OCTA 227 Midterm Flashcards
Sudden loss of blood supply to the brain that damages & kills brain cells resulting in neurological deficits related to the involved areas of the brain
Stroke (CVA)
paralysis on one side of the body
hemiplegia
partial motor loss on one side of the body
hemiparesis
Warning Signs of a stroke:
*Numbness/Weakness
*Confusion
*Slurred Speech
*Blurred vision
*Dizziness
*
- Right sided hemiplegia & sensory loss
- Right visual field cuts
- Impaired R/L discrimination, verbal apraxia
- Decreased analytical thinking, impaired logic, time concepts, memory, aphasia
Left CVA
- Left sided weakness & sensory loss
- Left field cuts, visual neglect
- Unilateral neglect
- Impaired attention span, understanding of whole, decreased creativity
- Impulsivity, emotional lability
- -Decreased ability to differentiate between gesture, decreased learning for familiar info
Right CVA
low muscle tone
hypotonicity
high muscle tone
hypertonicity
Synergy Patterns (Flexion)
- Scapular adduction & elevation
- Humeral abduction & external rotation
- Elbow flexion
- Forearm supination
- Wrist flexion
- Digit flexion
Synergy Patterns (Extension)
- Scapular abduction & depression
- Humeral adduction & internal rotation
- Elbow extension
- Forearm pronation & wrist & finger flexion or extension
Role of OT with Stroke pts
- Improving motor function on affected side
- Integrating sensory, visual perceptual, & cognitive functions
- Facilitating maximal level of functional independence
- Encourage return to life roles as possible
- Promote health management & maintenance behaviors to prevent recurrent stroke
Signs of Reflex Sympathetic Dystrophy (RSD)
-Pain, irregular blood flow, EDEMA, changes in skin temperature/color
Treatment for RSD
- elevating extremities
- positioning
- retrogade massage
- coban wrap
- AROM or PROM
- Ice
- Oral cortisone
- Assisted lymph drainage
Acquired language disorder that may result in variety of deficits in verbal comprehension, reading comprehension (alexia), oral expression, written expression (agraphia), ability to interpret gestures, or mathematical skills (acalculia)
Aphasia
can usually understand what words mean, but have trouble performing motor or output aspects
Broca Aphasia (expressive)
difficulty understanding language
Wernicke’s Aphasia (receptive)
loss of both language skills; ability to speak in usually gone; may appear to respond to gestures, voice tone changes, & facial expressions
Global Aphasia
The ability to plan and perform purposeful movement
Praxis
An impairment in praxis, deficit in the ability to perform purposeful movement despite normal motor power, sensation, coordination, and general comprehension
Apraxia
What are the 3 types of Apraxia?
- Ideomotor
- Constructional
- Ideational
A type of apraxia that involves the inability to perform a motor act on command
Ideomotor Apraxia
A type of apraxia that is a deficit in the ability to copy, draw, or construct a design, whether on command or spontaneously
Constructional Apraxia
A type of apraxia that involves the inability to comprehend concept of movement or execute act automatically or in response to a command (difficulty sequencing, etc)
Ideational Apraxia
A medical scale used to assess individuals after a closed head injury, including traumatic brain injury, based on cognitive and behavioral presentations as they emerge from coma
Rancho Los Amigos Scale
An injury that results from a penetrating (open) or nonpenetrating (closed injury to the brain
Traumatic Brain Injury (TBI)
direct trauma to the head by an object that penetrates the skull and brain
Open Brain Injury
caused by acceleration, deceleration, and rotational forces are applied to the head that cause brain tissue to shear (tear apart)
Closed brain injury
What are the 6 types of attention?
