Oce Neuro Flashcards
Subjective Ax for a stroke pt
Patient History:
Onset of stroke (time and date)
Type of stroke (ischemic, hemorrhagic, etc.)
Medical history (comorbidities, previous strokes, medications, etc.)
Current medications and their effects
Presenting Complaints:
Functional limitations (e.g., difficulty walking, inability to use one arm)
Pain (location, intensity, type of pain, aggravating and relieving factors)
Fatigue or energy levels
Spasticity, numbness, or tingling
Sensory changes (e.g., loss of sensation or altered perception)
Cognitive changes or difficulties with communication (aphasia, memory issues)
Goals and Expectations:
Short-term and long-term rehabilitation goals
Patient’s personal goals (e.g., return to work, regain independence in daily activities)
Psychosocial Factors:
Anxiety, depression, or stress related to stroke recovery
Social support system (family, caregivers, friends)
Patient’s level of motivation and understanding of their condition
Objective Ax for stroke pts
Postural Assessment:
Alignment of the body, head, and limbs (e.g., signs of scoliosis or postural asymmetry)
Muscle Strength:
Muscle testing (Manual Muscle Testing or MMT) to assess strength and weakness
Focus on muscle groups most affected by the stroke (e.g., upper and lower extremities)
Tone and Spasticity:
Assessment of muscle tone (using the Modified Ashworth Scale or Tardieu Scale for spasticity)
Hypertonia or hypotonia in affected limbs
Range of Motion (ROM):
Measurement of joint flexibility and movement, both active and passive
Limitations in movement due to weakness, spasticity, or joint contractures
Coordination and Motor Control:
Assessment of balance and coordination (e.g., using the Berg Balance Scale, Fugl-Meyer Assessment, or Timed Up and Go test)
Fine and gross motor skills (e.g., ability to grasp objects, manipulate fingers)
Gait Analysis:
Observation and analysis of walking pattern, gait speed, and stability
Assessment of the need for assistive devices (e.g., walker, cane)
Evaluation of abnormal gait patterns (e.g., hemiplegic gait)
Functional Mobility and Activities of Daily Living (ADLs):
Assessment of the patient’s ability to perform basic ADLs (e.g., dressing, grooming, bathing, walking, transferring)
Standardized assessments such as the Functional Independence Measure (FIM) or the Barthel Index
Sensation:
Testing for proprioception, light touch, temperature, pain sensation, and pressure
Assessing sensory deficits or loss
Cognitive and Communication:
Brief screening for cognitive function (e.g., Mini-Mental State Examination or MoCA)
Evaluation of speech and language, particularly if aphasia is present
Subjective Ax for spinal cord injury
Patient History:
Level of Injury: Location of the spinal cord injury (e.g., cervical, thoracic, lumbar, sacral).
Severity of Injury: Complete vs. incomplete injury.
Cause of Injury: Trauma (e.g., car accident, fall), medical condition (e.g., tumor, infection), or other causes.
Onset: When did the injury occur and what were the circumstances surrounding it?
Comorbidities: Any additional medical issues (e.g., cardiovascular diseases, respiratory conditions, fractures).
Current medications and their side effects.
Functional Complaints:
Loss of function: Specific movements or areas affected (e.g., loss of sensation, paralysis of limbs, difficulty breathing).
Pain: Type of pain (neuropathic pain, musculoskeletal pain), location, intensity, and frequency.
Autonomic Dysreflexia: If applicable, discuss any episodes of autonomic dysreflexia (common in injuries above T6).
Bladder and Bowel Function: Changes in bowel/bladder control or issues such as incontinence or urinary retention.
Spasticity/Flaccidity: Increased muscle tone (spasticity) or absence of tone (flaccidity).
Psychosocial Factors:
Mental Health: Feelings of depression, anxiety, or frustration related to the SCI and adjustment to new functional limitations.
Support System: Family, caregiver support, social network.
Goals: Functional goals (e.g., regain ability to transfer, improve mobility, return to work).
Quality of Life: Impact of the SCI on daily activities, social participation, and independence.
Patient’s Perception of Function:
Self-Reported Functionality: Patient’s own assessment of their abilities and limitations, including their awareness of deficits (e.g., strength, mobility, balance).
Objective Ax for spinal cord injury
Postural Assessment: Observation of posture.
Neurological Ax: Level and Extent of Injury: dermatome and myotome level using manual muscle testing (MMT) and sensory testing (light touch, pinprick, vibration)
Motor Function: Strength testing of key muscle groups (e.g., C5, C6, C7, T1, L2, L3, L4, L5, S1).
Reflexes: Deep tendon reflexes (e.g., patellar, Achilles) and pathological reflexes (e.g., clonus, Babinski sign).
