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OT 6320 > OT 6320 Test 3 > Flashcards

OT 6320 Test 3 Flashcards

1
Q

Vestibular Ocular Reflex (VOR)

A

Reflex that coordinates eye and head movement; eyes move to stay on target when head moves

  • head movement must be compensated for almost immediately to have clear vision
  • Works by: 1. inhibiting the extraocular muscles of one side while 2. exciting the extraocular muscles on the other side
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2
Q

Vestibular Spinal Reflex (VSR)

A

Reflexive body movement that signals motor system to keep person upright
-Made up of several reflexes that make up the righting reaction

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3
Q

Vertigo

A

Illusion of movement when there is no movement

-Spinning sensation, swimming head, floating sensation and light-headedness

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4
Q

Otolith

A

Senses linear motion; moving forward, backward and up and down. Senses gravity, acceleration, and deceleration
-the utricle (horizontal) and saccuals (vertical) are
part of the otolith system

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5
Q

Otoconia

A

Rocks/crystals that are embedded in the gelatinous layer that covers the hair cells (sterocillium and kinocillium)

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6
Q

BPPV

A

Benign Paroxysmal Positional Vertigo: Otoconia get displaced in one of the semicircular canals (posterior most common)

  • Triggered by lying down in bed, bending over and looking up
  • balance problems may persist hours or days after vertigo has stopped
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7
Q

Crista Ampullaris

A

The sensory organ of rotation found in pairs in the simicircular canals of the inner ear (3 pairs in total)
-sense angular acceleration and deceleration

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8
Q

Kinocilium

A

A special type of cilium on the apex of hair cells located in the sensory epithelium of the inner ear
-detects motion based on stimulation received by the endolymph and stereocilia

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9
Q

Semi-circular canal functions

A
  • Posterior semi-circular canals: detect lateral flexion and extension
  • Anterior semi-circular canals: detect up and down movement
  • Horizontal semi-circular canals: detect rotation
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10
Q

Vestibular Collic Reflex (VCR)

A

Stabilizes the head in space

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11
Q

Peripheral vestibular system

A
  • Functions: stabilizes visual images on the fovea of the retina during head movement for clear vision, maintain postural stability during head movement, and provides information used for spatial orientation
  • Structures: Semicurcular canals, utricle, saccule, CN VII (vestibulocochlear)
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12
Q

Cerebellar stroke misdiagnoses

A

Cerebellar strokes are commonly missed because symptoms mimic and episode of vertigo

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13
Q

Central structures of vestibular system

A
  • Brainstem: vestibular reflex control
  • Thalamus and cortex: arousal and conscious awareness of head and body in space
  • Medial and lateral vestibulo-spinal tracts: maintenance of postural control
  • Oculomotor nuclei (III, IV, VI): mediation of the vestibular ocular reflex
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14
Q

Common peripheral disease of dizziness and imbalance

A
  • vestibular neuritis (2nd most common cause of vertigo- presents as vestibular crisis- especially with left head movement- without associated auditory symptoms)
  • labyrinthitis
  • viruses (Ramsay Hunt)
  • acoustic neuroma
  • Meniere’s disease
  • BPPV
  • Toxicity
  • Water in ear
  • Sinus infection
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15
Q

Common central diseases of dizziness and imbalance

A
  • Disequilibrium of aging
  • CVA
  • Migraine
  • Head trauma
  • Tumors
  • MS
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16
Q

Meniere’s disease

A

Inner ear disorder resulting in hearing loss and vistibular symptoms.

  • Unknown cause
  • Features: spontaneous intense vertigo lasting several hours, postural imbalance, nystagmus, nausea, hearing loss
  • Vestibular exercises are NOT APPROPRIATE
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17
Q

Two possible causes of BPPV

A

1) Canalithiasis: Debris floating freely in the endolymph in the long arm of the semi-circular canal
2) Cupulolithiasis: Debris (otoconia) adhering to the cupula

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18
Q

Dix-Hallpike Test

A

Test for BPPV when otoconia are in anterior and posterior canal

  • Rotatory nystagmus is a sign that posterior canal is the cause of BPPV and the Epley’s Maneuver an be performed to treat
  • Lateral nystagmus is a sign that the lateral canal is the cause of BPPV
  • Vertical nystagmus is a sign that superior canal is the cause for BPPV.
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19
Q

Dysphagia definition

A

A swallowing disorder caused by problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.

