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DPT 830 Neuromuscular Rehab > Neuromuscular Unit 3 Exam > Flashcards

Neuromuscular Unit 3 Exam Flashcards

1
Q

an alteration in brain function or evidence of brain pathology caused by external force

A

traumatic brain injury (TBI)

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2
Q

what are some common causes of TBI?

A

falls
firearm injuries
motor vehicle crashes
assaults

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3
Q

what is a common cause of TBI that accounts for nearly half of TBI related hospitalization?

A

falls

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4
Q

leading cause of injury related death and disability

A

TBI

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5
Q

TBI incidence is highest in older ______ followed by infants and young adults/adolescents

A

older adults (>75)

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6
Q

men are ______ as likely as women to be hospitalized following a TBI

A

2x

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7
Q

do men or women have a higher rate of TBI related deaths?

A

men

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8
Q

what is the pathophysiology of a TBI?

A

result of a high velocity or high impact hit to the head leading to brain tissue damage

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9
Q

2 categories of brain tissue damage

A

primary injury
secondary injury

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10
Q

what the two mechanisms of primary injuries of TBI?

A

direct contact with an object
rapid acceleration/deceleration

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11
Q

primary injury mechanism that leads to focal brain damage

A

direct contact

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12
Q

TBI due to direct contact is between what two things?

A

skull and penetrating object

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13
Q

what are the four common areas of primary injury that result from direct contact mechanisms?

A

anterior temporal poles
frontal poles
lateral inferior temporal cortices
orbital frontal cortices

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14
Q

primary injury mechanism that causes sheer, tensile, and compressive forces in the brain

A

rapid acceleration/deceleration

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15
Q

sheer, tensile, and compressive forces in the brain lead to what injury?

A

traumatic axonal injury (TAI)

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16
Q

what other injury can occur with a TAI that signifies a severe brain injury where not only the axons are damaged but also the functional regions of the cortex are disrupted, often leading to significant cognitive impairments and neurological deficits

A

cortical disruption

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17
Q

why are changes in the brain due to a TAI difficult to view on a MRI or CT scan?

A

they are microscopic

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18
Q

common areas of TAI occurrence in the brain

A

corpus callosum
internal capsule
cerebral peduncle
brainstem

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19
Q

cell death following brain tissue damage

A

secondary injury of TBI

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20
Q

what are some examples of secondary injuries of TBI?

A

hypoxemia
hypotension
ischemia
edema
elevated ICP

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21
Q

what is the pathophysiology of a secondary TBI injury?

A

brain tissue damage triggers a cellular cascade causing cell death

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22
Q

release of glutamate and other excitatory neurotransmitters lead to increased brain swelling and therefore increased _____

A

ICP

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23
Q

blood pooling in the brain following a head injury

A

hematoma

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24
Q

3 hematoma classifications

A

epidural
subdural
intracerebral

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25
Q

what causes ICP to elevate?

A

swelling in the brain is confined by the rigidity of the skull

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26
Q

injuries that result from lack of oxygen to the brain caused by anoxia, hypotension, and damage to vascular areas of the brain

A

hypoxic ischemic injuries

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27
Q

main goal of early medical management of a TBI

A

maintain blood flood and oxygen delivery to the brain to reduce the risk of secondary injury

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28
Q

normal systolic BP

A

> 90 mmHg

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29
Q

normal O2 sats

A

> 90%

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30
Q

______ spine stabilized until ligamentous and/or bony injury can be ruled out

A

cervical

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31
Q

normal cerebral perfusion pressure (CPP)

A

> 60 mmHg

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32
Q

normal intracranial pressure (ICP)

A

< 20 mmHg

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33
Q

3 ways to monitor ICP

A

external ventricular drain
subdural bolt
fiber optic catheter

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34
Q

ICP should be monitored for individuals with any of these four things

A

GCS less than 8
acute findings on CT scan
systolic BP < 90 mmHg
> 40 years of age

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35
Q

way to treat elevated ICP pharmacologically?