Spinal Cord Integrity: ASIA (American Spinal Injury Association) Impairment Scale to classify the injury
Tone Assessment: Spasticity or Hypertonia: Assess resistance to passive movement, using tools like the Modified Ashworth Scale to grade spasticity.
Flaccidity: Absence of muscle tone, particularly in lower levels of injury or acute phases of SCI.
Range of Motion (ROM): arom prom
Functional Mobility:Bed Mobility;Transfers; Gait;Wheelchair Skills.
Balance and Stability: Functional tests like the Berg Balance Scale or Functional Reach Test.
Breathing and Respiratory Function:
Respiratory Muscle Function: Assess diaphragm, intercostal, and abdominal muscle function (especially in cervical injuries).
Chest Expansion: Observation of chest mobility, cough strength, and respiratory effort.
Autonomic Function:
Blood Pressure: Monitor for postural hypotension or autonomic dysreflexia (particularly in injuries above T6).
Temperature Regulation: Check for abnormal sweating or temperature control.
Skin Integrity:
Inspect for pressure sores or potential for it.
Pressure Relief: ability to perform pressure relief maneuvers
Psychosocial and Cognitive Assessment:
Cognitive Function: Assess attention, memory, and problem-solving abilities.
Emotional State: Psychological assessment for depression, anxiety, and coping mechanisms.
Outcome Measures:
The ASIA Impairment Scale (for classifying SCI severity)
Functional Independence Measure (FIM) or Spinal Cord Independence Measure (SCIM) for functional assessment
Modified Ashworth Scale for spasticity
Berg Balance Scale or Timely Up and Go (TUG) test (for those with some walking ability) in
Subjective ax for abi pt
Subjective Assessment:
Patient History:
Cause of Injury: The origin of the ABI (e.g., traumatic injury, stroke, anoxia, infection, tumor, or surgery).
Time of Injury: When did the ABI occur? Is it an acute or chronic injury?
Medical History
Medications
Presenting Complaints:
Functional Limitations: Areas where the patient feels limited
Pain: Type, intensity, location, and duration of pain
Cognitive Symptoms: Issues related to memory, attention, concentration, or executive function.
Motor Function: Difficulty with walking, balance, fine or gross motor skills, or coordination
Fatigue: Levels of fatigue
Mood:
Sensory Impairments:
Support System:
Mental Health
Goals:
Impact on Daily Life
Patient’s Perception of Function:
Self-Reported Functionality
Cognitive Awareness: Patient’s understanding of their limitations or deficits and their motivation for rehabilitation.
Objective ac for abi pt
Postural and Functional Observation:
Movement Patterns: Observe how the patient moves (e.g., gait, transfers, sitting, standing). Assess for abnormalities like spasticity, weakness, or tremors.
Motor Function:
Muscle Strength:MMT
Coordination and Motor Control: Assess fine motor control (e.g., finger dexterity) and gross motor control (e.g., arm or leg movements).
Tone Assessment: Test for spasticity (increased tone) or hypotonia (decreased tone) using scales such as the Modified Ashworth Scale.
Voluntary Movement: Assess the patient’s ability to initiate and control movement
Gait and Balance:
Gait ax
Balance Tests: Standardized balance assessments such as the Berg Balance Scale or Functional Reach Test.
Assistance with Walking: Determine if the patient needs assistive devices (e.g., cane, walker) and assess their ability to use them effectively.
Range of Motion (ROM):
Contractures
Sensory Function:
Sensory Testing: Test for light touch, pain, temperature, vibration, and proprioception to assess for sensory deficits.
Cognitive Screening: Conduct brief cognitive assessments
Attention and Concentration: Test the patient’s ability to focus and process information (e.g., counting backward, remembering sequences).
Language and Communication: Assess speech for fluency, comprehension, and articulation (e.g., aphasia, dysarthria).
Cognitive Functioning in Tasks: Observe how the patient performs cognitive tasks (e.g., following multi-step commands).
Functional Independence:
Activities of Daily Living (ADLs)
Functional Independence Measure (FIM): A standardized measure of functional independence and disability.
Spasticity and Reflexes:
Spasticity Testing: Use scales like the Modified Ashworth Scale to assess the presence and degree of spasticity.
Reflex Testing: Check deep tendon reflexes (e.g., patellar, Achilles), pathological reflexes (e.g., Babinski, clonus), and abnormal responses (e.g., hyperreflexia).
Pain Assessment:
Pain Location and Intensity: Use a pain scale (e.g., Numeric Rating Scale, Visual Analog Scale) to quantify pain intensity.
Pain Characteristics: Identify whether pain is musculoskeletal, neuropathic, or a combination.
Fatigue and Endurance:
Fatigue Level: Assess the patient’s perceived level of fatigue using tools like the Fatigue Severity Scale.
Endurance: Perform tests like the 6-Minute Walk Test (6MWT) to assess cardiovascular endurance and physical stamina.
