P1 - Positioning Patients Flashcards
what are primary problems relating to neurological issues
- Tonal changes
- Sensory deficit
- Neglect
- Balance and Coordination deficit
- Visual and speech deficit
- Weakness
- Cognitive issues
what are secondary problems relating to neurological issues
- Compensation
- Disuse: Weakness/atrophy
- Postural changes
- Altered body imagining
- Fatigue
- Pain from poor joint position
- Tight muscles
What can neurological injury lead to?
Neurological injury can lead to tonal changes.
What are the two general types of tonal changes based on the injury?
High tone or low tone
What are the two types of features of tonal changes?
Positive features and negative features.
how can a tonal change be positive
high tone in legs can help standing
What type of tone is associated with an Upper Motor Neuron (UMN) injury?
Hypertonicity (increased tone).
What type of tone is associated with a Lower Motor Neuron (LMN) injury?
Hypotonicity (decreased tone).
How does pain relate to tone changes?
Pain causes increased tone, and increased tone can also cause pain.
What is the typical tonal change pattern in the upper limb following neurological injury?
Flexion pattern.
What is the typical tonal change pattern in the lower limb following neurological injury?
Extension pattern.
Do both Upper Motor Neuron (UMN) and Lower Motor Neuron (LMN) injuries lead to weakness?
Yes, both UMN and LMN injuries lead to weakness.
What are two possible causes of weakness following neurological injury?
Weakness can result from disuse or pure loss of recruitment of motor units due to lack of descending drive.
What is a common symptom in many neurological conditions such as stroke, MS, and Parkinson’s Disease?
Lack of dexterity due to weakness and tonal changes.
Can someone have high tone and underlying muscle weakness at the same time?
es, one can have high tone with underlying muscle weakness at the same time.
Is muscle tone the same as voluntary muscle power?
no
What is neglect syndrome?
Neglect syndrome is a multifaceted neurological disorder where individuals fail to report, respond, or orient to external stimulation located contralateral to a brain lesion.
What differentiates neglect from primary sensory or motor deficits?
Neglect occurs when the failure to respond cannot be attributed to primary sensory or motor deficits such as hemianopia or paralysis.
What percentage of acute stroke patients report neglect?
Neglect is reported in 80% of acute stroke patients.
How does neglect lead to altered weight-bearing symmetry?
Neglect can result in individuals favoring one side of the body, leading to asymmetrical weight-bearing.
What is the first step to address altered weight-bearing symmetry in neglect?
Treat any tonal problems or range of movement issues that may be exacerbating the problem.
What type of exercises are recommended for the unaffected side in neglect patients?
Strengthening exercises for the unaffected side, focusing on functional movements to increase muscle activation and sensory feedback.
How can we help patients “retrain” their awareness of the affected side?
By encouraging them to weight-bear or orientate on the affected side to break the “vicious cycle” and increase sensory awareness.
how can you position a patient which hemiplegia
What is the ideal alignment of hips and knees in a chair or wheelchair?
The ideal alignment is 90 degrees of flexion at the hips and knees.
How can you assess whether a wheelchair seat is appropriate?
Check if the seat is too deep and if the footplates are at the correct height.
What should you consider when choosing a pressure cushion for a patient?
Consider the type of pressure cushion needed based on the patient’s specific requirements for pressure relief.
Why is trunk symmetry important in wheelchair positioning?
Trunk symmetry is crucial for balance and stability; assess if the patient needs trunk support and if they are leaning to one side.
How do you determine if a patient requires head support?
Assess whether the patient has adequate head control; if not, head support may be necessary.
What should be evaluated regarding armrests in a wheelchair?
Evaluate the type of armrests; consider their height, support, and functionality based on the patient’s needs.
What types of wheelchair propulsion should be considered?
Consider whether the wheelchair is self-propelling, push only, or powered, based on the patient’s abilities.
Why is it important to think about cognitive function when positioning in a chair or wheelchair?
Cognitive function, attention, vision, and neglect can all affect a patient’s ability to maintain proper positioning and use the chair effectively.
Why is it important to prevent the shortening of the Achilles tendons and gastrocnemius muscles?
Preventing shortening is crucial to avoid contractures, which can hinder rehabilitation and weight-bearing activities.
What are key interventions for preventing contractures in the Achilles tendon and gastrocnemius?
Splinting and stretching are key interventions.
What can be used initially to maintain a plantar grade position for the feet?
Pillows can be placed under the soles of the feet to maintain plantar grade
When might a referral to orthotics be necessary?
A referral may be needed to create a custom-made splint to ensure correct foot positioning.
What type of boots can be worn at night to prevent pressure sores?
Pressure-relieving boots can be worn at night to prevent pressure sores on the heels.
What should be considered if a person is only looking to the right in bed?
Consider positioning; visitors should sit on the left to provide auditory and visual stimulation from the neglected side.
How can the environment be adjusted to encourage orientation to the neglected side?
Move the bed, and place pictures or objects to look at on the wall or window/door on the neglected side.
What can be used to provide sensory stimulation to the neglected side?
A weighted blanket may be used for sensory stimulation.
What is an important communication strategy when providing touch therapy?
Talk to the patient before touching their arm and leg, explaining what you will do beforehand.
What type of handling should be used during physiotherapy sessions?
Use firm handling and touch to provide effective sensory feedback.
What is the goal of improving a person’s body schema in physiotherapy?
The goal is to enhance their representation of their body in space.
How can sensory and visual stimulation be increased for patients?
Use yourself, carers, equipment, and the environment to provide more sensory and visual stimulation.