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20
Q

Stages of swallowing

A
  1. Oral phase/oral prep: lip closure, facial tone, lateral jaw and tongue movement, soft palate pulled to contact with tongue= all preps food for swallowing
  2. Oral propulsive phase: tongue contacts with palate and propels bolus back to pharynx, and tongue and other muscles seal bolus to middle of tongue (1 sec)
  3. Pharyngeal phase: Laryngeal closure and upper esophageal sphincter opening, while tongue moves back towards pharyngeal wall (1 sec)
  4. Esophageal phase: peristaltic wave pushes bolus ahead and continues in sequential manner (8-20 sec)
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21
Q

Major muscles of the oral phase of swallowing

A
  • Lips: orbicularis oris (labial closure), levator/depressor anguli/labii superior/inferior
  • Cheeks: Buccinator (containment and manipulation of bolus)
  • Tongue: interinsic and extrinsic muscles (both work together to move in a coordinated pattern to make infinite tongue positions)
  • Mandible: termporalis, masseter, lateral/medial pterygoid
  • Suprahyoid (forms floor of the mouth and positions the hyoid) and infrahyoid muscles (depresses the hyoid)
22
Q

Major muscles of the pharyngeal phase of swallowing

A
  • Pharynx: nasopharynx, oropharynx and laryngopharynx

- ->Upper Esophageal Sphincter (UES): participates in swallowing, belching, retching and vomiting

23
Q

Muscles of the esophageal stage of swallowing

A

-3 esophageal areas: Cervical esophagus (pharynx to top of the sternum), thoracic esophagus (in chest cavity- bulk of esophagus), abdominal esophagus (shortest section- enters stomach at an angle)

24
Q

Videoswallow evaluation

A

Gold standard for testing dysphagia:

-completed by pt consuming some level of barium while being viewed with Radiology

25
Q

Fibberoptic endoscopic evaluation of swallowing (FEES)

A

Sending fiberoptic line via pts nasal cavity to check for dysphagia
-completes at bedside, mobile clinic or mobile unit

26
Q

Chin-down position for swallowing

A

Chin is tucked down toward the neck during the swallow; brings tongue base closer to the posterior pharyngeal wall, narrows the opening to the airway and widens the vallecular space

27
Q

Head rotation (to the side) position for swallowing

A

Head is turned to either the left or the right side, typically toward the damaged/weak side to direct the bolus to the stronger of the lateral channels of the pharynx

28
Q

Head tilt position for swallowing/eating

A

Head tilted to the strong side to keep the food on the chewing surface

29
Q

Effortful swallow

A

Dysphagia maneuver used to increase posterior tongue base movement to facilitate bolus clearance
-“Swallow and push hard with the tongue against the hard palate.”

30
Q

Mendelsohn maneuver

A

Dysphagia maneuver used to elevate the larynx and open the esophagus during the swallow to prevent food/liquid from falling into the airway
-“When you swallow feel your larynx move up in your throat. Swallow again and try to keep your voice box up. So hold it up with your muscles for several seconds.”

31
Q

Supraglottic swallow

A

Dysphagia maneuver used to close the vocal folds by voluntarily holding one’s breath before and during swallow in order to protect the airway.

  • “Hold your breath. Swallow. And then cough.”
  • *super-supraglottic swallow similar to this, but involves increased effore during breath hold which facilitates glottal closure
32
Q

Diet Placement

A
  • Regular diet
  • Soft diet
  • Mechanical soft diet- ground
  • Puree diet
  • Full liquid diet (thin, nectar, honey)
33
Q

Complete vs Incomplete SCI

A
  • Complete lesion: total absence of sensation in dermatomes below level of lesion
  • Incomplete lesion: sensory loss related to damage within specific spinal tracts
34
Q

Paraplegia vs tetraplegia

A
  • Paraplegic occurs at T1 or below (loss of leg function and sensation)
  • Tetraplegic occurs C1-C8 (loss of arm and leg function)
35
Q

Central cord syndrome

A

A lesion to the centrally located structures of region, produces greater weakness in the upper limbs than the lower limbs
-common in elderly with arthritic changes

36
Q

C1-C3 SCI

A
  • Muscles: sternocleidomastoid, cervical paraspinal, neck accessory
  • Movement: neck flexion/extension/rotation
  • Function: complete paralysis of arms, body and legs (some head and neck function may persist)
  • Needs: electric wheelchair with sip and puff or chin control, ventilator to breath, complete assistance for feeding and grooming, and may require computer with specialized operation to communicate
37
Q

C4 SCI

A
  • Muscles: upper/lower trapezius, cervical paraspinal muscles, and levator scapulae
  • Movement: neck flexion/extension/rotation, scapular elevation, inspiration
  • Function: full head and neck movement, limited shoulder movement, complete paralysis of body and neck
  • Needs: Electric wheelchair most likely needing sip and puff and chin controls, able to breath without ventilator but requiring assistance to cough, complete assistance for feeding and grooming and homemaking
38
Q

C5 SCI

A
  • Muscles: deltoid, biceps, brachialis, brachioradialis, rhomboids, serratus anterior, teres minor and major
  • Movement: shoulder flexion/abduction/etension, elbow flexion, supination, scapular AB/adduction
  • Function: Full head and neck movement with good strength good shoulder movement, ELBOW FLEXION (no extension), no finger or wrist movement, complete body and leg paralysis
  • Needs: electric wheelchair may be used with hand controls, manual wheelchairs may be used short even distances, breathing without ventilator, coughing assistance required, assistance needed for most personal care (some UE independent) and complete assistance for homemaking
39
Q