A

sedating medications
(example: Barbituates)

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36
Q

ways to treat an elevated ICP

A

HOB at 30 degrees
hypothermia
medically induced coma
surgical decompression
shunt placement
osmotherapy

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37
Q

imaging used initially following a TBI because it is fastest

A

CT scan

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38
Q

imaging used 24-48 hours following a TBI for higher sensitivity OR if initial scan was negative

A

MRI

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39
Q

3 neurosurgeries that may be needed for subdural hematomas or other lesions for ICP management

A

craniotomy
craniectomy
burr holes

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40
Q

removal of part of the skill bone with immediate replacement during the same surgery

A

craniotomy

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41
Q

a portion of the skull bone is removed and not immediately replaced

A

craniectomy

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42
Q

replacement surgery of the skull using the patient’s or other material such as titanium

A

cranioplasty

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43
Q

small holes are drilled in the skull to relieve pressure on the brain

A

burr holes

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44
Q

continued overactivity of the sympathetic nervous system following a TBI

A

paroxysmal sympathetic hyperactivity (PSH)

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45
Q

paroxysmal sympathetic hyperactivity (PSH) is also known as what?

A

sympathetic storming

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46
Q

% incidence of PSH

A

30%

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47
Q

symptoms of PSH

A

elevated HR, RR, and BP
diaphoresis
decerebrate/decorticate posturing
hypertonia
teeth grinding

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48
Q

abnormal development of bone

A

osteogenesis

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49
Q

abnormal development of bone in areas of soft tissue

A

heterotrophic ossification (HO)

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50
Q

HO most often occurs in what two joints?

A

hip and knee

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51
Q

clinically significant HO occurs in what percentage range of adult patients with TBI?

A

10-20%

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52
Q

individuals with _______ are at an increased risk of developing HO

A

spasticity

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53
Q

early symptoms of HO

A

swelling
ROM limitations
joint pain
redness/warmth
low grade fever

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54
Q

how can HO be managed pharmacologically?

A

NSAIDs

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55
Q

what limitation is important to address with physical therapy for patients with HO?

A

range of motion

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56
Q

_______ may be indicated for HO patients in cases of severe activity limitations

A

surgery

57
Q

timeframe of immediate posttraumatic seizures

A

< 24 hours following TBI

58
Q

timeframe of early posttraumatic seizures

A

1 to 7 days following TBI

59
Q

timeframe of late posttraumatic seizures

A

> 7 days following TBI

60
Q

mild GCS score

A

8 or less

61
Q

moderate GCS score

A

9 to 12

62
Q

severe GCS score

A

13 to 15

63
Q

3 disorders of consciousness

A

coma
unresponsive wakefulness
minimally conscious state

64
Q

complete absence of arousal or awareness with no sleep/wake cycle, ventilator dependent

A

coma

65
Q

arousable to external stimuli but no awareness of self or environment, reflexive movement may be present

A

unresponsive wakefulness

66
Q

self or environment awareness with spontaneous eye opening, inconsistently localize to stimuli

A

minimally conscious state

67
Q

refers to the time after a TBI where the patient exhibits disorientation, confusion, and memory loss

A

posttraumatic amnesia (PTA)

68
Q

what is the duration of PTA?

A

the length of time from injury to when a patient can consistently remember ongoing events

69
Q

PTA duration is predictive of what four things?

A

functional independence
employment
overall recovery
independent living 1 year post injury

70
Q

true or false: patients in PTA cannot benefit from rehab

A

false

71
Q

PTA timeframe of a mild TBI

A

0-1 day

72
Q

PTA timeframe of a moderate TBI

A

more than a day but less than a week

73
Q

PTA timeframe of a severe TBI

A

more than 7 days

74
Q

outcome measure to assess for recall of events preceding and following the injury

A

the galveston orientation and amnesia test (GOAT)

75
Q

scores below ___ on the GOAT indicate PTA

A

75

76
Q

outcome measure consisting of 10 questions assessing time, place, and circumstances

A

orientation log (O-log)

77
Q

scores of ____ or higher on the O-log are considered WNL

A

25 out of 30 or higher

78
Q

scores below ___ on the O-log indicate PTA

A

25

79
Q

4 negative pronostic factors

A

low GCS score
age
CT showing mass lesions
prolonged PTA

80
Q

what 3 ICF domains are impacted following a TBI?

