deficits
66
Q

Parkinsons intervention

A

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
Q

spina bifida

A
  • 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
Q

tethered cord

A
  • 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
Q

shunt not working (spina bifida)

A

1st year= soft spot on head and head growth

2nd year= headache, vomiting, irritability

70
Q

Muscular Dystrophy symptoms

A
  • low muscle tone and weakness
  • difficulty w/ oral motor feeding
  • deformities of extremities and spine due to weakness
  • difficulty w/ breathing
71
Q

Huntinington’s chorea

A
  • choreiform movements and progressive intellectual deterioration
72
Q

ALS symptoms

A
  • 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
Q

ALS Eval

A
  • 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
Q

ALS early-stage intervention

A

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
Q

ALS late-stage intervention

A
  • 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
Q

ALS stages

A

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
Q

brachial plexus and Erb’s palsy, Klumpke’s palsy

A

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
Q

peripheral neuropathy symptoms

A
  • syndrome of sensory, motor, reflex and vasomotor symptoms
  • symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve
79
Q

GBS symptoms

A
  • acute, rapid progressive disorder
  • musuclar weakness
  • distal sensory loss/parathesias
  • affects distally more than proximally
  • fatigue
  • swallowing problems
80
Q

GBS phases

A

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
Q

GBS eval

A

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
Q

GBS intervention

A

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
Q

myasthenia gravis

A

weakness in voluntary muscles (eye, facial expressions)

84
Q

post-polio syndrome symptoms

A
  • new onset of weakness
  • easily fatigued
  • muscle pain
  • joint pain
  • cold intolerance
  • atrophy
  • loss of functional skills
85
Q

multiple sclerosis

A
  • slow progressing CNS disease
  • early stages= LE weakness, fatigue mgmt
  • later stages= vision and cognition
86
Q

considerations for MS

A
  • 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
Q

MS eval

A
  • 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
Q

MS intervention

A
  • ADL and cognitive training
  • energy conversation, education about disease
  • work/home modifications
  • mobility aids/ AT
  • safety awareness
  • stress management training (diaphragmatic breathing)
  • splinting
89
Q

OT Eval for neurological disorders

A
  • occupational profile
  • ADLs and IADLs
  • determine sensory/motor dysfunctions
  • determine cognitive/perceptual dysfunctions
  • determine psychological dysfucntions
90
Q

OT Intervention for Neurological Disorders

A
  • Use a COMPENSATORY approach for progressive disorders (ALS and muscular dystrophy)
  • Use combination of RESTORATIVE/REHABILTATIVE approach for nonprogressive disorders (TBI, SCI)
91
Q

OT Intervention for pain

A
  • 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
Q

hyperresponsive (sensory avoider)

A

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
Q

gravitational insecurity

A

-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
Q

hyporesponsive

A
  • 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
Q

Intervention for seizures

A
  • 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
Q
A

OT EXAM (17 decks)

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