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Neurology > Neurorehabilitation > Flashcards

Neurorehabilitation Flashcards

1
Q

What does this define?

  • a process of active change
  • by which a person who has become disabled acquires the knowledge and skills needed
  • for optimal physical, psychological and social function.
A

The definition of rehabilitation!

a process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological and social function.

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2
Q

What classification does impairment, activity limitations and restrictions to life participation come under?

A

the international classification of functioning, disability and health (ICF)

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3
Q

whaat does impairment, acitivty limitations and restrictions to life partificpation mean as part of the ICF (international classification of functioning, disability and health)?

A
  • imapirment
  • disorder of body structure or function e.g. anatomical or physiolgocial/pychological systems physiology
    • e.g. L MCA infarct resultin in aphasia w/1 word utterances
  • activity limitations
  • problems carrying out tasks or acitivities
    • e.g. unable to converse successfully with family
  • restrictions to life participation
  • problems participating in personally relevant aspects of life
    • e.g. unable to fulfil role of supportive mother to 5y.o daughter
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4
Q

what are restorative vs comensatory techniques in neurorehab?

A
  • Restorative - assumes impairment is reversible
  • Compensatory - assumes impairment is irreversible
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5
Q

What techniques are used to prevent impairments from worsening?

A
  • Passive range of movement
  • Stretching
  • Positioning to prevent contracture
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6
Q

What does physical therapy and other techniques aim to achieve within neurorehab?

A

reorginisation of cortical maps –> recovery

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7
Q

What LT complications can arise from chronic neuro conditions seen in neurorehab (that need to be prevented)?

A

Physical

  • Spasticity
  • Contractures
  • neurogenic bladder and bowel dysfunction
  • Aspiration / chest infections
  • pressure sores
  • DVT

Mental

  • Pain
  • Depression
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8
Q

What model of rehab is currently used?

A

Interdisciplinary model of rehab:

Interdisciplinary working involves a partnership between a team of health professionals and a client in a participatory, collaborative and coordinated approach to share decision making around health issues

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9
Q

How do you write a problems list in neurorehab?

A

you use the ICF by looking at

  1. what impairments they have,
  2. the acitivies they require assistance for/are unable to manage and
  3. the participation thay are unable to do/require assistance with
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10
Q

What is spascticity?

A

a velocity dependent increase in muscle tone

  • results from the disruption of the descending inhibitory modulation of alpha motor neurones
  • TF –> hyper excitability + abnormal processing of sensory input from affected muscles and their stretch receptors
  • a.g. the affected muscles sensory input is abnormal (stretch receptors) & the alpha motor neurones normal inhibitory modulation is disrupted –> spasticity
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11
Q

what scale measures resistance during passive soft-tissue stretching and is used as a simple measure of spasticity?

A

the Modified Ashworth scale

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12
Q

What complications can spasticity lead to?

A
  1. Muscle shortening
  2. Contractures
  3. Functional limitations due to limb deformity mechanics
  4. Associated spams & pain
  5. Pressure sores
  6. Low mood
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13
Q
  • Baclofen
  • Tizanidine
  • Dantrolene
  • Benzodiazepines
  • Gabapentin
  • Cannabinoids

Are all what?

A

Anti-spastic medications

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14
Q

Which anti-spastic drug is this?

  • Centrally acting antagonist that binds to GABA B receptors
  • May cause nausea, drowsiness, deranged liver function
  • Most commonly used and effective
A

Baclofen

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15
Q

Which anti-spastic agent is this?

Has some anti-spastic properties and my be used as a single agent to treat neuropathic pain and spasticity

A

gabapentin

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16
Q

Which anti-spastic agent is this?

  • Centrally acting antagonist to GABA A receptors
  • Causes sedation so much more useful at night than in the daytime
A

benzodiazepine

17
Q

Which anti-spastic agent is this?

  • Suppresses calcium release from sarcoplasmic receptors therefore reducing the force of muscle contractions
    • May cause fatal hepatitis
    • Generally considered to be not as well-tolerated as baclofen
A

Dantrolene

18
Q

Which anti-spastic agent is this?

  • Centrally acting agonist action at alpha-2 adrenergic receptor sites
  • May cause sedation, visual hallucinations and deranged liver function
  • Generally considered to be not as well tolerated as baclofen
A

Tizanidine

19
Q

Which anti-spastic medication does this describe?

Nasal spray licensed for use in multiple sclerosis in patients suffering painful spasms

A

cannabinoids

20
Q

What use does orthotics have in spasticity?

A

Splints may be required to maintain joint position

21
Q

When may surgery be useful in spasciticty?

A

Surgical management may be required for

  1. contracture release and
  2. deformity correction
22
Q

nerve blockade may be useful as a permanent method of reducing muscle activity in a group of muscles e.g. spasticity

  • the susbtence is injected directly into nerves and denervation is caused by inflammation and subsequent fibrosis
  • There was much concern about dysasthesia (unpleasant sensation felt when touched) in the affected nerve but this does not seem to occur in clinical practice

What substance is used?

A

Phenol

23
Q

What method of anti-spasmotic delivery is Most commonly used for non-functioning lower limbs when oral medications are not tolerated or sufficient ?

A

intra-thecal baclofen (between arach & pia)

  • Involves the insertion of an electronic pump into the abdominal wall
  • which delivers baclofen to the cerebrospinal fluid

Generally well tolerated most complications being infection and bleeding at the catheter insertion site

  • Test doses are required first
24
Q

What injection blocks the release of Ach at the NMJ and tf prevents muscle contraction, making it useful for focal spasticity….?

A

Botulinum toxin A!

  • however limited dose per procedure and number of injections per year
  • repeat injections maybe required
  • Peak effects at 3-4 weeks post injection with lasting effects up until 3-4 months
  • Very well-tolerated
    • rarely serial use may result in antibody formation
25
Q

How does baclofen work?

A

Centrally acting antagonist that binds to GABA B receptors

26
Q

What SE’s may baclofen give?

A

May cause nausea, drowsiness, deranged liver function

—> Most commonly used and effective

27
Q

How does tizanidine work?

A

Centrally acting agonist action at alpha-2 adrenergic receptor sites

–> Alpha 2 receptor agonists reduce central and peripheral sympathetic overflow and via peripheral presynaptic receptors may reduce peripheral neurotransmitter release.

28
Q

What are the SE of tizanidine?

A

May cause sedation, visual hallucinations and deranged liver function

  • Generally considered to be not as well tolerated as baclofen
29
Q

How does dantrolene work?

A

Suppresses calcium release from sarcoplasmic receptors therefore reducing the force of muscle contractions

30
Q

What are the SE of dantrolene?

A

May cause fatal hepatitis

  • Generally considered to be not as well-tolerated as baclofen
31
Q

How do benzos work for spasciticy?

A

Centrally acting antagonist to GABA A receptors

  • Causes sedation so much more useful at night than in the daytime
32
Q

What uses does gabapentin have in spasticity?

A

Has some anti-spastic properties and my be used as a single agent to treat neuropathic pain and spasticity

33
Q

When is cannabinoid nasal spray licensed?

A

licensed nasal spray for use in MS patiends suffering painful spasms

Neurology (7 decks)

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