C6 SCI

A
  • Muscles: pectoralis, supinator, extensor carpi radialis longus and brevis, latissimus dorsi
  • Movement: scapular protraction, horizontal adduction, forearm suppination, radial wrist extension
  • Function: Full head and neck movement, good shoulder movement, GOOD WRIST EXTENSION and elbow flexion, no finger movement or elbow extension, complete paralysis of body and legs
  • Needs: electric wheelchair with hand controls (some manual wheelchair use), can begin transferring with SLIDING BOARD, independent with UE dressing and breathing, needs assistance with household and grooming tasks
40
Q

C7-C8 SCI

A
  • Muscles: sternal pectoralis, triceps, pronator quadratis, external carpi ulnaris, flexor carpi radialis, flexor digitorum profundus/superficialis, extensor communis, pronator/flexor/extensor/abductor pollicis
  • Movement: elbow extension, ulnar wrist extension, wrist flexion, finger flexion, extension and abduction
  • Function: FULL ELBOW EXTENSION and flexion, full wrist flexion and extension, partial finger movement and much thumb movement, paralysis of body and legs
  • Needs: Able to manage bladder and bowel independently, independent in grooming and mostly independent for homemaking, can drive with hand controls
41
Q

T1-T4 SCI

A
  • Muscles: intrinsics of hand including thumbs, internal and internal intercostals, erector spinae
  • Movement: UE, limited trunk stability, increased lung capacity
  • Function: FULL USE OF ARMS, WRISTS, AND FINGERS, complete loss of lower body and legs, some upper body strength and balance
  • Needs: complete independence during mealtimes and personal care, some respiratory endurance issues and may need help with some homemaking activities
42
Q

Key muscles of determining level of lesion

A 
Hip Flexors (flexes hip)- L2
Elbow Extensors (triceps straightens elbow)  -C7
Knee Extensors (quadriceps straightens knee) -L3
Wrist Extensors (cock-up wrist) -C6  
Small finger abductors (spreads fingers) -T1
Ankle dorsiflexors (bends ankle up and lifts foot) -L4
Finger flexors (flex fingers to grip) -C8
Ankle plantarflexors (calf muscles push foot down) -S1
Elbow flexors (biceps flexes forearm) -C5
Long toes extensors (lifts big toe) -L5
43
Q

Acute care management of SCI

A
  • Positioning and deformity control: moving them and getting them functional
  • Skin integrity
  • ADL skills
  • Strengthening/ROM
  • Upright tolerance
  • **Getting them ready to go home
44
Q

Inpatient rehab management of SCI

A
  • Upright tolerance
  • ADL’s
  • Learning body is space
  • Functional mobility
  • Spinal shock resolve
  • EDUCATION KEY!
  • **Focus on independence and community re-engagement
45
Q

Outpatient/home health management of SCI

A
  • ROM/strengthening
  • Community access
  • Training
  • ADL skills/ Body in space skills
46
Q

Orthostatic hypotension- SCI

A

Low BP due to lack of SNS; ususally happens when changing positions

  • Symptoms: dizziness, fainting, nausea, pallor, sudden weakness
  • can prevent: ace wraps, abdominal binder, increasing sitting tolerance
47
Q

Autonomic Dysreflexia

A
  • *LESIONS T6 AND ABOVE
  • overreaction of autonomic nervous system below level of SCI; usually from something benign like full bladder or need to defecate
  • need to check blockage or kinks in bladder and bowel system, areas of restriction (tight clothes), relieve urinary pressure
48
Q

Deep Vein Thrombosis- SCI

A

Common after SCI due to vessel modification and changes in blood coagulation

  • signs: pain, swelling, fever
  • treatment: blood thinners, compression, bed rest
49
Q

Urinary tract problems with SCI

A

No way to consciously know if bladder full and muscles may not be able to voluntarily empty

  • Urine may back up in kidneys (reflux)
  • May lead to UTI (fever, chills, nausea, spasms)
  • Prevent: times voiding, meds, catheters: intermittent (if self cath is an option), condom catheters (if muscles can contract to urinate) or indwelling (if unable to manage)
50
Q

Pressure sores

A

An appearance of a red area that does not clear in 30 min or turn white with pressure: sign of pressure sore forming

  • Stage 1: epidural and dural layers red and deteriorating, Stage 2: damage reaches adipose tissue, Stage 3: damage reaches muscle, Stage 4: destruction of bone and joint
  • shifting weight and changing position can prevent
51
Q

Heterotopic Ossification

A

Calcium deposits in the form of mature bone to soft tissue

  • can lead to stiffness and even jt fusion: must prevent this from happening
  • presents as limited ROM, swelling, pain
  • prevented by meds and surgery (no aggressive stretching or ROM)

OT 6320 (1 decks)

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