A

body function/structure impairments
activity limitations
participation restrictions

81
Q

mental process of knowing and applying information

A

cognition

82
Q

scale to address behavioral and cognitive recovery post brain injury

A

Ranchos Amigos Levels of Cognitive Functioning (LOCF)

83
Q

which Ranchos Amigos LOCF? patient is in deep sleep and is unresponsive to any stimuli

A

level I: no response

84
Q

which Ranchos Amigos LOCF? patient reacts inconsistently and non purposefully to stimuli in a non specific manner

A

level II: generalized response

85
Q

which Ranchos Amigos LOCF? patient reacts specifically but inconsistently to stimuli, may follow simple commands in an inconsistent delayed manner

A

level III: localized response

86
Q

which Ranchos Amigos LOCF? patient is unable to cooperate directly with treatment efforts, incoherent or inappropriate words, heightened activity and bizarre behavior, no selective attention, lacks short + long term recall, may confabulate

A

level IV: confused agitated

87
Q

which Ranchos Amigos LOCF? patient can respond to simple commands consistently, random response to complex commands, has attention to environmental but lacks focused attention to a task, words are confabulatory or inappropriate, memory is impaired, inappropriate use of objects, can perform old learned tasks but unable to learn new information

A

level V: confused inappropriate

88
Q

which Ranchos Amigos LOCF? patient can demonstrate goal directed behavior but needs external input or direction, shows carry over for relearned tasks, follows simple directions consistently, past memories are showing up more in depth than recent memories, may have wrong answer to questions but inappropriate in answers

A

level VI: confused appropriate

89
Q

which Ranchos Amigos LOCF? patient has minimal to no confusion, oriented and demonstrates appropriate behavior in structured and familiar environments, able to go through structured routines automatically, shows carry over of new learning but requires additional time, able to participate in structured social and recreational activities, demonstrates impaired judgement

A

level VII: automatic appropriate

90
Q

which Ranchos Amigos LOCF? patient demonstrates carry over of new learning, no supervision is required once task is learned, able to recall past and recent events, patient may have difficulty with abstract reasoning, tolerance to stress, and judgement in emergency or unusual circumstances in comparison to premorbid abilities

A

level VIII: purposeful appropriate

91
Q

what two levels were added to the Ranchos Amigos LOCF to reflect higher levels of brain injury recovery?

A

level IX: purposeful appropriate with stand by assist on request
level X: purposeful appropriate modified independent

92
Q

long term impact of TBI on health has correlations to what two types of diseases?

A

neurodegenerative and psychiatric

93
Q

what are examples of neurodegenerative diseases that are correlated to TBI?

A

Parkinson’s disease
Alzheimer’s disease
frontotemporal disease
chronic traumatic encephalopathy (CTE)

94
Q

what are examples of psychiatric diseases that are correlated to TBI?

A

depression and anxiety

95
Q

how 3 things are used to diagnose TBI severity?

A

LOC
AOC
PTA

96
Q

LOC duration for moderate TBI

A

> 30 minutes
< 24 hours

97
Q

LOC duration for severe TBI

A

> 24 hours

98
Q

AOC duration for moderate and severe TBIs

A

both > 24 hours

99
Q

PTA duration for moderate TBI

A

1 to 7 days

100
Q

PTA duration for severe TBI

A

> 7 days

101
Q

possible signs of cognitive and physical fatigue

A

irritability
decreased attention
initiation delay
decreased focus
worsening physical skills

102
Q

early mobilization < ___ hours after surgery is shown to reduce hospital stays and reduce the risk of secondary complications

A

< 72 hours

103
Q

contraindications to early mobilization

A

spine instability
elevated ICP
low CPP

104
Q

precautions to early mobilization

A

wounds
weight bearing restrictions
joint integrity
autonomic instability
fluctuating cardiovascular symptoms

105
Q

upright posture encourages _________

A

alertness

106
Q

with acute TBI, head of bed should not be lower than 30 degrees for what purpose?