Outcome Measures:
The ASIA Impairment Scale
Functional Independence Measure (FIM)
Berg Balance Scale
Timothy’s Walking Test
Modified Ashworth Scale for spasticity
Montreal Cognitive Assessment (MoCA) for cognitive screening
Obj ax for abi
1-Postural and Functional Observation
2:Motor Function
Muscle Strength (MMT)
Tone Assessment (Modified Ashworth Scale)
Voluntary Movement
3:Coordination
4:Gait and Balance
Gait Analysis
Assistive Devices
Balance Testing (e.g., Berg Balance Scale, Functional Reach Test)
5-Range of Motion (ROM)
6-Functional Mobility
Bed Mobility
Transfers
Standing and Walking
7:Spasticity and Reflexes
8-Strength and Endurance
Muscular Endurance
6-Minute Walk Test (6MWT)
9-Pain and Sensory Function
Pain Assessment (Numeric Rating Scale, Visual Analog Scale)
Sensory Function (light touch, pain, temperature, vibration)
Duchene pt interventions
• Avoid aggressive strengthening (especially eccentric contraction)
Stretching and ROM exercises
• Gait training
Education on overexertion (stop when tired) and energy conservation
• Respiratory exercises
• Breath stacking
• Assistive cough
• Incentive spirometer
• Transfer training
• Equipment selection (e.g., wheelchair, transfer lifts, power mobility)
RA
What is RA?
• Systemic inflammatory disease characterized by symmetrical polyarthritis
Diagnosis RA
Criteria 1 to 4 must have been present for at least 6 weeks
1-Morning stiffness lasting at least 1 hour
- Soft-tissue swelling or fluid in at least 3 joint areas simultaneously
3- at least one area swollen in a wrist, MCP, or PIP joint
4-Symmetrical arthritis
5-Rheumatoid nodules bumps
- Abnormal amounts of serum rheumatoid factor (RF)
7-Erosions or bony decalcification on radiographs of the hand and wrist
Signs and symptoms for RA
Morning stiffness
• Lasting > 1 hour
• Generalized stiffness
• Progressively eases with movement
• Severity and duration of morning stiffness are directly related to the degree of disease activity
• Extreme fatigue
• Weight loss/loss of appetite
• Fever
Malaise
Bikateraand symetridal pattern
Efusion- swelling
Artralgia
Crepitus
Deformity
Loss of function
Pseudo laxity
Eventually progressing tonfusion leading to immobility
***cervical spine involvement (c1-2)
Pts with RA and neurological signs
Pts w cervicak radiculopathy should be reffered immediately to a physician
C1-2 involvement ( transverse kig of c1 weaken or rupture allowing herniation)
Ax for pts with RA
History
Physical examination:
saji ( active joint count)
Rom
Strength
Joint stability
Cardiovascular status
Functional examination
Mobility, gait and balance
Sendory integrity
Ra red flags
Claudication pain pattern ( can be estenosis)
Fever,malaise,weight loss
Focal or diffuse weakness
History of significant trauma (instability)
Hot,swollen joint ( can be infection)
Neurogenic pain ( burning,numbess,paresthesia) can be spinal cord lesion
RA PT tx
Modalities for pain relief (heat) tens ifc
Rom and flexibility execs
Strengthen exercs
Cardiovascular training
Functional training
Gait and balance training
Joint protection
Education
Differences between RA,OA and lupus
RA: symetrical joint involvement,particularly small joints, AM stiffness at least one hour,joint erosion. Systemic inflammation
• Lupus (SLE): Characteristic malar rash, photosensitivity, positive ANA and anti-dsDNA, systemic involvement with kidney, heart, and lung manifestations
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• Osteoarthritis (A): Asymmetrical joint involvement, primarily weight-bearing joints, bony enlargements (Heberden’s/Bouchard’s nodes), and mild systemic symptoms.
Physical exam for Ankilosing spondylitis
Observation
Spinal rom ( flex and spine rotation)
Peripheral rom
Chest expansion measurements
Palpation
Basmi ( bath ankulosing spondylitis metrology index) tool to ax spinal mobility
Cervical rotation, tragus to wall, modified schober,finger to floor lateal flex and intermalleolar dostabce
Pt interventions for OSteoporosis
Postural education
• Falls prevention education
• Strength training avoid flex based execs
• Weight bearing exercises
Burns pt tx
Prevent and manage any pulmonary complications
Examine the injury
Reduce risk of infection
Maximal rom is achieved
Maximal strength and independence amb
Scar formation minimized
Positioning and splinting
Arom/prim
Deep friction massage
Pt intervention for DM
Education on diabetic foot care
Exercises
Hiv pt tx
Energy cons. Techniques
Pain management
Managing secondary complications such as weakness,fatigue
Rom,. Aerobic and resistance