- Focused
- Sustained
- Selective
- Alternating
- Divided
- Concentration
A type of attention that gives you ability to respond to different kinds of stimulation
Focused Attention
A type of attention that gives you the ability to maintain attention for a long time (vigilance)
Sustained Attention
A type of attention that gives you the ability to activate and inhibit responses selectively
Selective Attention
A type of attention that gives you the ability to alternate back and forth between mental tasks
Alternating Attention
A type of attention that gives you the ability to do several things at once
Divided Attention
A type of attention that gives you the ability to do mental work while attending tasks
Concentration
disorder that causes lasting pain, usually in an arm or leg, and it shows up after an injury, stroke, or even heart attack
Reflex Sympathetic Dystrophy (RSD)
used to asses edema
Volumeter
What are some ways to manage edema:
- Elevation
- Massage
- Compression
- AROM
a response on the rancho los amigos scale where the pt appears to be in deep sleep, completely unresponsive to any stimuli
No response
a response on the rancho los amigos scale where the pt reacts inconsistently and non-purposefully; responses may be delayed
Generalized response
a response on the rancho los amigos scale where the pt responds specifically but inconsistently with delays to stimuli; turns head to sound (not consistent)
Localized response
a response on the rancho los amigos scale where the pt has a heightened state of activity with decreased ability to process info; responds primarily to their own internal confusion; may be euphoric or hostile; may overreact to stimuli
Confused-Agitated Response
a response on the rancho los amigos scale where the pt appears alert and is able torespond to simple commands fairly consistently; as complexity increases, responses become non-purposeful, fragmented; maybe agitated as a result of external stimuli; out of proportion to stimuli
Confused-Inappropriate, Non-Agitated
a response on the rancho los amigos scale where the pt appears to have goal-directed behavior but is dependent on the external input for direction
Confused- Appropriate
a response on the rancho los amigos scale where the pt follows simple directions consistently and shows carry-over for relearned task (self-care) ; increased awareness of self, family, and basic needs
Automatic- Appropriate
a response on the rancho los amigos scale where the pt appears appropriate and oriented within hospital and home setting; completes ADLs automatically(robot-like) with supervision due to decreased insight and reactional activities; need routine
Purposeful- Appropriate
humerus drops and supraspinatus and other muscles stretch
Subluxation
Treatment for subluxation:
Affected extremity supported at all times:
Bed- proper support to achieve alignment
W/C- lapboard
Ambulating/Transferring- Kinesiotaping, sling
Modified Diet Progression:
Food: Puree, fine chopped, mechanical soft, regular
Liquids: Pudding, honey thick, nectar thick, thin
Dressing sequence for Hemiplegia Pts: Shirt
Putting shirt on (dress): affected extremity first and then unaffected extremity
Taking shirt off (undress): unaffected extremity first and the the affected extremity
Dressing sequence for Hemiplegia Pts: Pants
Cross affected leg over unaffected leg and put affected leg in first followed by unaffected leg
Considerations for feeding candidates:
Decrease: Distractions,
Increase: complexity of task, short step directions, arranging items, how much time
levels 1-3: Total assistance
levels 4-6: Confused/Agitated
levels 7/8: Automatic/Purposeful
Ranch Los Amigos Scale
an approach that seeks to improve and restore cognitive skills
Remedial approach
an functional approach that uses intact cognitive skills to compensate for deficits
Adaptive approach
An adaptive approach that normally would use rehabilitation model to promote adaptation of/to the environment so pt is successful in occupations
Top Down Approach
An remedial approach that normally would use the biomechanical model to restore function, working on lower level skills, and focusing on impairment to be successful in occupations
Bottom Up approach
Remedial approach for Memory Deficits:
- organization facilitates recall
* attention training results in improved memory
Adaptive approach for Memory Deficits:
- Active listening
- Note taking (lists, schedules, direction)
- Rehearsal (retaining through mental repetition; working memory)
Remedial Approach for Problem Solving Deficits:
- Have pt read & reread directions
- Train pt to generate alternatives
- Teach pt to evaluate and select most effective alternatives
Adaptive Approach for Problem Solving Deficits:
- Instruct pt to check for errors before proceeding
- Provide external cues to reduce pts use of inappropriate strategies
- Teach pt importance of asking for help when unable to solve a problemy
Remedial Approach for Visual Perception Organization & Processing Skills:
- Assumes the adult brain can repair/reorganize after injury
- Seeks to cause CNS function
- Can use these approaches: sensory-integrative, neurodevelopment, transfer-of-training
Adaptive Approach for Visual Perception Organization & Processing Skills:
- Tx is repetitive; relies on the intact portions of the brain to compensate
- Make pt aware of deficit & teach pt to work with deficit & adapt the environment
When grading an activity what are the cognitive considerations?
- Environment
- Complexity of task
- Directions
- Spatial Arrangement of items
- Time
What are the different remedial approach?
- Bottom up approach
- Sensory integrative
- Neurodevelopmental
- Transfer-of-learning
an remedial approach that integrates sensations into normal activity
Sensory Integrative
an remedial approach that restore normal movement through handling techniques & repetitive movements
Neurodevelopmental
an remedial approach that assumes practice in specific perceptual skill drills will generalize to better performance in daily activities that require the same perceptual skills; generalization
Transfer-to-learning
Pt will complete toilet transfers
Pt will Self feed
Pt will complete lower body dressing
LTG’s
Pt will perform toilet transfers with MOD assist from bed to BSC using grab bars PRN within one week
STG
Pt will perform self feeding with min assist within one week
STG
Therapeutic activity for muscle strength and resistance
Have pt seated upright in a chair. Pt will place theraband under feet & use the affected forearm to pull up with multiple reps followed by the affected arm and repeat
Therapeutic activity for sitting balance
Have pt seated on firm surface with mirror in front. Have therapist use verbal and physical cues for pt to sit upright. If pt slouch he can use hand to push body upright. Once pt can sit upright and maintain the position the therapists will push pt sided to side, front to back. Pt cant tip over
Therapeutic activity for reaching and stretching
- Have pt seated in a chair at a table and place a physio ball in front of him. Have pt roll ball back and forth and side to side crossing the midline on the table. switch arms
- Grabbing velcro balls off wall behind him and placing them in bin in front of him
Therapeutic activity for ROM
- Have pt seated in between an elevated table and a regular table. Have pt grab cones off regular table and place on elevated table repeatedly until cones are all on the elevated table.
- Graded arc seated
Therapeutic activity for core strength & endurance
- have pt seated in chair playing ball toss
* seated tossing bean bags in 3 bins
Therapeutic activity for balance
- have pt practice sit to stands with out hands
* ring toss seated EOB