A

ICP

107
Q

true or false: early mobilization is beneficial for patients with disorders of consciousness

A

true

108
Q

what are some possible progressions of early mobilization?

A

sitting EOB
wheelchair transfers
supported standing
tilt table
walking

109
Q

______ can be medically managed with Amantadine

A

arousal

110
Q

for patients with decreased alertness and arousal levels, should treatment be done in an open or closed environment?

A

closed

111
Q

bed positioning should be changed every __ hours to prevent bed sores and off weight pressure areas

A

every 2 hours

112
Q

maintaining range of motion prevents _________, which can be occur due to immobility and spasticity

A

contractures

113
Q

therapists may consider positioning static ______ to maintain range of motion

A

splints

114
Q

what is serial casting?

A

immobilizing a joint at end range in a cast for 2 to 5 days at a time, further stretching is performed and a new cast is set with new end range of motion until significant gains in range of motion are made

115
Q

serial casting is often indicated for _________ or _______ contractures due to spastic posturing

A

plantar flexors or biceps

116
Q

injection for focal management of spasticity

A

botulinum toxin (botox)

117
Q

how long does botox last?

A

3 to 4 months

118
Q

how do botox and oral medications manage spasticity differently?

A

botox: local
oral: widespread

119
Q

examples of oral medications that manage spasticity

A

Baclofen
Diazepam
Dantrolene

120
Q

what is the side effect of oral medications when treating spasticity that is the opposite goal of physical therapy?

A

drowsiness (decreased arousal)

121
Q

pump inserted in the abdomen that delivers medication directly into the spinal cord to manage severe spasticity

A

Baclofen pump

122
Q

why might a baclofen pump be used over an injection?

A

allows for a higher dosage of

123
Q

surgery for contracture management due to severe spasticity

A

musculotendinous surgery

124
Q

type of wheelchair that is necessary for a patient with poor head + trunk control because it positions them upright, can also tilt for pressure relief

A

tilt in space wheelchair

125
Q

how often should a patient change positions in a wheelchair?

A

every 15 minutes

126
Q

wheelchair progression from a tilt in space wheelchair

A

K005 ultra light weight wheelchair

127
Q

type of wheelchair that allows for customized trunk support and cushions based off sensation, ability to weight shift, and pelvic alignment

A

K005 ultra light weight wheelchair

128
Q

poor ______ can place a patient at a risk for repeat head injury

A

balance

129
Q

_____ ______ impairments can lead to decreased walking speeds and balance deficits

A

dual task

130
Q

common vision problem post TBI that can contribute to worsening balance

A

diplopia

131
Q

what sensory system commonly experiences dysfunction post TBI causing dizziness (BPPV)?

A

vestibular system

132
Q

in regards to aerobic conditioning, what is the TBI population at high risk of?

A

deconditioning

133
Q

ACSM guidelines for aerobic conditioning post stroke + TBI

A

3-5 days a week
40-70% of HRR
20-60 minutes/session

134
Q

ACSM guidelines for resistance training post stroke + TBI

A

2 days/week
1-3 sets of 8-15 reps
50-70% of 1RM

135
Q

_________ of healthcare providers, routine, family members, and of addressing inappropriate behaviors is important when treating confused and agitated patients

A

consistency

136
Q

expect limited _________ in confused and agitated patients, meaning no new learning

A

carryover

137
Q

in confused and agitated patients, focus on functional activities for ______ of tasks

A

automaticity

138
Q
A

DPT 830 Neuromuscular Rehab (3 decks)

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