Neurological impairments

Question 1

C5 SCI and splinting/assistive devices

Answer 1

• C5 SCI’s benefit from mobile arm support to support weight of arm during activities (grasping/holding objects w/ require wrist stabilization)
• Dorsal splints useful to provide sensory feedback

Question 2

C6-C7 SCI and splinting

Answer 2

Wrist-hand orthosis- or tenodesis splint- useful for maximizing pinch strength

Question 3

Decorticate rigidity

Answer 3

Abnormal flexion:

• Upper extremities are in spastic flexion w/ internal rotation and adduction; lower extremities are in spastic extension, internal rotation and adduction
• Level 3 Glascow Scale

Question 4

Decerebrate rigidity

Answer 4

Extensor response:

• Upper and lower extremities are in spastic extension, adduction and internal rotation
• indicates severe brain damage; Glascow level 2

Question 5

Autonomic dysreflexia precautions

Answer 5

• Loosen restrictive clothing or devices; check catheter for obstructions
• Pts should carry medical card describing condition and treatment

Question 6

Hemiparesis symptoms

Answer 6

Affected side weakness, edema, and joint contractures

Question 7

How often should pressure relief techniques be performed to reduce skin breakdown

Answer 7

Every 30 minutes

Question 8

Rancho Los Amigos Level I

Answer 8

No response; completely unresponsive to any stimuli

Question 9

Rancho Los Amigos Level II

Answer 9

Generalized response; exhibits inconsistent and nonpurposeful reactions to stimuli

Question 10

Rancho Los Amigos Level III

Answer 10

Localized response; reacts specifically and inconsistently to to stimuli

Question 11

Rancho Los Amigos Level IV

Answer 11

Confused/agitated; has heightened state of activity with severely decreased ability to process information

Question 12

Rancho Los Amigos Level V

Answer 12

Confused, inappropriate non-agitated; appears alert with fairly consistent reactions, although increased complexity of commands causes random responses

Question 13

Rancho Los Amigos Level VI

Answer 13

Confused, appropriate; exhibits goal-directed behavior but is dependent on external input for directions

Question 14

Rancho Los Amigos Level VII

Answer 14

Automatic/appropriate: behaves appropriately and is oriented to place and routine but frequently displays shallow recall

Question 15

Rancho Los Amigos Levels VII-X

Answer 15

Purposeful and appropriate; is alert and oriented and able to recall and integrate past and recent events

Question 16

Strategy for TBI patient with sequencing deficits

Answer 16

Minimizing environmental distractions and decreasing the complexity of the task will allow the client to experience success in completing one step of the task at a time

Question 17

Strategy for TBI patient with agitation during session

Answer 17

Providing passive orientation information and preparing the client for what to expect in the session will provide the client with a sense of familiarity, decreasing confusion and agitation

Question 18

Ataxia vs tremors

Answer 18

• Ataxia: Movements that appear oscillating and exaggerated (seen often in pts with TBI)
• Tremors: involuntary rhythmic oscillations which are not as exaggerated as those seen in clients with ataxia.

Question 19

Hemiparesis and recovery for ADL function

Answer 19

-First focus on postural stability, utilizing edge-of-bed activities to increase
Postural stability is essential to performing many ADLs, and hemiparesis influences the client’s ability to maintain postural stability at the edge of the bed.